Baby Nichols Arrives, Part 2: It Gets Worse

If you missed the beginning of this story, it can be found here.

 Wednesday

So, to continue. I called Denise and cried that I couldn’t handle it anymore, that I was scared and that I didn’t know what to do. She asked how far apart the contractions were now. “Still every ten minutes!!!!” I wailed, full of despair. “Okay, I’m coming over,” she said. “Let me get up and get a cup of coffee and I’ll come and check you. We’ll figure out what’s going on.”

The contractions were still a steady 10 minutes apart as I waited for her to come. I had given up entirely at trying to cope through each one and just let them hit me and screamed and screamed into a pillow until they were over.

Denise finally arrived a little after seven. I was flopped miserably on the bed when she came in, completely exhausted and awaiting the next wave of doom heading my direction. She was getting ready to check me when I felt the next contraction coming on, and I instantly flung myself onto my pillow and screamed through it. “Whew!” she said afterward. “That came on quick!” I didn’t say anything. I think I was beyond words at that point.

Her face was solemn but unsurprised as she checked my cervix. “Yeah… I figured as much… no change from yesterday.” I wasn’t surprised, either. I’d harbored a tiny, tiny hope that she’d exclaim something like “Oh, you’re eight centimeters!”, but deep inside I knew better. I was still at 3cm.

She sighed. “Are you at all familiar with ‘incoordinate contractions’?” she asked me. I shrugged miserably and shook my head. “That seems to be what’s going on here,” she said. “The uterus gets itself worked into a cycle where the muscles are firing inconsistently from one another; they come on very quickly, from the bottom to the top, like a knife plunging up suddenly.” She gestured what she meant as she spoke. “The muscles contract extremely hard, but since the muscle groups aren’t coordinating with each other the right way, they aren’t working to open the cervix at all. If it makes you feel any better, they usually do hurt worse than regular labor contractions. They’re like the peak of a transition contraction, but with the peak lasting the entire time.”

I gazed at her forlornly, still flopped on the bed. The last part did make me feel minutely better – at least I wasn’t crazy or being a total baby about the level of pain. Later, when I looked up ‘incoordinate contractions’ online, the phrase was often paired with words like ‘hypertonic’, and extreme, transition-like pain is a common sign of them.

She sighed as she removed her gloves. “You really, really need to sleep. I’m hoping that if you get some rest, things will settle down enough that the cycle will end and labor can get started for real.”

 I blanched at the thought of labor ‘starting for real’. “I’ve been doing this for TWELVE HOURS,” I whispered. “How can I possibly go through an entire labor still, after this?”

“I promise you, when we get things moving they will feel very different,” she assured me. “You said yourself that these feel different than they did in your last labor. When regular labor contractions come and are closer together, don’t forget that your body will produce endorphins to help you through them. And on top of that, you’ll have a chance to work into them and into the peak, instead of being hit with a minute-long peak all at once!” I theoretically knew she was right, but was still apprehensive about what was to come.

She rummaged in her supplies bag and pulled out a bottle of pills. “I’m going to give you some sleeping medication. I want you to try and sleep. You probably won’t sleep through the contractions, but you should be able to fall asleep again right after each one.” She gave me two pills and also an herbal sleeping supplement. “Call me when you wake up,” she said, and then left the room to go update Todd and head out.

I did get very sleepy and dozed. The contractions spaced out to 15 minutes again, which was something of a relief, but it was still a nightmare when I would have one. If anything, it was more of a nightmare, because I would be yanked from my hazy sleep by the instant pain with little warning, and then scream into my pillow and writhe around until it was over, then fall into a half-sleep again. Finally at 9:30 I woke up for a contraction that threw me onto the floor screaming and had had enough. Once again, I didn’t know what to do. What I was doing – waiting, essentially – was clearly not working. I’d hoped that resting would stop them, but it had only slowed them down. I started to panic. How was this going to end? The only solution I could think of was going to the hospital. If I got an epidural, then I would be able to actually sleep for a solid chunk of time, and I felt like if I could just sleep, and have a real rest from this madness, then I would be able to start real labor from the beginning and handle it fine. But, of course, I knew it wouldn’t work like that. First of all, would they even give me an epidural at 3cm when I wasn’t even in labor? Probably not. Second of all, once I was in the hospital, I’d be stuck in the hospital, and I’d almost certainly be given Pitocin to get things moving. At this point, I wasn’t opposed to that idea at all – after all, people have Pitocin and epidurals all the time and have perfectly healthy babies – but I also knew in the back of my ever-trying-to-be-sensible-mind that it would have serious financial repercussions for us, even with my insurance, and that if I wanted to go to the hospital, I had better really, REALLY want to go to the hospital. There would be no turning back at that point.

