....and then there were four...

I woke up at 1:00 a.m. on a Monday morning to check on Oliver because he had been crying and I noticed I was having contractions. They weren't painful, but they were more uncomfortable than the false alarms I'd experienced a few nights in a row prior to that night. Those would occur at short, but regular intervals until I fell asleep. This time they were strong enough that I couldn't do more than drift in and out of sleep.

When morning arrived and I knew Chris was about to get up for work, I debated what to do. The contractions could stop at any time, or even if I were in the early stages of labor, I could continue like this all day. Chris had been so anxiously waiting for me to go into labor that I didn't want to get his hopes up or have him take a vacation day that would be much better used after the baby arrived. Because I knew my mother-in-law had the day off for Columbus Day, I called my in-laws and was careful to announce as soon as my father-in-law answered the phone that this wasn't "the call," but that I wasn't sure what was going on, but regardless, had been awake since 1:00 a.m. and could use some help with Oliver. My mother-in-law said she'd be over in an hour and without hesitation, Chris said he wasn't going in to work. He wasn't taking any chances this time about being "left behind." When I thought my water had broken with Oliver, I told Chris it probably wasn't my water, insisted he go to work and then called him an hour later from the hospital.

The contractions continued to be strong, and seemed to last longer than anything I experienced before, but they were so sporadic, sometimes only coming every 20 minutes, that I began to second-guess myself. I had all these people staying home to help me, but it began to feel like overkill. Oliver was happy to have so much attention, though, and I started to pack and do a few things around the house to keep my mind off the contractions and be prepared just in case this was the real deal.

By ten o'clock that morning, the contractions were so strong that I wanted to do nothing more than be able to lie in bed when one occurred. Chris put my laptop next to me in bed, opened up an online contraction calculator and convinced me it was time to start tracking them. Whereas only an hour earlier I had confided in Chris that I was worried this was all going to be a false alarm, after just a half an hour of laying quietly and tracking, I realized the contractions were coming five minutes apart for 60 seconds each. By the time I called Labor and Delivery, the pain in my voice was noticeable to the nurse on the other end who told me it was time to come in.

Nan took Oliver to the park so Chris could pack her car with everything he'd need for a stay with his grandparents, which as I mentioned in an earlier post, was more than I was planning on bringing to the hospital for myself. Since the chaos of trying to pack up might have been stressful for him to watch, I was relieved he wasn't around. But when Nan brought him back to get the last things before taking him back to her house, I couldn't do more than issue a quick goodbye. I wanted to hug him and explain why he was going to stay with Grandma and Grandpa for awhile, but he looked so happy and excited to be hanging out with Grandma, that I didn't want to make him sad by bursting into tears, which I was on the verge of doing if they didn't make what thankfully was a quick exit. Chris assured me he wasn't crying as they drove off.

The hospital is so close to our house that I was hoping we'd be able to make it there between contractions. One started just as Chris hit a bump in the driveway of the hospital and the pain confirmed that if I had driven myself to the hospital the last time, I clearly had not been very far in the labor process. Yet as I sat in the triage room waiting for a nurse to see me, I wondered if it'd be possible that after shipping Oliver off to his grandparents, rushing to get out the door and lugging our luggage into the hospital, if I'd still be sent back home. The nurse confirmed that I was barely three centimeters dilated. But my contractions were frequent and they'd admit me regardless because I was 41 weeks and they don't take chances at that point.

An epidural had always been part of my labor plan and I felt like I was in enough pain to warrant one. Since I'd be confined to bed, the nurse encouraged me to walk as much as possible first. I never felt like the walking was doing me any good. Just like at home, I wanted to collapse into bed when a contraction came on, but in the long, empty hospital corridors, there wasn't even a railing to lean against. I eventually retreated back to my room and the anesthesiologist was on his way.

Have you ever read up on what an epidural entails? It sounds horrid, but knowing the relief it would bring, I was ready to get the process over with. I felt relief once the epidural was in. Psychological relief, that is. I was anxious about the procedure, but thought that once the pain was gone, the end of my pregnancy would be in clear sight.

