Friday, December 30, 2011

The Birthening, Part 1: Induction

It's taken about two months to write this. Babies are a bit more work when they're out of the womb... and they're distractingly cute even when they're not being work. So I don't apologize for the delay. :-)

I had had my usual appointment with the midwives on Thursday, October 13. At that appointment they had told me I should come in over the weekend to do a quick blood pressure check. I had initially agreed to Sunday, but the prospect of one last weekend at home, just me and DH, without a 2-hour round trip drive to the hospital, was much more appealing... so I called on Friday and said I would come in on Monday, the 17th.

I went to work on Monday and had difficulty concentrating. I think, in the back of my mind, I knew I wasn't coming back in for a long time. Rather than spur me to productivity, though, the thought just made me listless. Since I'd already trained the part-time temp who was going to cover much of my job, I was mostly tying up small loose ends, anyway. I left a little early so I could take the el train to the hospital and be there by 4:00.

When I got to the midwives' office, there was some confusion: apparently someone had written me down for a noon check-in, when I had explicitly told the person on the phone that I would be there at 4:00. So I ended up twiddling my thumbs in the waiting room for some extra time, telling myself to be calm.

That was the whole problem with the blood pressure stuff: it got more tense each time I got checked, because I knew they would want to induce me, and I didn't want to be induced for a million reasons (including my sister's terrible failed induction/ c-section nightmare), so I had to stay calm. But telling yourself, "STAY CALM!" doesn't really, uh, work.

Finally, I was called back to an exam room and a nurse checked my blood pressure. I tried so hard to take deep, slow breaths while she was doing it, but my heart was racing.

150/80. Way too high.

In the past, they'd let me sit for five minutes and check it again. I naively thought they would do this at this appointment, too. They were also planning a cervical check and everything, so I de-pantsed myself and sat in the room with that big paper sheet over my lap for a moment and then Midwife Amy came in. She did a cervical check and declared me completely closed.

Here's where I was clearly just in denial: in my mind, what she told me ("completely closed") was that my body just isn't ready to have the baby yet, so they're going to send me home, tell me to relax, and they'll see me Thursday at my regular appointment.

Amy didn't see it that way, and the tone of resolution in her voice made me break out in to a sweat. She was giving me two options: be admitted to the hospital right now, or go home and pack a bag and return with DH tonight. Being completely closed just meant they'd have to do more work to get me ripened up.

I felt a little thick-headed: both options sounded like an induction would be starting within hours. But she just said my cervix is closed. After months of focusing on medication-free childbirth and hoping to let labor happen naturally - the whole reason I was working with midwives - this just puzzled me. At one point Amy said, "were we not clear that this was probably going to happen?" And I had to admit that, yes, they'd been talking induction for weeks. I just hadn't been listening.

Of course, I was also alone. This was the only appointment throughout the course of my pregnancy when DH hadn't accompanied me. Amy let me get dressed and call him before I had to make a decision.

My hands were shaking when I dialed home.

I explained what the situation was, and we agreed that I would come home, we'd eat a little dinner and pack up, and we'd come in to the hospital that night.

When Amy returned, I told her the situation, and she said she'd let Labor and Delivery know I was coming in. I explained how far we lived from the hospital and that it would likely be late - after 9:00pm - and she said that was fine.

With that, I left. As I walked toward the train, looking down at my big pregnant belly, I told myself that this was a lucky thing - I was getting one last chance to be on my own before I have this baby. A little time to myself to think.

In reality, I was scared and upset. This was all going wrong. I'd managed to carry a baby for 39+ weeks, but I was doing something wrong and now they're forcing the kid out when he's not ready. My hands were still shaking. I wanted a hug. (To be fair, Amy could see that: she gave me a big hug before I left and told me everything would be fine).

So I called my parents.

Parents of adult children: if your daughter calls you and says, with a nervous voice, that she's about to be induced, the first response you give should be "Are you OK? How are you feeling? Everything is going to be fine."

Despite your overwhelming excitement about the impending birth of a new grandchild, your response should not be: "GREAT! We're getting in the car RIGHT AWAY!" Which is precisely what my mother said.

My mother's enthusiasm didn't help. I was fighting a lump in my throat, and now I had to tell her to cool her jets, I'm completely closed, this is going to take a long time, et cetera. I had expected that she would remember how long my sister was in the hospital during her induction before they finally pulled my niece out via c-section, but apparently all that stuff about forgetting labor extends to grandmothers, too.