Regardless, I called Denise. “That wasn’t very long,” she said, disappointed. “I CAN’T do this anymore! PLEASE HELP ME!” I cried. “It’s too much! They hurt too much! I can’t take it!” I was getting hysterical. “Okay,” she said. “Okay. I need to think. I’m going to hang up and think, but I’m going to come back over.”

A short while later, I got a text and then a call from Ginna, the therapist I’d been seeing for my EMDR therapy to process Max’s birth. Ginna and Denise are very good friends and have been for many years, and have attended a number of births together over the years as well, which is how Denise recommended Ginna to me for therapy in the first place. Ginna spoke to me soothingly, trying to help me remember my affirmations and all the mental prep work I’d done, much as Denise had done the night before. And, just like the night before, it was well intended, but not helpful at all. I had done all of that preparation for labor, not for crazy monster non-labor hell. She said something about trusting my body and remembering that it "knew how to do this". I remember thinking "Clearly, my body does not know how to do this - this is all wrong! I feel like I'm dying and I'm not even technically in labor and there is no end in sight!" I felt like I was broken. “If you want, I can clear my afternoon after about twelve and come over,” Ginna said. I told her that I didn’t want to interrupt her schedule, but she insisted that she wouldn’t have offered if she didn’t want to. I relented – I didn’t know if I would even go into regular labor at any point, but I knew that I desperately needed help. She promised to be there by twelve thirty.

I hung up and texted Denise, “please hurry!” to which she responded, “On my way!”. I decided to run another bath just for something to do besides lie around trying to decide if I should really go to the hospital or not. If I could help it, I really didn’t want to go – I didn’t think I needed to be in the hospital for the actual labor, I just desperately needed a way to sleep and hopefully stop this craziness, and I knew that if I went to the hospital now I’d have to be there for the actual labor, too.

I got back in the tub. Denise came. She said that she was in the process of trying to get some stronger, prescription sleeping medication for me from the nurse practitioner/nurse midwife I’ve seen before whom she also works with. “There are only two options from here,” she said. “We either need to get you to sleep, or we need to get things moving for real.” I knew that sleep wasn’t going to work – even with prescription medication, it wouldn’t be strong enough for me to sleep through the contractions. I asked her if she meant breaking my water to get things moving, which scared me when I was only 3cm, but she said no, she wanted to try something else first. I leaned back in the tub and she checked me, first of all. “Oh, you are a little bit more open now,” she said. “Not a lot, but your cervix feels softer. That’s a good sign.” She stripped my membranes again and then started manipulating my cervix in other ways. It was pretty uncomfortable, but still nothing compared to the contractions I’d now been suffering for going on sixteen hours. I don’t think ANYTHING could compare to those contractions. I’m really not exaggerating when I go on about how much they hurt.

After doing all the manipulation and holding some pressure points and such, she sat back and said, “Alright, you’re nice and open now.” She was saying that she hoped that by dilating my cervix, it would kick my uterus out of its incoordinate cycle and get all of the muscles working together in a normal labor pattern, which would not only feel better but get this show on the road. “You’re like eight centimeters!” she said brightly. I did a complete double take. “Eight centimeters??? Are you sure??” I asked, absolutely shocked. How could that be possible? “Yes,” she confirmed. “It’s a “sleeve-y” eight, and when I let go it slides back a bit toward maybe six, but I can easily stretch you to eight. I think once we get the baby’s head down on your cervix, things will go pretty quickly. I bet we have a baby in a couple of hours here.”

I was flabbergasted. A couple of hours?? I had been expecting to have to go through an entire, normal-length labor still at this point, starting from 3cm. Earlier on the phone Ginna had said, “Sarah, you’re going to have a baby today!” but I hadn’t believed her; I had thought that she didn’t understand the incoordinate contraction thing and I had been convinced that the only way out at this point was to stop the contractions, sleep, and then go into labor later or a different day. But here we were. I’d suddenly gone from not even “being in labor” (again, meaning active, productive labor here – obviously I’d been laboring pretty hard all night!) and not knowing when I would be, to being told I was going to have a baby in a couple of hours. Total trip.

We waited for awhile for me to have a contraction. It was about fifteen minutes, and then one came – and it felt SO. DIFFERENT. Blessedly, fantastically different. Oh my goodness. The relief. I can’t even express it in words. It was a real contraction, and it was as I remember them feeling from my first labor – it was deep, and low, and came on slowly and then built into a peak, squeezing tightly, and then relaxing and releasing a burst of oxytocin and endorphins that washed over my body like an orgasm. A very intense feeling, certainly but NOTHING, ABSOLUTELY NOTHING AND I CANNOT STRESS THAT ENOUGH, like the incoordinate contractions of before. This was the “pain”, if you can even call it that, of my body doing its normal, healthy, productive work, not the PAIN! of something in my body being terribly wrong. What a difference. Labor did get very painful again later, but it was never as bad as those contractions.

