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TENS Machine

         After 41 weeks and 5 days in Mom's womb (and a few failed attempts to get labour going naturally), it was beginning to look like our little one might need some help to come out into the world.  After talking to Heidi (our amazing midwife) about our options, we decided Cervadil might be the best way to go.  Dr Badawi at the Wetaskiwin hospital was willing to give me some prostaglandin gel, followed by Cervadil to get my cervix, which just wasn't effacing, soft enough to help labour on its way.  We thought with the Cervadil, labour could get started and I could go home to labour and deliver at home as planned.

            On Tuesday, October 19th at 1:00pm, Justin and I headed in to the hospital for the prostaglandin gel.  I met Dr. Badawi, two lovely nurses, Trish and Angela, and the Unit Manager, who tried to convince me that labouring at home was a bad idea and suggested that all her hospital bylaws and rules indicated that we should labour and deliver in the hospital.  She did suggest, very accommodatingly, that we could bring in our pool to the hospital and have our waterbirth there, but, as some of my former high school students would say, "I just wasn't feeling it..."  We smiled, nodded and very politely, noncommittally thanked them for the offer, took the prostaglandin gel, stayed for an hour hooked up to their monitor and then  went home to rest.  The gel, as expected, made me uncomfortable, with lots of cramping and generalized tightening, but didn't put me into labour. 

            At 7:30pm, it was time to go back to the hospital for the Cervadil.  The Cervadil went in, and I had to stay hooked up to a monitor for two hours.  I read and rested while Justin read background papers from work and finally, at around 10:30, we could go home.  Shortly before going home, the monitor indicated that my "generalized tightening" was settling into a consistent pattern of contractions.  Sheri, one of the night nurses, suggested that a warm bath might really get things going if I wanted to increase my chances of this working.  Dr. Badawi told us to go home and rest as he thought "most of the action" would be the next day.

            I went to bed shortly after we got home, reading and trying to relax.  Justin joined me in bed around 11:30pm and I tried to sleep.  After half an hour, I was uncomfortable and not asleep and decided to get up and try Sheri's bath idea.  I thought...warm water, that could help me relax .  It might feel nice.  The warm water did feel nice, but I couldn't get comfortable.  My back hurt, so I couldn't just sit back in the tub.  The tub wasn't wide enough for me to get into any position where I was comfortably under enough water to really relax, so I wiggled and squirmed around for a half hour and then got out of the tub, thinking, It seems like I'm having contractions.  This must be it.  I got out of the tub and started to prepare for labour.  I got my relaxing music out.  I lit some candles.  I got my yoga ball and yoga mat and basically collected the things I thought might help.  I wracked my brain for positions where I might be able to weather out each contraction, trying to remember  some of the positions that Heidi had given me pictures of and waiting for my instincts to suggest to me what I could do to handle them.  I couldn't for the life of me think of positions that I could handle.  I decided this was something Justin could help me with and decided to wake him up at 1:00am.  At the same time, I checked the clock when contractions hit and I felt pretty sure they were about five minutes apart.  Things were progressing really fast. 

            I woke up Justin, who groggily got up, took a few minutes to gather his bearings and then was right there with me, ready to help.  I asked him to pull ideas out of the labour positions jar so I could try different things, but before he could even help, I had another contraction, and another one, and another one.  All I could do was drape myself over my yoga ball and cry, scream, and hurt.  I tried to think of all the coping methods I had imagined myself using, so I could try to cope, but the contractions were intense, hard, and fast and I couldn't catch a break in between to think of any coping method.  Around 1:15 am Justin asked me if I thought it was time to call Heidi and I said yes.  

            I then began to vomit from the overwhelming intensity of everything, which was an incredible relief (if disgusting).  I remember thinking, one of my pregnancy books says that vomiting normally happens  during transition (8-10cm dilation)-- If I'm already vomiting, maybe I'm in transition way faster than expected.  I asked Justin to get the pool ready because I remembered a friend of mine saying that the water had "cut her pain in half" and I had absolutely no idea how I was going to manage any other way, so while I had planned on saving the pool for "the bitter end", I thought I needed the pool....stat! 