I don't blame her for being excited, of course. I just wouldn't have minded some reassurance. But she'd never been induced, anyway, and the one time she was threatened with it she was 42 weeks pregnant and it was a very hot August and she was SO DONE with being pregnant. I had not yet reached that point.

My parents insisted they would be leaving after dinner to drive halfway to Chicago (this panicked me. In hindsight, I shouldn't have called them until at least 24 hours later, or maybe even until after the kid was born).

My next call was to my brother, who had told me weeks earlier that he was keeping his phone by his side 24/7 in case I needed anything in the last days of pregnancy. His response was pretty much exactly what I needed to hear. He started with "Is everything OK? How do you feel about this? Is there anything you need?"

As my sister has said, our brother is rare among men. He absolutely loves being an uncle and was very excited about meeting his nephew, but he didn't let that get in the way of taking care of his lil' sister.

By the time I finished talking with my brother, I was on the el train, and I didn't want to be discussing the state of my cervix within the hearing of train strangers, so I moved to texting people: first my sister, then a few close friends and one co-worker. The slow process of sending text messages on my clunky phone helped distract me from the sweat that was developing in my armpits. As encouraging/excited responses trickled in, they helped me feel a little better.

I was on the train over an hour: first the brown line, then the green line. It felt like a year. I felt alone, detached from all the people around me in a completely different way than the usual commute. I wondered if they could tell what was about to happen to me.

When I called DH and told him I was almost home, he suggested he'd order a pizza for delivery, and then he would come meet me at my train stop. That sounded good to me.

When I finally got off the train and saw him walking toward me, I kind of started to lose it - I realized I'd been mostly keeping my cool in public but was really, truly freaked out. As he came closer, I started to cry. He gave me a hug and we walked through the dark together to our home, our last time doing something like this without worrying about the kid.

Once I was at home, my sister called. She, also, was very reassuring, and told me that her induction had been earlier in her pregnancy and it was really unusual, and that mine would go much more smoothly, and a million other kind things. I was gathering up things to pack while she talked to me, and then DH started badgering me about cash for the pizza delivery while I was still on the phone with my sister, and then my sister started asking about when she could visit in January, and I felt myself starting to crack: "You know, we still have to get packed up for the hospital, it's a little crazy here right now..." I was starting to cry again.

I got off the phone with my sister, and I - proud moment here - screamed at DH. But seriously, I felt like I was about to cede all control of my body and our baby to a bunch of doctors, and he can't get eighteen f***ing dollars together? And he didn't so much as wash a dish while I was trapped on the train, even though he knew we'd be in the hospital for days? I was pissed. Then it turned out I didn't have enough cash, and I really lost it. The stupid pizza was supposed to simplify things, and now I could feel my blood pressure going through the roof, and it was clear that I had to fix the situation even though my brain couldn't handle anything additional at that point. I told DH to call the pizza place and give them our debit card number, which for some reason he thought wasn't possible.

He called. It worked. We got our pizza. Things went a little better once we ate something.

We packed up the bag, and headed out in to the October evening, late enough that traffic wasn't bad.

We got to the hospital around 9:30pm - after hours, so we had to press a special button to be admitted to the main doors by some remote security person who buzzed us in. We carried all our stuff up to Labor and Delivery, and between the two of us we looked like we had planned to spend a month: we had bags of snacks and drinks, my body pillow, a laptop, and a million other things.

When we got to the secure L&D doors, I picked up the phone on the wall and said, "we're here for an induction", and they let us right in, no questions asked.

We schlepped up to the nurse's station with all our bags. The nurse at the desk did not inspire confidence: she acted like she had no clue who the hell we were. I had to repeat my name several times, and repeat that I was with the midwives, and it was an induction, over and over again. I was so ready to bolt back out the door at that point. Had I known what the next few days would be like, I probably would have. Finally, the nurse (who still kind of looked like she was just making things up) admitted us to L&D room 311.

I thought to myself, "this is where it's all going to happen. I'm going to meet my son in this room."

I changed in to a hospital gown and climbed on to the hospital bed. Another nurse came in and gave me an IV hep-lock and a hospital bracelet, and hooked me up to the continuous fetal heart rate monitor. The kiddo's heartbeat was nice and steady. Since I was going to be on medication, I had to have the monitor on all the time. Fortunately, I could still walk around: if I had to wander further than a few feet from the bed, I could just unhook the monitors, toss the cords behind my neck, and walk over to the bathroom or whatever. I was pretty happy about that.

