The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Saturday, December 29, 2007

Given Up on Me Yet?

For those die-hard blog fans who are still checking in regularly, I figured I owed you an update. Actually, life has been a blur since the Bean made his appearance. Keeping my blog updated has been pretty much the last thing on my mind. But my uncle (and loyal blog reader) reminded me that I owed it to the people who have stuck around not to drop off the face of the earth. 

So since I have been quite vocal about birth, my fears, my pregnancy and obstetrics in general... here is my birth story. In typical Couz fashion, told with unvarnished honesty. Don't expect eloquence, or even coherence, as no amount of post-call in the world compares to the exhaustion of a new mom.

Here's how I remember it. At 41 weeks and 4 days we arrived at the hospital for my scheduled induction at 8am. There is some debate over elective induction before 42 weeks, but because the due date that I gave my midwives was the latest of all of the due dates I had been given that spanned a 2 week range I was very confident that if anything I was actually further along than estimated. And after being unable to walk for the past few weeks of pregnancy due to hip pain, I was more than ready. When we arrived at L&D I was checked by the OB on call (I had chosen my induction date based largely on the call schedule of an obstetrician that I particularly respected) and was 3 cm dilated. I had been contracting irregularly for the past 3 days, so the OB decided to break my waters and see if that would move things along. I agreed. Easy-peasy-- waters broken, clear, baby doing great, and I was already 80% effaced. The nurse assigned to me predicts that I will give birth before the end of her shift. 

So the contractions got stronger, and I walked in the halls as best I could. I had tested GBS positive a few weeks prior, so I had the company of an IV pole as well as my husband. It was actually handy for leaning on during contractions. They never settled into a regular pattern though, and by noon I was experiencing some hard-core back labour. So they decided to start the Oxytocin drip, and labour got stronger and more intense. I kept forgetting to breathe through contractions because I was just so focused on getting through them. It was frustrating because none of the coping mechanisms that we'd gone over with the midwife were really helping, and every contraction felt like my lower back and pelvic bones were being ripped apart.

By 6pm or so I requested an epidural. 6 hours of augmented back labour was more than enough for me. The anesthesiologist arrived surprisingly quickly, which was a blessing since the first attempt at the epidural didn't work. Apparently I have a very superficial epidural space which confused the anesthetist. Thankfully he suspected it wasn't in the right place and stuck around for 30 minutes until it became clear that it wasn't working and re-did it. I barely felt it at all, either try. By that point I would have gotten a hundred epidurals for the back labour to stop. It eventually did, and I was in a much better mood. Or at least I was in a better mood until I dilated to 8 cm or so and threw up all over my husband more than once as I went through transition. Gah.

The pressure was crazy. Even with the epidural taking the 'sharp' aspect of the pain away, every contraction felt like a giant softball was being wedged against my left hip. I NEVER want to think about that hip now that my pregnancy is over. It was by far the worst part of the whole thing. So now I'm fully dilated, pushing, and coping okay but still having a rough go of it in spite of the epidural. And my stomach was still trying to turn itself inside out every few minutes. Good times. 

By 2am my midwife re-consulted the OB (who had passed my care back to the midwife after my induction was deemed to be progressing appropriately) because I had been pushing hard-core for over 3 hours with little progress to show for it. The Bean seemed to be sitting somewhat transverse (again, that damn head against my left hip) and had no interest in coming past my pubic bone. Not even rocking back and forth. At this point, the Bean was still way too high to consider any other strategy (meaning vacuum or forceps assistance).

At this point things got a little blurry. The OB came in and assessed me, and strongly recommended a c-section. And ironically... I freaked right the f*ck out. For all of my talk about opting for a scheduled elective c-section, I've never had surgery before and the idea scared the hell out of me. Apparently the first thing I said was "I can't have a section... my house has too many stairs!"

I did agree, though. The OB on call was a very conservative one with a low c-section rate, so if she thought that it was indicated I was not about to argue. Thankfully, the Bean had tolerated all of the labour and pushing very well. So since the goal of the whole thing was 'healthy Bean, healthy Couz', off to the section room we went.

The first thing I told the anesthesiologist when we got to the OR was that I thought I was going to throw up again. He said that there wasn't much he could give me that was still safe in pregnancy (since I was going to be pregnant for another 10-15 minutes or so) and that the one thing he could give me would likely make me feel drugged. I don't even remember what it was. But obviously I also realized that throwing up during abdominal surgery wasn't really an option. Unfortunately, I had a really strong reaction to that med and don't really remember much but hazy bits and pieces until sometime the next morning. Which really sucks, because I missed my own son's birth. But Mr. Couz was there the whole time, and was a total rock. I love that man.

Such was the way that The Bean came into the world. Weighing in at 8 lbs, 4 oz with APGAR's of 8 and 9. Just needed a little oxygen at birth to get going, and was fine after that. It was a little surprising that he was so big, considering that both my family and Mr. Couz's families tended to make small babies and everyone was expecting a wee thing. Guess he dropped so early he had everyone fooled. 

Recovery has been a lot more difficult that I expected. The pain was manageable, but I bled so much during surgery that my post-op hemoglobin was only 70. Plus, it took quite a bit of time for my milk to come in which cause the Bean to be pretty jaundiced (although he didn't require phototherapy, thankfully) and to lose over 10% of his birth weight by the time we were discharged on post-op day 4. And of course, I grossly underestimated how much time I'd be in hospital-- I expected to stay between 4-12 hours post-partum, depending on whether or not I got an epidural. Instead I came in on a Saturday morning and didn't leave until Tuesday night. And for all my talk about elective sections it never seriously occurred to me that I'd need one. I felt frustrated by the way it went down-- after 18 hours of labour the fact that I needed a section anyway felt like a failure. I still haven't figured out how I feel about all of it. But I am very disappointed with the fact that the only bits and pieces of The Bean's birth that I can recall feel like I'm trying to look through a heavy fog. I hate feeling drugged. This was my first experience on the other side of the health care system, and that was interesting. There will definitely be further reflection on that in the future. 

So in the three weeks or so since giving birth I've been focused on recovering (more difficult when you can't tolerate oral iron) and getting to know my little Bean. He's beautiful, but don't take my word for it...