            When the pool was ready, I got in expecting it to be the answer to my prayers, but sadly, it wasn't.  My back still hurt, so I couldn't sit, I had nothing to lean on, the only position I could use was on all fours, which worked, but was exhausting as there was no obvious "resting pose" between contractions.  I asked Justin to squeeze my back through contractions as Kelsey has taught us in prenatal class (thank you!) and it helped, but I still couldn't cope.  I tried to practise Kriya breathing, I tried to make low moaning sounds, I tried to practise any of the labour advice I had been taught.  Occasionally, I succeeded, but what came most naturally was screaming, crying, and more vomit.  At this point, I held onto two thoughts: When Heidi gets here, she can check me and tell me how far dilated I am--I sure hope I'm almost there.  And, When Heidi gets here, I'll tell her I'm done, I want to go to the hospital, I want an epidural...I know I said I wanted a natural birth, but I don't care anymore...this is so much harder than I thought it would be.  I just want it to stop.  I kept asking Justin, "What time is it?" knowing that since we had called Heidi at 1:15, she'd be there around 2:15.  I was a long, difficult wait.  She arrived around 2:30, asking, "How are we doing?" 

            "Bad,"  I said

            "Bad," she repeated and laughed.

            "I want to go to the hospital.  I want an epidural."

            She laughed again.

            Meanwhile, Carly, the student midwife, took on the role of doula, coaching me through contractions and getting me to breathe in a more calming fashion, getting me to make lower moaning sounds, helping me to cope better.  On the one hand, I hated her for making me do something so tough, on the other hand, it helped.  At the same time Justin and Carly traded off squeezing my back through each contraction, since it was hard work to apply so much pressure.

            I told Heidi I wanted her to check me and she suggested that we wait.  I was thinking I'm sure I'm almost there...check me dammit!  Heidi continued to smile and resist my request, saying, "What if I check you and you're only 6 cm, then what?" 

            "Then I want to go to the hospital for an epidural."

            Heidi laughed again.

            I asked a second or third time and Heidi finally agreed to check me, announcing that I was 8-9 cm dilated.  Thank God.   A short while later, I heard her call Gaelyn, the back-up midwife, telling her I was fully dilated, that my water hadn't broken, that there was a mass of membranes right below the baby's head that I needed to break through to get the baby out.  Meanwhile Carly suggested I visualize breaking through that bubble of membranes with each push.  Heidi and Carly suggested a few different positions for me to try where I might be able to push better and maybe break through those membranes.  I did my best to follow their advice, but I didn't feel like I was getting anywhere.  I asked Heidi to break the membranes for me.  She said she could, but that there were drawbacks...they could find meconium (poo) in the baby's water, suggesting we would need to transfer to hospital, it might make the labour more intense.  I mulled over her comments, but my gut said...if they break my waters, then it'll make pushing easier and I might just be able to get this baby out soon.

            In what seemed like no time, I heard the door open.  I thought to myself, Hmm...maybe David (our basement tenant) got tired of hearing my screams and cries and decided to get out of the house.  As it turns out, I was wrong; Gaelyn had arrived.  It felt like no time, which is impossible because Gaelyn would have had to have driven from Edmonton, which takes an hour, but somehow with Carly, Heidi, and Justin working together to get me through each contraction, I had managed to labour for two hours in the pool without noticing how much time had gone by.  Gaelyn, Heidi told me later, arrived at about 4:30am.  Two hours after Heidi had arrived.  Two hours after I had begged to go to the hospital for an epidural.

            At some point, I noticed Heidi was gone from the room and had been gone for awhile, leaving Justin and Carly with me to coach me through a few attempts to push through the membranes and get baby out.  I asked where Heidi had gone.  Carly told me she had gone to the bedroom to get things set up so that they could break my waters.  Shortly thereafter, Justin helped me out of the pool, wrapped me in a towel and led me to the bedroom, where they had his side of the bed all set up for me.  I remember commenting on how cold the room was and asking if the window was open.  Justin assured me the window was closed and told me I was just cold because I'd been sitting in the pool for awhile. 

            I lay back on the bed, Heidi broke my water and announced joyfully that the waters were clear.  No meconium.  Good news.  Now I just had to push the baby out.  Now, I have no idea where I got the idea that pushing a baby out was easy.  But for some reason, I had heard somewhere, at some time, from someone, that the labour was hard, that waiting to fully dilate was hard, but then when the urge to push came, you just had to push baby out...piece of cake.  For some reason, I thought I had reached the easy part.  Um.  Wrong.