Except the pain didn't go away. And so started one of the most frustrating parts of my labor - feeling like not enough was done to help me manage pain. I told the nurse I was barely feeling any relief, but she just told me it takes a certain amount of time for the medication to take full effect. But since I'd had an epidural before, I knew that although it can take 15-20 minutes for full relief, you can feel the progress towards full pain relief during that time. After telling me I needed to give it more time, she disappeared for awhile. After about an hour, she finally called the anesthesiologist in again when I insisted it wasn't working AT ALL.

A new doctor came in and told me he'd have to redo the epidural (versus putting additional medications into the catheter already inserted in my spine). This news made me panic - the fear of the needle hitting another nerve and sending shooting pain down my right leg was still too fresh in my mind from the first attempt. But he was quick and I could already feel relief with the first contraction. It was annoying to have my whole lower body immobilized and feel that tingling feeling in my legs and feet like they had fallen asleep. But the complete relief of pain is exactly what I remember from my labor with Oliver and made the discomfort/pain of putting in the epidural worth it.

With an effective epidural, I could finally relax. I may have even dozed off. I felt like I was able to conserve my strength for what was turning into a long labor. I chatted calmly with Chris and even made some phone calls. When I could feel the epidural start to wear off, just as it had during my labor with Oliver, I didn't panic. This time I had a button I could push to self-administer more pain medication. At worst, I thought, the anesthesiologist would be called back in, like he had been during my labor with Oliver. The next possible scenario was being told I was too far along for the anesthesiologist to come in time.

I never thought the epidural would stop working and they just wouldn't try again. When discomfort started to turn into pain, I pushed the button, but the pain only grew more intense. While a friendly enough person, the nurse didn't offer me any other comfort or advice other than to keep pushing the button to administer more pain medication, which I could only do every 20 minutes and did so to no avail for over two hours. As I sobbed during each contraction, little emotion registered with her. I thought, how could she have a patient lying right next to her moaning and crying and not do anything?

At 9:00 p.m. I was only six centimeters dilated, at 10:00 p.m., seven, and at 11:00 p.m., eight. At that rate, I'd start pushing at 1:00 a.m., 24 hours after I'd last woken up after a partial night's sleep, and then could still have another two or three hours of pushing before the baby came out, or not. I had pushed for over two hours with Oliver with little progress and after four attempts with the vacuum, it was clear he was not going to come out. I feared the same scenario repeating itself.

Although I knew the likelihood of a successful VBAC wasn't very high, I never thought I'd feel a sense of failure. I assumed it'd be obvious that a c-section was the only option and therefore would have just felt disappointment that a vaginal birth wasn't going to work out. I didn't think I'd be in a position where I felt like not enough was tried and the OB on call and the nurse had written me off as a c-section. I never thought I'd ask for a c-section because I couldn't imagine enduring such pain. I really felt like I was giving up.

I only held on as long as I did because I knew a nurse shift change would be occurring around 11:00 p.m. Not a lot was going to change the situation at that point, but maybe the next nurse would show more compassion and make me feel better or offer a different perspective on my options. But I'd had enough by that point. The anesthesiologist hadn't come back in and just told the nurse to prop my bed up a bit more with the theory that gravity would help get the medications in my body where they needed to go to be effective. (Didn't work.) The OB did appear in my room, but just long enough to say there was nothing more they could do for my pain, and then he walked out.

By the time I signed the paperwork consenting to the c-section, I had cried enough over my sense of failure and was feeling instead anxious, but almost excited, about what was finally going to be the impending birth of our son. A small group from the OR appeared in my room to prep me there for surgery and they were kind and reassuring.

Because the epidural hadn't been working for me, the fourth anesthesiologist to be involved in my care that night, wanted to do a spinal, (yet enough needle in my back) which was considered quicker and more reliable than an epidural. If that didn't work, they'd have to put me under. The spinal did work, and despite the epidural not working in the spot where it had needed to, it had numbed other parts of my body, because I didn't feel anything when they administered the spinal.

I know a side effect of anesthesia is nausea, but luckily a friend had told me the story of how she'd thrown up during her c-section. When I felt a mild, but sudden nausea, I said something and a small bucket appeared just to the left of my face in time for me to throw up. (Well, since I hadn't eaten anything in 12 hours, it was more dry heaving.) Just then Chris appeared in the OR dressed in scrubs and with my camera over his shoulder. I told him to take pictures of whatever he wanted, but not of me. Not with my tear-stained face and dribbles of vomit/drool coming from my mouth.