“Ah… it feels good,” I said, relaxing into the water. I was so encouraged and, finally, not afraid.

Todd called my mom to come and get Max, and began setting up and filling the birth pool in the living room and doing the rest of the labor chores; Denise took baby heart tones and hung out with me for awhile, timing contractions but basically watching me sleep in the tub. I had another contraction after 10 minutes, but then the next one came at 8 minutes or so! I realized I hadn’t eaten since our lunch with friends the previous day and was so hungry that I was nauseous, so Denise got me a banana and some iced tea or coconut water or something. I had a couple of bites. She left me in the tub for awhile to make me some rice, but eventually I got out because I was getting restless.

The contractions were still only about eight minutes apart, sometimes ten.  Denise wanted to break my water to further stimulate things to progress. I sighed, knowing that that meant that things would get more intense, which was hard to face, but I knew it would have to happen eventually. I said I wanted a little time to eat and prepare myself, which I did. I was feeling great despite my apprehension. I got my banjo out and played it joyfully through three contractions; focusing on some of the more difficult riffs took my attention off of the intensity of the contractions and made them more tolerable. I got back up and walked around, so happy to be in actual labor and not feeling like the world was going to end every ten minutes.

Finally, after a few bites of rice and some husband kissing and such, we went in to the bedroom so Denise could break my water. She wasn’t sure if she’d managed to hook the bag or not, as there was no gush and we didn’t notice any trickles when I stood up, but she thought she probably had. (In retrospect, I think it didn’t actually get broken or was maybe punctured in a spot that the baby’s head plugged, as we’ll see later.) I was also 8.5 – 9 centimeters at this point, so even though the contractions were sluggish, they were accomplishing a little bit. The baby’s head was still not engaged very well (ahem… birthy people… red flags yet?), so we were hoping that breaking the waters would help with that as well and really kick this thing into high gear once and for all.

Finally, I got into the birth pool. Bliss!! The water felt SO good. It is a big pool – bigger around than a kiddie pool, oval shaped, and very deep. The water came up to my chest when I was sitting down. I leaned forward over the side and relaxed. When a contraction would come, I’d either sway my body back and forth on my knees or let my legs float up and back and wriggle around. The contractions were definitely getting stronger at this point – they were painful and it took a lot of concentration to get through them. It was certainly not pleasant – these were transition-strength contractions, after all – but STILL nothing like the incoordinate ones. The level of pain at the peak was probably the same or similar, but the entire contraction wasn’t a peak like the incoordinate ones. I could work into it and then had that awesome release at the end.

Ginna arrived, which was good timing because I was starting to need help getting through contractions. She got down next to me by the birth pool and rubbed my back, held my hands through contractions, massaged my hands. She had me look into her eyes during a contraction, which was SO HELPFUL! What an eye-opener, pun intended. ;-) I wish I’d thought or someone had thought to have me do that during my labor with Max. It was so grounding to gaze straight into her eyes, and when the scariest and most painful part of the contraction peaked, I knew that I wouldn’t float away or lose my mind, because she was there, and I was there, and we were still in my living room and doing okay and then whoosh, the contraction would be over. I felt like I had help! What a relief! At this point I started making very loud, low sounds through the contractions, like singing and moaning combined. As they got stronger, I needed to make even bigger sounds to get through them, and the best one I found was angry tiger growling. I would growl mightily and ferociously, and the best thing ever is that Ginna did it right back at me – we were growling together! I’d stare straight into her eyes and roar for all I was worth and she’d stare back and growl and I would feel almost angry – not actually angry, but just an intensity of feeling akin to anger – and roar and growl some more. It was completely awesome. Primal womanhood! (<-- one of my affirmation/key phrases. ;-p)

What was not completely awesome, however, was the effectiveness of my labor. Contractions were STILL only ever seven to ten minutes apart and irregular. Denise started coming over to me in the pool exactly every four minutes and stimulating my uterus all over from the outside to make it contract, which did work for awhile. So I had these “artificially induced” contractions every four minutes for awhile. Then she waited to time my own natural contractions. I was busy growling and not paying too much attention, and still enjoying being in normal labor and not the bowels of incoordinate hell. I knew deep down that things were not quite right and that we needed to get things moving, but the big chicken part of me was also very glad that the contractions weren’t closer together (silly, I know, because when transition contractions happen the way they’re supposed to – every two to three minutes – the endorphins not only kick in stronger and help lower the pain, but it’s much easier to find a rhythm when the timing of the contractions is quick and predictable) and didn’t want to really commit to making them closer together.

