I tried to sleep but I just couldn’t…I was too nervous/excited and the nurse was coming in every two hours to check my vitals and up the pitocin. Plus, it’s not very comfortable to sleep with the monitors on your belly and hooked up to an IV, and then having to get up every bit to pee because of the IV. I highly recommend avoiding all of those things if you can.
At about 4 in the morning a nurse came in and informed me she was turning off the pitocin. She was one of those control freak nurses who doesn’t like patients asking questions. “Why?” I asked. “Your baby is having trouble.” “What do you mean?” “He’s having problems.” “What KIND of problems?” “Decels.” “Variable or late decels?” “Late.” “How often?” “With every contraction.” I finally got her to explain that the doctor wanted to give the baby a break from the pitocin to see if the decels resolved themselves and to, I think, regain the variability in his heart rate, which is an indicator of how well the baby can cope with these kinds of contractions. I woke up Mark, filled him in, and he went and get our doula. At this point I only had 4 units of pitocin, at 1 unit every 2 hours. I could feel contractions, but just barely. Late decels with this little medication was not a good sign. I had been worried about this scenario because I’d noticed that baby Smudge had had some issues with good variability off and on for weeks. Sometimes it would take an hour to get his heart rate to go up enough to pass the NST.
I changed position some, and then I think Mark, our doula, and I decided I should get some sleep. Around 6:00 I was informed that the baby was still having decels, even though the stop of pitocin had basically stopped my labor. I guess these were variable decels; I couldn’t see the monitor from my bed. I tried changing positions again. If it had been a cord issue, the changing of positions should have helped stop the decels.
About 8 or 9:00 in the morning the OB on call and her resident came in to talk with me. The decels had finally stopped, but she wasn’t willing to put me back on pitocin yet. If I wanted to wait a few hours and see if the baby went all that time without any decelerations, maybe they could try the pit again, but she wasn’t confident that Smudge would tolerate it any better given how he looked on the monitor for several hours afterwards. The other option of course was a c-section, which the doctor felt was necessary. Going home was not going to happen.
I had suspected this was coming, and had just sent Mark home to get himself more insulin, thinking the doctors wouldn’t come by till later in the morning and that way he wouldn’t have to leave while I was in recovery. The way I saw it, it was either c-section now or put the baby through more stress and have a c-section later, possibly an emergency one that would necessitate general anesthesia, since I had no epidural in. My doula and I had spent the time from 6 till now trying to think of other options, but this was looking like a case where a c-section was actually warranted, depressing to me as that was. Consenting to the c-section now, as opposed to an emergency situation, would allow me more control over the situation, something I did not have at all when I had the Menininho.
The doctor didn’t want to waste any time: she was ready to do the c-section then. I convinced her to wait until Mark got back. In the meanwhile I showered and went over my birth plan with the doctors: I wanted to be kept abreast of what they were doing, I wanted to hold my son in my arms before they took him away, and if possible I wanted delayed cord clamping for a few moments, all of which they agreed to (though Mark said they didn’t actually delay the clamping).
However, then the resident started in on me about getting my tubes tied. I understand that this is a normal question to be asked if you’re having a c-section, but this was at least the 6th time I’d been asked. She got frustrated that I wouldn’t agree to one (having Marfan, I avoid unnecessary surgeries) and demanded to know a date for my husband’s vasectomy. Then she wanted to insert an IUD, which I again refused to. This went on for several minutes. It was incredibly degrading and even my doula was upset by it! There have been many times during this pregnancy when doctors have made comments about me not having any other children, from the first prenatal appointment onward. Several of these doctors didn’t know me or my case at all, just my diagnosis, so the belief that I should not have any more children was based solely on the fact that I have a disability. Ugh.
Aaaaanyway, then I met with the anesthesiology resident to discuss my spinal catheter. I really didn’t like her at first. She called the attending while in the room with me and said “Yah, I’m here with Mrs. Zimmerman. Yah, her baby was having decels earlier but he’s fine now, but she wants a c-section,” then left the room. I looked at my doula and said “WHAT?! It’s my understanding this is not an elective c-section” and she agreed with me. I think this was just an example of a resident not knowing all the information, but it was unsettling. When she came back with the attending I asked the attending to be the one to do the spinal cath insertion, because I thought he’d be better at dealing with it (dural ectasia makes doing a spinal cath difficult). I felt bad because I could tell the resident was insulted. After the 3 of us discussed it further I decided she could do it after all because neither doctor has experience with d/e and she does several a day, whereas the attendant does about 1 a month.
Finally, it was time to go. I got suited up in my compression stockings, Mark put on his “outfit,” and I walked to the OR.
They wouldn’t allow our doula to be in the OR with me at all, which was definitely upsetting, but they did let Mark hold my hands while I had the spinal catheter put in. I am still surprised at how peaceful I was the entire time. I cried a bit after I got the reglan for nausea and it made me sick and I began to worry that I’d pass out on the table, but other than that I was very calm. The surgery itself felt really odd, and I’m pretty sure the resident made a mistake at one point, judging on some things the attending said, but she fixed whatever it was. The attending anesthesiologist explained everything as it happened, and offered to lower the curtain so that Mark and I could watch our son being born. I surprised myself and declined, but Mark stood up and peered over. I cried when I heard his first cries and never wanted to let him go when they handed me him all swaddled up.
After Mark and Baby J left, the attending OB had a few words for me. She said she believed there was a problem with my placenta and offered to send it to the lab so I could maybe have some closure as to why Baby J was in distress. I hope to have results in a few weeks. She also told me that my uterus was extremely thin at the previous incision site, such that she thought it was a very good thing I’d had the c-section…“you made the right choice,” she’d said. (Again…I didn’t feel like there was a real choice.) She told me that she was trying to strengthen up the site in case I should ever have a 3rd pregnancy and want to try for a VBA2C.
Shortly thereafter, Mark, Baby J, and I were reunited in the recovery room. I was able to nurse him right away. Overall the c-section and recovery experience this time around was a million times better than it was when I had the Menininho. I’m still trying to process all my feelings about having a second surgery, but I am very glad to finally have Baby J here and any sad feelings about how he got here don’t take away from that.