            Justin asked how long it normally takes to push the baby out.  Good question, I thought.  Heidi told me not to listen, and then told him (and me) that for first-time moms it could take up to two hours.  Oh man, I thought, really?  Holy crap. I asked, "What time is it now?"

            " About five."

            Okay, I thought, I have to make it until seven.  In my mind I had a target, a goal.  Two hours seemed crappy, but at least now I knew what I was in for.

            Heidi's records show that I started "effectively pushing" at 6:07am.  When I asked what I was doing from five to six, she and Justin both said, "pretty much just  lying in bed".   I wasn't getting a strong urge to push, my back really hurt, and I told them so.  Heidi suggested that she apply the TENS machine to my back.  I agreed.  The machine in place and doing its thing, I could feel the baby make a major shift inside me and I commented on it moving. 

            Recognizing that I wasn't really making and progress, Heidi and Carly suggested I get out of bed to try other positions.  They suggested a few: standing, squatting and so forth.  My memory is fuzzy, but I think I tried a couple different things unsuccessfully before  asking if I could try taking a shower.  They thought it was a great idea, Justin prepared the shower and I got in.  The water felt nice, but then the first contraction came.  In our shower there is nothing to hold onto.  No bars, no ledges, just two shower curtains coming down on either side of you.  With nothing to grab onto, no Justin or Carly to help me cope, I had no choice but to get down on all fours...standing was just too hard.  Another contraction on all fours and I decided I couldn't handle the shower.  I got out and got onto all fours on the bathmat, asking Heidi, "What happens if I say I'm done?"

            She told me that I had already gone further than I thought I could.  She also said she thought I was resisting the pain and that I needed to really push through it if I wanted to make progress.  She suggested we try a few more positions before giving up.  I did my best to do what she said.  I couldn't tell you what order things happened in.  I know I heard Heidi ask Justin which side of the bed I normally slept on and when I returned to the bedroom sometime later, it was my side of the bed they had set up with blue pads for me.  I remembered thinking, Gee, that's nice of them.  At a time like this where the only important thing is getting this baby out, they still were thoughtful enough to make sure I was set up on my own side of the bed. At some point, I asked her how much longer.  She said she didn't want to tell me, since she could be wrong.  I asked her to make her best guess.  "Ten contractions," she said.  Meanwhile, Gaelyn was setting up the bedroom for the delivery.  Heidi pointed out that they wouldn't be setting up the room for delivery unless I was really close.

            I was back on the bed (my side) with Justin and Carly each grabbing one leg, me grabbing my thighs to pull them back as I pushed, sometimes hitting the right spot, sometimes not.  Heidi started telling me she could see the baby's head, she could see hair, I was making progress, I was almost there.  She tried to hold up her mirror so I could see my progress, but she didn't get the angle quite right, so I could only see my pubic hair and I could feel that by trying to focus my energy on the mirror, I was losing my focus on pushing.  "I can't see,"  I told her. " I'll just push."  Every time I pushed, they would say, "Good, that's it.  You've got it."  Or sometimes they say, "Right down into your bum."  Or sometimes they said nothing.  From what they were saying, it seemed, I could tell how I was doing.  Every time I pushed, I listened for their comments.  A "That's it,"  meant I was doing it right.  A "Right down into your bum." meant I was pushing, but not quite the right way.  When they said nothing, at least in my mind, it meant I was making no progress. 

            At some point, Heidi told me they were starting to see meconium and that the recommendation when you see meconium is to deliver in hospital.  I said nothing.  I just kept pushing.  A few minutes later, Heidi asked me if this was where I wanted to deliver my baby.  I said, "yes."  I thought, since Heidi had told me I only had a few more contractions left, there was no point in going to hospital now.  It wouldn't be long before baby would be here.

            They told me I was making progress, I was almost there.  The end was in sight.  Heidi suggested I put my hand down and feel for myself.  Their definition of "almost there" and mine were clearly different.  When I felt, I could feel baby's head, but it was a good index finger away from being out.  That didn't seem almost there to me. 