Denise wanted me to get out of the pool and start moving around and being active. I didn’t want to, and I lollygagged for awhile. (Yes, I just used the word ‘lollygagged’. I know, I’m so cool I can’t even stand it.) But finally I knew it needed to be done and I got out and they all toweled me off. We started with Denise holding my arms and supporting me as I squatted, hoping that squatting would get the baby’s head low enough to hit my cervix and cause a contraction. It worked, and after that contraction I started pacing with my legs very wide and doing lunges, trying to accomplish the same effect. After a few minutes I went back to Denise and she stimulated my uterus and we did the squat again. It wasn’t working. I stood up and she did more stimulation and I squatted and did have a contraction, but it was shorter and not as strong. I paced and lunged around the house some more, walked circles quickly around the pool, walked up and down the hall, put a leg up on a chair and lunged into it. No contractions. Ten minutes passed. Denise started stimulating my uterus very vigorously, rubbing and prodding and shaking it all over, and we squatted, and stimulated, and squatted again. No contractions. I walked more. No contractions. It had been a good fifteen minutes by this point.

Hmm.

Denise shook her head. “You’re tired, Sarah,” she said. “Your uterus is tired. You haven’t slept in three days. What I really think needs to happen here is that you need to rest.”

Ugh. I knew she was right. I was scared of resting – I was afraid of those contractions ripping me up out of the bed as they had earlier and the night before. I was scared of losing what little rhythm I’d managed to find. I think, deep down, I was scared to really commit and have this baby, especially in light of the surreal and dysfunctional labor. I didn’t know if I could actually do it. It seemed like my body kept postponing that moment of truth for which I’d been preparing for months, and my mind, afraid, wasn’t quite up to pushing my body onward to that point.

“I’d like to check you first,” she continued. “Then I think Ginna and I are going to step out and take a breather and let you guys rest for awhile.”

I was terrified at the thought of being left alone, but knew that resting was the only option at this point. We went into the bedroom and I lay on my back as she checked me. It seemed like it was taking longer than usual.

“You’re about nine centimeters. I’m not sure that we broke the water before or not… let me just check something… hmm…” She basically started digging around, feeling and evaluating and doing her midwife thing. Suddenly I felt a warm gush of fluid against my butt. “Whoah!” I said. “That was definitely my water!” She nodded but didn’t say anything and kept feeling around, a look of concentration on her face. I was tired, and feeling discouraged and scared about the lack of progress with my labor, about the pain, about my ability to actual do this giant thing. It was about three o’clock in the afternoon at this point. I closed my eyes wearily. Ginna came into the room at that point and crawled upon the bed and kissed me on the cheek. I smiled half-heartedly, but I was starting to feel despondent.

Denise looked grim. “Now that the waters are broken I can feel the sagittal sutures better,” she said. (The sagittal sutures are the lines where the bones of the skull meet and overlap; you can tell a baby’s position by feeling the direction of the lines.) “The baby’s completely posterior.”

…Of course.

(A posterior or “sunny side up” presentation is where the baby’s spine is against the mom’s spine and she is facing forward, as opposed to anterior, when the baby’s spine is facing outward and she is facing toward the mom’s back. The reason this is important during birth is because when the baby is anterior, the smallest part of the head goes through the pelvis first; when baby’s posterior, the large, flat part of the head tries to go through first, which doesn’t fit as well and in some women might not fit at all. Imagine putting on a turtleneck sweater; you pull it over your head with the pointier, narrower, back part of your head going through first; if you try to pull it over the flatter front part of your head, it often gets stuck. Same idea.)

I had spent MONTHS of this pregnancy trying to avoid a posterior baby, because I so badly wanted the birth to go as smoothly as possible and had my doubts about being able to birth a posterior head if the head was very large, as Max’s head had been. (This fear is probably not rational, because I have a big pelvis anyway and because Max’s giant head came out with a whole extra inch of fist and arm next to it, which probably took more fitting than a posterior head would, but still, it is a fear that I’ve had.) I’d been doing all sorts of exercises and never ever leaned back or reclined if I could help it and tried everything to get the baby to stay anterior. And the baby was anterior for most of the pregnancy! At my appointment the Monday before Denise had been able to feel the sutures and the baby was anterior.

But it wasn’t now.

This explained a lot about the dysfunctional labor. When the head isn’t well engaged in the pelvis and the head isn’t applying very good pressure against the cervix, things just don’t progress as they normally would.

I was in complete despair at this point. More than anything, I was so, so tired. I was starting to have a hard time dealing with the pain of the contractions again. I just didn’t have the energy. And now, to learn that the baby was posterior – my greatest fear realized.

I hadn't slept in days. I had barely eaten. I'd been in excruciating, abnormal labor for a good twenty hours. The baby was posterior. I was exhausted. More than anything, I was terrified. It just didn’t seem possible that I was going to make it through this birth.

Click here for Baby Nichols Arrives, Part 3!