I wonder how my labor with Soren affected Chris. He was pretty much helpless to do anything about my pain and second worse to being in pain is to watch someone you love be in pain. I think perhaps he focuses instead on the miracle that had happened. He told me later how he thinks Oliver is the greatest, how he loved our family of three and how suddenly we were four. Having a new baby, no matter how he was delivered into this world, is the coolest thing ever, he thought.

The mood in the operating room was jovial. It wasn't a somber occasion full of regret because of how the baby was going to be delivered. A baby was about to be born and that was something to celebrate. Right after Soren let out his first cries, the OB started the room full of staff in singing Happy Birthday. And a happy birthday it was indeed.

TOLAC discussion

Because of the type of incision made during c-sections performed a generation ago, for women of my mom's generation, it was "once a c-section, always a c-section." I still encounter this assumption among older women (and men) who learn that I had a c-section with Oliver. They want to know my c-section date instead of my due date. I end up with a lot of explaining to do.

Thanks to a change in the way a c-section is performed, which automatically makes a future vaginal labor a safer and thus more realistic possibility, (the incision is now made horizontally across the uterus instead of vertically, which would likely cause a uterine rupture during a future trial of labor) as well as a better understanding in the medical community of the risks and benefits of vaginal births after cesareans, vaginal births for women who've had a previous c-section are now a supported option. (Not all doctors want to or are allowed to perform them, but that's a different matter.) Thus, many people nowadays have heard the term VBAC, (vaginal birth after cesarean) but the more accurate term is TOLAC(trial of labor after cesarean).

Even though my former OB estimated my chances at a successful VBAC as 50/50, when I became pregnant with my second child, it was really important to me to find an OB who was allowed to perform VBACs and would discuss my delivery options with me. (This was the case with my former OB, but I moved and needed to find someone closer to my new home.) I wanted to make the best decision for myself, even if that decision was to be a planned, repeat c-section.

It was a frustrating process in the beginning, as I had to start with a list of in-network providers from my insurance company and literally start calling around. The midwife I see for preventative care was clearly out, as was virtually every midwife, so luckily I was never interested in a home birth or birth center delivery. My only real option was under the care of a obstetrician, but I discovered that many simply will not (or cannot) consider TOLACs, no matter what my medical history. (Based on a variety of factors, some women are better "candidates" for a successful VBAC than others.)

I eventually found a new OB, whose mentor during residency happened to be my former OB, and whose practice is housed in the hospital less than two miles from my house where I plan to deliver. Even though I still had no idea whether I actually wanted to pursue a TOLAC, at least my more limited options going into this second pregnancy remained open.

Some people (again, older generation) don't understand why having the choice is such a big deal. Why don't people listen to doctors anymore and just do what they say, I was asked? I do trust doctors and rely on their medical advice that's based on years of education and training. But in medicine, even with hard data, there's not always a right or wrong answer. There are different risks and benefits associated with every course of action and patients need to take the information from their doctors and decide what's best for them. Sometimes the decision is simple, like deciding between a prevenative measure versus a wait-and-see approach for a non-life-treatening or non-debilitating condition, while others, like cancer treatments, could make patients decide between a comfortable end of life or a risky treatment with little chance of success.

In my case, I am listening to my doctor. She would have told me if she thought there were too many risks associated with a TOLAC. Instead, in her medical opinion, it would be fine for me to have a c-section (after 39 weeks), schedule a c-section, but see if I go into labor, or pursue a TOLAC, even if the result is hours of pushing and then an unplanned c-section. The risks of surgery, the risks of labor, the benefits to the baby of laboring, the benefits of waiting for the baby/my body to induce labor - they're all a wash. She's very supportive of TOLACs, even when the result will most likely be a c-section and she concurs with my concern about the risks of repeat c-sections, given that Chris and I possibly want to have more kids. Instead, I've got to decide between the 50/50 odds of delivering vaginally and avoiding the pain, recovery and complications of surgery, the likely scenario of having a labor similar to Oliver's (hours of pushing, but unable to deliver the baby, resulting in an unplanned c-section) or planning for a c-section, knowing that while it's still surgery, the complications and recovery time are reduced. There are a myriad of other factors - personal, medical and logistical - that point me simultanously at all three options. Right now I'm in an indecisive, wait-and-see mode and hoping I come to terms with not the right decision, because there is none, but the better decision.