            I began to become aware of the fact that it was past seven and I was still pushing.  I had passed the two hour mark that was my limit.  I also became aware that their comments of "That's it, you've got it" were becoming fewer and fewer.  And I noticed that  while they said I was making progress, it seemed, from their faces, their tone of voice, and what my body was telling me, that we had hit a wall.  Baby, it seemed, was moving out and then sliding back in, and moving out and back in again. 

            Sensing the stall, Heidi and company once again suggested I get out of bed.  Maybe some upright positions, with the help of gravity would get baby moving.  I tried standing up, leaning on my dresser.  They told me I needed to tuck my bum in and push.  This position seemed very hard.  So hard to stand up and push and stay in the right position.  They then suggested a position where Justin, sitting on the bed, could hold me up into a squat.  We tried it once, but again it seemed to take so much strength just to hold myself up, that I had no strength left for pushing.  I asked if I could go to the toilet.  I think I felt the urge to poo, and maybe I did or maybe it was simply Baby on my rectum.  Either way, the toilet seemed like the place to be. 

            They thought the toilet was a  great idea.  While I was on the toilet, trying to poo/trying to get Baby out, Heidi held the Doppler up to where baby was supposed to be.  I was getting tired of that damn Doppler.  It seemed they were constantly checking Baby's pulse at the most inopportune time.  I pushed Heidi away out of frustration.  Carly was squatting in the bathroom doorway next to Heidi.  Heidi turned to her and said, "One ten." 

            "Hmmm,"  Carly said, "That doesn't tell us much."

            Both Heidi and Carly's faces conveyed there was a problem.  I didn't know a lot about Dopplers and heartbeats, but I seemed to remember that Baby's heartbeat was normally 120 to 130 or higher.

            Around this point, as I was standing up off the toilet, leaning on the bathroom counter, aware that it was very nearly eight.  Heidi said to me, " I think we should start to think about timelines..."  She didn't use the word hospital, but I knew she was asking me at what point I wanted to go to hospital.  In my mind, I had gone past seven o'clock, which was my limit.  I had gone WAAAY past the ten contractions Heidi had suggested what seemed ages ago and I had spent at least the past fifteen minutes feeling that, despite my efforts, Baby wasn't coming any closer to getting out.

            "How about now?" I both asked and stated, without really needing an answer.

            "I think that's reasonable.  We're coming up on (did she say two or three hours?) of pushing..."

            I really didn't care if she thought it was reasonable or not.  I had asked her at 2:30 to go to the hospital.  I had come close to quitting at 6:00.  Both times she managed to talk me out of it, coach me to go further, and push me past my limits.  This time, if she was going to let me go to hospital, I was all for it. 

            The hospital bag I had packed in case of emergency was already in the car, since Justin and I didn't know what was going to happen when we went in for the prostaglandin gel.  At this point I was naked from the waist down.  I asked Justin to get me a diaper, then I got into a pair of pyjama pants.  I asked him for my flip flops, I got my coat and purse off the hook at the back door and we were ready to go.  I took us less than fifteen minutes before we were in the car and ready to leave.  The midwives were still scrambling to pack up all their things, but weren't far behind us.

            The drive from our house to the Wetaskiwin Hospital is not a long one.   While I've never actually timed it, I would say it takes seven minutes maximum.  Or, that's how long it would take if there were not a train going through town.  This trip to the hospital was our third trip in nineteen hours.  It was, however, the first trip where a train was going through town.  Sigh.  Murphy's law.  Justin's reaction was, "You're fucking kidding me, " but luckily he was able to turn left at the intersection before the tracks and head to the next intersection.  By the time we reached the next railway crossing, the train had passed and we could cross the tracks without incident.  We made it to the hospital in no time. 

            While in the car, I felt a sense of relief.  This would all be over soon, I knew.  I had a few contractions in the car, but without the midwives telling me what to do, I felt less pressure to "perform".  I just pushed because, well, what else was there to do?  I felt like I was pooping my pants, but that's what the diaper was for, right?  I couldn't tell you whether I was pooping, pushing, or both, but either way, I made my way through a few contractions in the car before we got to the hospital. 

