When I was in week 34 of my pregnancy, I was working part-time at a preschool (9am-1:00 pm each day). I had a commute and prep time before class started so I was waking up at 7 am. I'm not a morning person (if you ever notice when most of my blog entries are posted you'll know that I'm a night owl). I was constantly tired in my pregnancy. I'd get home from work and have to take a long nap each afternoon just so I could function the next day. One day, I had to rush away from work for a prenatal appointment, but that day had already been a struggle. I was fighting nausea the whole day (strange for the third trimester) and had thrown up 3 times, once as I was getting into the car to head to the appointment. Already feeling tired and sick, I encountered unexpected traffic which was making me late to the appointment. I generally get very stressed when I am late to something so the combination of being impatient, stressed sick and tired was not going well for that appointment. I then parked rather far away from the clinic and had to walk (more like jog since I was worried about being so late).
That sets the stage for what happened at the appointment. In typical technocratic style, once checked in, I was weighed, pee collected in a cup, blood pressure assessed. Would anyone like to guess what my blood pressure was after my previous hour?
The midwife comes in and goes over the results of the glucose intolerance test from the previous appointment. The values were higher than normal prompting a discussion regarding gestational diabetes.
As an aside, I knew the results were going to be skewed because I was unable to handle the glucola being the only nutrition in my body at the time. Rather than sweating it out since I felt very close to passing out, I snacked on my ever handy blood sugar stabilizing snacks I carried around with me. The good news is that I didn't pass out on the way to the lab, the bad news is the false result on the test.
It already was not a good day to hear news like that, coupled with the way the midwife said it. She seemed very unaware to my stress level and was not sensitive to how concerned I was regarding the way in which she stated it and my frustration with her for not consenting to the 3 hour fasting test as a follow-up. If I had had such a negative reaction to the 1 hour test, having eaten lunch just before that appointment, how in the world would I cope with a overnight, drink the glucola on an empty stomach after waking up even earlier than usual and then waiting 3 hours test?
So after that conversation, the midwife plunged right into, "...and your blood pressure measurement from earlier indicated that you have pregnancy induced hypertension." If you have a copy of William's Obstetrics handy, or any other prenatal care textbook nearby, you'll find that the minimum criteria for a diagnosis of PIH is a diastolic value of over 90. In the same paragraph in William's it states that some practitioners like to make the diagnosis when a woman's diastolic is elevated 15 points above her baseline, which would have been true in my case, but if one were to continue reading, one would see that William's states that is not a recommended procedure for diagnosis.
I was visibly upset by this time at the appointment and receiving no assurances, compassion or comfort from the midwife who was speaking to me. I called my husband and in tears told him what was happening. He at the time had been having a conversation with his advisor and when he heard my husband say, after looking at his phone, "Oh. Its a number from the medical center. It must be Jenne probably calling from her prenatal appointment right now," said, "That means something is wrong. Go. Now."
He ran over to the clinic (on campus) and we sat down with the midwife. My husband was surprised at how the midwife was handling the situation because based on what she was telling him, he didn't see that she was making a reasonable assessment. She counseled that I go on immediate bedrest and cut salt out of my diet entirely. Although we were not entirely trusting her judgement, we decided that bedrest was better safe than sorry. We spent the next week trying to get a better sense of the risks of PIH (by this time they had dropped the concern of GD) and we couldn't get a better sense of their concerns based on the information they had given us. We consulted with a number of the midwives and nurse's assistants on staff and we basically got, "PIH can lead to preeclampsia and preeclampsia can mean that the baby dies and the mother can stroke out and die."
We did our own homework and read up on what we were being told, and it didn't add up. I still stayed on bed rest and attended the non-stress test appointments that were scheduled twice weekly. But we knew that what was happening was not as serious as they made it out to be.
A couple of weeks later, at an appointment with another midwife in the practice, I was told, "In all my 20 years of being midwife, I've never see a woman with blood pressure like yours go into labor on her own without being induced." Not only does that say something about her practice style, it also says something about her knowledge.
Up until this point, in my prenatal care, I had tried on a number of occasions to discuss with the midwives policies relating to the birth. Each time I had been told that we would discuss it later. I had never had a satisfactory discussion about my desire to have an unmedicated birth using Hypnobirthing. The midwives did not seem interested in discussing it.
Now at this appointment where I'm being told, they'll basically pressure me into an induction whether I like it or not or whether its indicated or not, I felt like I needed to run away from that practice. But I was 35 weeks pregnant with my first baby, living in a big city that I wasn't familiar with having moved there less than 6 months before, and not very knowledgeable regarding birth options. I thought, if a midwifery practice is going to be this unpleasant to work with, how could working with an OB be any better? We considered and discussed transferring over care to the OBs in the practice, but I was scared of the medical mindset. I wanted midwifery care, but didn't know enough and felt that I didn't have even time to find out about out of hospital options.
So I stayed, like a domestic abuse victim in a violent, toxic relationship.
A friend volunteered to be my doula to help protect me from the unwanted advances of the hospital staff. Having made those arrangements, I told myself that I would hope for the best and pray that labor started on its own before the threat of induction became more real.
In week 37, after 3 weeks on bedrest, and having made it to "full-term" I asked my husband what the soonest time would be okay with his schedule as a first year graduate student for the baby to be born. He said that after Thursday Jan 25 all his tests would be done and that weekend would be an okay time.