Then Midwife Kim came in and talked with me for a while about the next steps: I'd have a dose of Cervadil that would stay in for 12 hours, then they would assess me. If I wasn't quite ripe yet, they'd give me another 12-hour dose of Cervadil. After that, Pitocin. She told me that sometimes, Cervadil is enough to just get things rolling on their own. I hoped for that outcome, because I'd heard some bad things about Pitocin.

She then gave me the first dose of Cervadil, which is a suppository-type thing that gets inserted in to the cervix. Oh lordy, was that unpleasant. I knew Kim to be pretty skilled when she has to deal with the nether-regions, so I think Cervadil just kind of hurts. Once it was in, though, I couldn't really feel it.

Around 11:00pm, we settled in for the night. DH pulled out the chair-bed thing in the room and put on some pajamas, and I reclined my hospital bed. We turned down the volume on the fetal heart rate monitor, turned down the lights, and waited for things to get started.

Tuesday, December 13, 2011

Boob Juice: the situation so far

One of the reasons I haven't finished the birth story is that my hands have been full, in a very real sense, with feeding this baby. With the exception of three days, my 8-week-old son has been fed only breast milk, and he's thriving: he's over 12 pounds now, and is big and strong (95th percentile for length! And he can already roll over! And... I'll stop. But I'm very proud of him). After the first five days of his life, my milk supply has kept up with his demand pretty well; the "girls" are producing plenty to keep him fed.

Easy peasy, then, right?

Not exactly.

About two weeks ago, as I was struggling through yet another excruciatingly painful nursing session, I was composing a blog post in my head entitled, "Breastfeeding is An Enormous Pain in the Ass". I felt duped, and I felt like there was no getting out of the hell I'd gotten myself in to: my child was thriving on my plentiful milk, but I was crying at the end of (and sometimes the start of) each nursing session. This was clearly great for him and awful for me. Everyone had told me that the first two to three weeks would be difficult, but things shifted from challenging (i.e., figuring out the mechanics of nursing a new baby) to painful after those three weeks. I kept thinking I needed to tough it out, or maybe I was just more tender because I had a big, strong baby who liked to eat in gulps, or maybe I was doing something wrong... it all boiled down to something being flawed with me, or with my approach. I just had to figure out what it was.

Thanksgiving week was when it finally hit the fan; when I was sobbing in bed while my son was contentedly nursing. I was sobbing for two reasons:

A) The unending, burning, stabbing pain while my son nursed, and

B) The need to stock up on milk so I could go shopping with my mother that Saturday.

Item B is probably the topic for a separate post about difficulties with my family and their growing tendency to ignore my needs, but it did mean that I was pumping milk after each nursing session, trying to glean enough extra so I could spend precious hours away from my month-old son, shlepping around in a crowded shopping mall during Black Friday weekend. This was creating additional stress for me, which wasn't helped by item A: pain.

DH made the suggestion, while I was weeping, that I just start pumping until I could figure out what was going on. We had both given up on what we thought were La Leche League lies ("breastfeeding should never hurt!"), but he offered that perhaps it shouldn't actually hurt this much. And pumping was less painful.

The Sunday after Turkey Day I began exclusively pumping, and our baby started getting all his milk from bottles. (Side note: He is so easygoing. As long as there's milk, he doesn't care where it's coming from. I love this kid.) While I pumped, I Googled things like "agonizing pain while breastfeeding". And I learned a few things:

First, I learned that, while "breastfeeding should never hurt", it often does, especially in the early weeks. I found a message board of women describing the pain when their babies initially latch on as being equal to or worse than labor pains - and I nodded in agreement. And while I was told to expect "discomfort" for 2-3 weeks, several of these women said it took two to three MONTHS before that latch-on pain dissipated.

And by "latch-on pain", I mean take-your-breath-away, toe-curling, 9 on a scale of 1 to 10 pain.

Second, I learned that, though it can (and often does) hurt to start with, what should never happen while breastfeeding is a burning feeling, like the intense burn I would have for about 30 minutes after each feeding. That's a sign of a problem. Other chest-area problem signs I had: urgent itching during a nursing session, occasional shooting pains at any time, and, yes, pain intense enough that I cried while feeding my son.