            At the hospital, Justin asked if I wanted him to drop me off at the door while he parked the car, but I said no.  The thought of being separated from him at this point in time seemed awful.  So, he parked the car and we began to walk to the entrance.  Heidi and Carly were right behind us and quickly joined us on the sidewalk.  Justin apologized to them from making me walk from the parking lot, even though it was what I wanted.  Walking to the hospital door.  One contraction.  I stopped, leaned on someone or something.  Pushed.  We walked some more.  Outside the elevator.  One contraction.  I leaned on the wall railing.  Pushed.  In the elevator.  Another contraction.  I leaned on the rail in the elevator.  Pushed.  Just off the elevator.  Another contraction.  Justin decided it was time to get me a wheelchair or we'd never reach the ward. 

            As Justin pushed me down the hall to the labour and delivery ward, we were met by the nurses.  Heidi had called ahead to tell them we were coming and to give them the details.  I was whisked into the first delivery room, stood up out of the chair.  Trish, who we had met the day before, got me to get out of my pants, shirt and diaper, into a hospital gown and onto the bed. 

            In an instant, Dr. Badawi was there, getting me to push.  I didn't want to push anymore.  I was tired and I wanted them to do the work for me.  Somewhere along the line, someone had mentioned that at the hospital they would try a vacuum extraction.  I can't remember when I got this information, but I knew that once I got to the hospital, that was what they were going to try.  So, I asked them, "Aren't you going to use the vacuum?"  They told me they were just setting it up.    All the while, Dr. Badawi is telling me to continue pushing, coaching me through contractions and I'm giving it all I can because I know it's almost over.  Also, Heidi and crew are once again showing signs of progress in their voices.  I am told, by Justin and Heidi, that there was a huge difference in the how much of the head they were seeing at the hospital than from at home.

            At some point, Dr. Badawi asked me if I wanted a local anesthetic; I said yes.  Anything, at this point...  Just get it out! 

            They tried to use the vacuum once.  It popped off. 

            They tried again.  It popped off.

            Once more.  It popped off.

            The rules say, if you try to use the vacuum three times and Baby doesn't come out, you have to stop. 

            What happened next I was completely unaware of.  I just know that I was being told to push and I continued to push.   It turns out that Dr. Badawi was left to debate between the forceps and an episiotomy to get Baby out.  Justin tells me that there were three types of forceps out on the table ready to go.  But, (thankfully) Dr. Badawi instead chose the episiotomy option.  I had no idea this was happening.  I was just pushing when I was told to.  Then, the moment came when they told me not to push anymore.  I panted.  I knew that if they were telling me not to push, that meant the baby's head was out.  Finally.  When I was allowed to push again, I pushed out my...son!  I heard Justin cry, "It's a boy!"  I was shocked.  I was sure that I was having a girl.  I was elated.  I had given birth.  9:02am. 8 pounds, 11 ounces.

            He was placed on my chest briefly, where I was filled with emotion as I looked at the most beautiful sight I'd ever seen--better than the Rocky Mountains, better than sunsets in Thailand.  My goopy, gucky son was more beautiful than anything.  He was taken from me  to the assessment table, where I could watch him from a distance.  Everyone except Dr. Badawi headed over to the assessment table and then Dr. Badawi coached me, in two pushes, to push out the placenta.  Soon Justin was back by my side and Dr. Badawi was stitching me up.  I felt the stitches go in and it was only at that point that I realized that I had had an episiotomy. 

             In tears, I turned to Justin and said, over and over again, "We have a son!  We have a son!"    Justin said, "Now we just need a name for him." As I watched him over on the assessment table, sitting calmly, with no tears, the first name that popped into my head was James.  At the same time, Justin looked at me and asked, "James?"  So James it was.  "We just need a middle name now, " I said.  "James Thomas Benjamin," Justin suggested.  I liked it.

            At some point Heidi brought over the placenta to look at and then we were given it to take home as we had planned to plant it under a tree, a tree planted just for James.

            Finally, James was brought to me and laid on my chest.  I held him and tried to feed him and though our initial attempt at feeding was clumsy, I felt that we had at least bonded.  I held him, looking down at the most beautiful boy in the world, completely in love. 

            Ordinarily, a birth story would end here, but for our James, the story has a second chapter.  As we were still filled with elated exhaustion, another doctor came over and told us that James had breathed in some of his meconium, that he had been able to clear it all out of his system, but that there was a risk that infection might develop.  He told us that the NICU team from the Stollery hospital had been called and that James would be taken to hospital where he could be monitored and where the proper care would be available if an infection did develop.  No mother wants to be told that her child needs to be hospitalized, but I was reassured that he was only being sent as a precaution.