Bedrest was, in some sense, a blessing. At the time I was enrolled in my M.Ed program and I had work to do. I spent the month of bedrest doing assignments and getting started on my thesis. It was helpful. But the drawbacks were also considerable. I felt myself getting weaker the longer I stayed inactive and immobile. I'm pretty sure the baby moved into an unfavorable position and further exacerbated the scoliosis in my spine. I started getting headaches and being dizzy, which just made the midwives want to say I told you so since those are indication of progressing preeclampsia, but its also a sign of weakness as a result of inactivity and a lack of salt in the diet. I believe these factors contributed to the long labor (38 hours) as well as the hours of back labor (17 hours worth). Add that to being a first time mom, going into labor earlier than it would have likely been otherwise at 38 weeks, its not surprising that I had a long early labor. It would have been very helpful to know of Ina May Gaskin's teachings for husbands and wives to; as she calls it, "cuddle and smooch" during labor.
We made it to that Thursday, and we decided that we would try out the strategy of starting labor via intercourse and what I've jokingly heard referred to as "prostaglandin application." And then we prayed. We prayed that labor would start and the baby would come, so that we would be protected from the providers that at this point we did not feel safe with. We then fell asleep and I was woken up 4 hours later by menstrual-like cramps coming every 15 minutes.
I let Peter sleep but I couldn't. I was so excited and so relieved that labor had started on its own. At six am, I couldn't keep my excitement to myself anymore and I woke Peter up. We talked, we were happy and we decided that it was just be stupid to go to the hospital at that point because we knew for sure that we were going to avoid going to the hospital too early. We then discussed if I should go to the scheduled non-stress test at 11 am. We decided to keep the appointment, if not to avoid the within 24 hour cancelation fee. But before, I wanted a big breakfast. So like a runner getting ready for a marathon, we went to IHOP and I throughly enjoyed my breakfast feeling exhilarated that not only had I thwarted the mid-witch, I was going to meet my baby.
At the appointment, we knew it was too early to go to the hospital, even though I had been contracting for close to 11 hours at that point (still 6-10, sometimes 15 minutes apart, easy to manage). The NST showed that I was having irregular contractions and my cervix was dilated 3 centimeters. We were surprised when the midwife at the clinic called up the Labor and Delivery and told us that we would be checking in. I thought it was still too early, but went with the recommendation.
Then we enter what I call the flight pattern period of my labor. Labor and Delivery said they were full, they could take me so I should go home. At home, I got a visit from my visiting teachers--they thought it was very strange that I was in labor and welcoming them over and how calm I was dealing with it, but it was early labor and it was easy to handle. After calling and checking with Labor and Delivery a couple of times, they were still busy. So I waited. All I wanted to do at that point was to go into my labor space and focus, turn inward--what I called at the time "holing-up." I couldn't do that at home knowing that I'd have to leave. (This is about the time that homebirth started sounding appealing but completely out of the question since it would have been completely unplanned). We went out to lunch, basically tried to distract ourselves and stay near by the house and the hospital in case we got the call saying we could come in.
At 4 pm, we were finally able to get into Labor and Delivery. No progress. Contractions still 6-10 minutes apart. Hourly vaginal examines commence. We walk the halls of the hospital. At the gift shop, we find a mini set of bowling pins with a marble to "bowl" with. We buy it in celebration of the anniversary of the day we met three years to the day before at the bowling alley in the BYU student services center. Looking back, we should have just gone to the bowling alley and bowled through early labor.
At 9pm, 1/2 centimeter progress and the midwife starts talking options. She offers 1) send me home with an Ambien to sleep, 2) give me morphine, move me to another room in the hospital (not L&D) and make sure I'm sleeping or 3) pitocin augmentation and breaking water.
Is this starting to sound like a phenomenon that you've heard of before?
As I sat on a birth bath and handle contractions as they come, we refused, refused, refused. My husband tried to talk to them but they refuse to talk with anyone other than me. We countered with, sure, its reasonable to clear the LDR room for another mother in labor, but we'd refuse the morphine and go to another room to let labor progress on its own. Its surprising how hostile the midwife was to that. The room was only offered if I accepted medicinal sedation. At the time, that felt so dehumanizing. Like I was being viewed as a dying horse that needed to be take out back and shot to be put out of its misery. Or that she wanted to make me the hospital's prisoner, but instead of using shackles, she was going to use drugs (hello, 24's use of medical torture?) An OB was called in and we were told, "You have no more options. Its time for you to leave. Get out."
As we pack up and get ready to leave, we look for a nurse, or a midwife or the receptionist at the check-in test to find out when they would like us to call back or at what point to return, and there's no one around. So we leave, feeling neglected and confused.
Go figure, that once at home, labor picks up pretty quickly and intensely. I started having a hard time finding a comfortable position. I could lay down comfortably and I had been upright for so long that my legs were tired. I started having back labor and it was difficult to support myself on the birth ball. My husband and doula tried to get some sleep. They gave up pretty quickly and then helped me into the bathtub. The water was too shallow, and not hot enough, the tub walls hard and uncomfortable. So I lay hurting, cold and shivering. I start to get frustrated and despondent. I call L&D and I'm told that I can come back in and get checked for progress but I might be turned away again. I'm gun-shy at this point and I'm too afraid to go back in, too upset with the insensitive way I was treated earlier, knowing that the same midwife would still be on the shift. I found that she was going to get off shift at 8 am, so I became determined to stick it out.
We get to the hospital at 8am and she's still there. She does the triage exam which I've blocked from my memory. All I remember from that is spots of blood on the floor of the triage room that did not belong to me.
That's a good point to stop and refer you to birth story that I wrote soon after Willem was born, and have edited slightly since then.
In the next few days, I'll post regarding some insights I've learned since experiencing this.