Dr. Google told me I might have thrush, which hadn't occurred to me. OK, it had, but I kept checking my baby's mouth and he had none of the fuzzy white spots I knew to look for, and he never acted irritated when he nursed. If he didn't have thrush, how could I have it?

That Monday, I relayed my concerns to our pediatrician at the kiddo's one-month appointment. The doctor checked him carefully and told me she saw no signs of thrush in him, but it was possible - especially if I'd been given antibiotics and he hadn't - that I had thrush but hadn't transmitted it to the baby. She suggested I use Lotrimin (yes, the athlete's foot medicine) 3 or 4 times a day and see if that helped.

She also did what all the health professionals do, and complimented me on my milk supply. Thanks, but I would enjoy being able to give the milk to my child without the delivery of said liquid being such an issue.

After a couple of days of only pumping and using Lotrimin, I didn't feel like things had improved markedly - I was crying less, but only because I wasn't nursing. And I was sad about not nursing.

Also, all the dealing with bottles and the pump actually created a lot of friction between me and DH: when I exclusively nursed, I just took charge of the kid for an hour at a time, no fuss, no muss. I was forced to put my feet up and DH had some time to do what he wanted. With the exclusive bottle feeding, DH would feed him while I pumped, or else I would feed and burp the baby and then hand him over to DH so I could then pump... and then one of us would have to wash all the pump parts and bottle apparatus every day or so. It was a huge hassle, and felt like way more work for both of us.

So on that Wednesday I did what I should have done probably two weeks earlier: I called the midwife's office. The triage nurse who talked with me was awesome - she immediately made it clear that I shouldn't be in this kind of pain, and she made me feel, for the first time in a long time, that I wasn't inherently flawed or doing anything wrong. After a couple of conversations with her, I had a prescription waiting for me at a local pharmacy: two doses of Diflucan and a tub of All-Purpose Nipple Ointment. I'd heard of APNO several times, and it kind of sounded like a wonder treatment. Diflucan was referred to in a lot of the search results I found when I Googled around about thrush.

The nurse also told me that as soon as things stopped hurting terribly, I should get back to nursing the kiddo - there wasn't a big concern about giving him the thrush.

So a third thing I learned is something plenty of people have told me: ASK FOR HELP. If something hurts? Ask for help. If you feel like something's just not right? Ask for help! If you're crying while you're feeding your kid? Ask. For. Help. Or clarification, at least. I got really invested in toughing it out when what I needed was a prescription.

And a fourth thing: if you're sore (and if you're nursing, you will be, especially if you give birth to a mini-Hoover like my son), use these Soft Shells. They were recommended to me by a new-mom friend of mine and they work beautifully. Between these and my prescription ointment I started healing noticeably in a couple of days.

We're up to the point now that I'm nursing the kiddo about half-time, and the other half of his feedings he's getting bottles of pumped milk. In the last couple of days, I've had several nursing sessions when latch-on pain was minimal, and the rest of the feeding was essentially pain-free. It's amazing, and I think I can see where this is going: I'm back to hoping I'll be able to breastfeed this kid for a solid year, whereas a few weeks ago 12 months sounded like a lifetime of pain and suffering.

When it doesn't hurt, I have to say that nursing a baby is pretty awesome, in the true sense of the word. I gestated this baby, and now I'm still sustaining him with my body. I love the snuggle time that is guaranteed during a nursing session, and generally extends for a while afterward when I'm burping him and he dozes off on my chest, content with a full tummy. Nursing can certainly feel like the best kind of tender loving care a mother can give to her child.

But while I already stated for the record that I would be completely fine with some formula supplementation - which is exactly what we ended up doing in the first few days of his life, when he had jaundice, my milk hadn't yet come in, and he needed to poop out that bilirubin - I will now say, after two months, that I certainly don't blame women who don't stick with breastfeeding. If I hadn't had two solid months off work and a spouse who was home with me full-time and a health care professional who was extremely supportive, I don't think I could have weathered the learning curve. Of course now I know I had some issues that were unaddressed for too long (ASK! FOR! HELP!), so my case was probably not typical.

So, yes, so far we're exclusively breastfeeding, and as we come to the 2-month point I anticipate that will continue to be the case. But just because it's "natural" does NOT mean it's easy, not in the first two months, at least. I'm becoming convinced that anyone who says it is must be trying to sell you something.