            Around noon, the NICU team arrived with the giant isolette for our tiny boy.  It's amazing how one little boy could have so many bells and whistles and gadgets.  Justin or Dad (who had arrived around 11:15am), I don't remember who, asked if I could go with him in the ambulance and they told us no, there wasn't enough room.  Ouch.  James was assessed and then closed up into the giant plastic box, where the NICU team noticed he was hungry and was rooting and reassured him that I'd be along soon to feed him.  Ouch.  I was told James was going to the Grey Nuns, because their neonatal unit had a space for parents to room-in with babies, whereas the Misericordia Hospital, the other option, did not.

            Around that time, lunch came and Trish mentioned that she could take me to have a shower if I wanted.  I was told by Angela that they might be able to get me a bed at the Grey Nuns, or I could stay at the Wetaskiwin Hospital, or I could discharge myself  "against medical advice" to room-in with James.  I asked them to see if they could get me a bed at the Grey Nuns, but Dr. Badawi came in later saying that it would be hard to get me a bed at the Grey Nuns, since they didn't have the best relationship with the Grey Nuns and that there was nothing really wrong with me for me to be hospitalized.  He suggested I discharge myself to be with James.  I ate lunch, Angela came and took me to the shower, which included a Sitz bath  (ahhhh, so refreshing!) I then came back, dressed in real clothes and I had to discharge myself, "against medical advice" (which was funny, since Dr. Badawi actually suggested I leave the hospital!) and Dad drove me up to Edmonton, where I was reunited with my little boy.  I fed him for a few minutes and then we both fell asleep in each other's arms, exhausted and happy.

            We spent the next 48 hours in hospital, which was a mixed blessing.  The positives of the experience were that we got seen by a lactation consultant on our second day, who made breastfeeding go MUCH better and, I'm sure, made James a lot happier!  We also got a great bathing demonstration on his going home day, so those extra supports were nice.  On the other hand, James spent those 48 hours hooked up to a machine that monitored his vital signs constantly, and if any of his vitals went below or above normal, a nurse came in instantly to check on him.  He was also hooked up to an IV and had a shunt in his foot (and later his hand) for antibiotics to be given.  Breastfeeding a boy with an IV in his hand, three sensors on his chest and a probe on his foot has its limitations, not to mention that it was frustrating that , when James got fussy, and his heart rate when a bit above normal, there was a nurse poking her head in to check on him, making the whole process of calming him down extra stressful. 

            In the end, no infection developed, James was 100% fine, and we got to go home and we've been in love ever since!

So what happened?

            After debriefing with Heidi, here's our best guess as to what happened.  During most of the labour, James head was likely cocked to one side, meaning that he wasn't fully engaged and wasn't able to come out vaginally.  At some points, when Heidi and crew were seeing the head, they may have been seeing the swelling that my pushing on him was causing, but not seeing true progress.  When I felt James shift inside me after the TENS machine was applied, that was likely when James finally dropped into a position that made vaginal birth possible.  Had we not applied the TENS machine, Heidi hypothesized, I would have needed a C-section.  Thank God for the TENS.  When James did shift, he shifted into the OP (Occipital Posterior) position, meaning his back was against my back, and he was trying to point the widest possible diameter of his head out of my body--the toughest position he could have been in for me to push out! 

            The perfectionist in me wants to receive "top marks" for birthing well and feels like somehow accepting a local anesthetic makes me a wimp.  But I suppose all things considered, I did well!  James had a tough entry into this world and came out calm and healthy.  Well done, kiddo!  And I had an intense, fast, difficult labour and delivery and only took a small amount of anesthetic to cope.   I think we both did an awesome job. 

            P.S.  As a side note, but a very important one, Justin was amazing, and, if he ever decides to stop curating, then I think he could be one of the world's best and only male doulas.  He was 100% the best labour partner I could ever have hoped for.  From squeezing my back, to being totally reassuring with his words and his voice, to holding my legs through contractions, to setting up the pool, he was absolutely amazing.  I'm proud of us.  We make a great team!