Birth story - Heather and baby Caroline

⚠️ use of word contractions, talk of pain intervention, cerclage ⚠️

Background info:

During my first pregnancy, I was diagnosed with a bicornuate uterus. My water spontaneously broke at 36 weeks 2 days, and I had my first daughter the next day via induction. It was a positive experience, but I did opt for pain meds, mainly because of my lack of preparation and inability to cope with the intensity of the induction.

Early on in this pregnancy, my doctors had indicated that there was no specific cause of why I went into preterm labor last pregnancy (maybe down to uterus shape), and that I may or may not have it happen this time. I would have a few more ultrasounds than typical just to monitor things, but they anticipated everything being OK.

Fast forward to my 18 week ultrasound, and it showed that my cervix was significantly shortened. They recommended that I have a cerclage placed the next day in the OR. I was also started on daily progesterone. Other than pelvic rest, I had no other complications throughout the pregnancy (aside from “normal” aches and pains which I addressed with chiropractic care). I had Braxton Hicks contractions from about 20 weeks on, as I did during my first pregnancy.

At ~28 wks I learned about PBC and purchased the course. I watched all the videos over the next few weeks and began listening to the positive affirmations before bed. I made a list of all the videos I wanted my husband to watch, and by 36 weeks he made sure to watch his portion.

At 36wks they removed the cerclage and indicated some go into labor right away, and others end up delivering full-term. The week after the cerclage removal I lost parts of my mucous plug and had an increase in Braxton Hicks, but then things seemed to remain stable. At my 37 wk appt they did a pelvic exam and I was 2cm dilated and 20% effaced. Although it was great news that there were no eminent indications that I would go into labor early and that the baby could keep cooking, things were beginning to pick up with Covid. My OB mentioned that hospital policies were changing daily regarding visitors/birth partners - some hospitals in the US were not allowing ANY one other than the patient. They were predicting a surge in cases in our area the week of my due date. This made me super uneasy because I couldn’t imagine giving birth without my husband. My OB brought up the possibility of an induction (any time after 39 wks at my preference). She thought I would be a favorable candidate since my cervix was already beginning to change, plus this was my 2nd child. After talking it over with my husband, we were in agreement to induce at 39w2d. We had a family member on lockdown with us for weeks, so that they could watch our 3 yr old daughter. There were few things in the world going on that we felt like we had control over, but having a set date with my husband present + child care coverage put us both at ease.

At my 39wk appt, I was 4cm and 60% effaced, so my OB was very hopeful it would be a smooth induction. She even joked that I should have the baby by dinner time on induction day.

Induction day:

We had a good breakfast, packed the last few items in our bags, and headed to the hospital for our 10am start time. When we got to the parking deck, my parents (who live an hour away), met us there and gave us a socially distanced wave and well wishes as we headed in. They are super supportive and were disappointed they weren’t permitted to wait in the lobby, as they did with our firstborn. They were planning on staying close by for the duration of the labor/delivery, as a way of showing support. We checked in at triage, and as we were walking to our room, I made mention that if they had a room with a tub, I would be interested in potentially using it during labor. The nurse said they had one available, and would put me in a room across the hall then, instead of the one she was originally going to put us in. As we got settled I opened the blinds in the room to let in some natural light, and across the way was the parking deck we just parked in. Sure enough, I could see our car, and my parents car. We sent them a text to let them know we could see their car, and if we stood up at the window, they were able to see us too. We joked that they probably had a better view in this spot outside of the hospital then they would have in the waiting room (don’t worry though, we kept the blinds pulled once things started picking up 😉)

By about noon, they started my IV, including Pitocin. I was already having contractions, but nothing strong enough for me to really make note of. I asked my nurse early on when a good time was to use the tub. At this hospital they don’t condone delivering in tubs, only laboring in them, so the nurse said they usually recommend waiting until about 6 cm to get in, for it to provide the greatest amount of relief. I was hoping to not have an epidural, but I also had a very flexible mindset. I was resolved with the fact that an induction meant a higher likelihood of needing pain medication, but I was willing to wait it out as long as I could. They even had an anaesthesiologist come talk to me, just to review all of my options and to let me know that I could have an epidural at any point in time, even if I was 10 cm, as long as I could sit still long enough for them to do the procedure.

Around 1.30pm, I was already in established labor, according to the Freya app, as well as what the nurses were noting on the screen. I had wireless monitors on my belly to track contractions and babies heart rate. Things were very manageable - I was pausing at contractions, but still felt very in control. By 2:00, the intensity picked up, but I was still having no problems handling the contractions using up breathing. I communicated that things were getting more intense, so the nurse had a resident come in to give me a cervical exam, at which point I was only 4.5cm. The baby was still at a -2 position, so they asked if it would be OK if they broke my water, to help the baby settle further in my pelvis, and to help things along. My husband and I were comfortable with this intervention, and gave them permission.

At 3:00 I was only dilated to a 5 and 80% effaced, but contractions were much more intense. At this point, I asked my nurse to start filling the tub, as she indicated it could take a while to get it ready. I tried sitting on a ball, but that wasn’t comfortable for me. I preferred leaning over the bed, swaying and just getting into my zone. The up breathing was invaluable for me, as well as just remembering that it would only be a few cycles of the breathing before the contraction would already be on its way down. Due to the Pitocin, I didn’t have have much of a break between surges. After a visit to the restroom, I confessed to my husband that if the tub wasn’t ready soon and/or didn’t provide much relief, I wasn’t sure how much longer I could go without pain interventions. I realized in that moment this could be transition, but since I had just been evaluated at a 5, I was doubting my progress. Upon leaving the restroom, my nurse said that the tub was filled enough for me to get in if I was ready. I was relieved to hear this, and made my way over there with the help of my husband. Just as I was about to get in, I got super flushed feeling, and a bit lightheaded. My nurse instantly made me go back over to the bed to monitor myself and the baby. I was still feeling flushed/warm, so my husband began putting cool wash cloths on my neck as I laid on my side and that felt amazing. After several contractions, my nurse was pleased with my vitals, and the baby’s heartbeat, so she said as long as I wasn’t feeling “pushy” I could head back to the tub to get in. I decided to wait one more contraction as my coping sounds/breathing had changed, and that’s when I realized that I was having a different sensation. A resident came in to have another check, and we discovered I was 100% effaced, 10cm dilated, and +2 position (aka ready to push). The nurse then tried paging three different doctors, all were busy with other patients at the time, and my OB had not made her way there yet. I remained calm, because I figured between the two nurses in the room as well as the resident, somebody would be able to catch this baby if need be. I did a few pushes in a semi squatting position leaning over the back of the bed, but didn’t feel like this was very productive for me. I then switched to laying on my side, and I felt much better. After pushing for four or five contractions, the baby’s head was out in 1 push, and 1 more push was the rest of the body. An OB did make it in time to officially “catch the baby” but my nurse and the resident were so sweet the entire time, giving me the best encouragement and cheering me on. The baby was immediately placed on my chest as they announced it was a girl. We had delayed cord clamping and my personal OB came in just before I delivered the placenta (about 5 mins after baby). I was then told I had a minor graze, and only required one stitch due to it being a “bleeder”, otherwise they would’ve just let it heal by itself.

In summary, my labor was just about 4.5 hours from the start of pitocin, progressing from 5cm to pushing and out in under an hour. Our sweet Caroline Elise made her debut at 4:21 pm, just in time for dinner 😉 and my husband was able to do a Lion King-esque reveal to my parents patiently waiting across the way 🤍