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...


45 Comments:

Blogger Ms. SuperScience said...

Congratulations, he is beautiful!!

L & D sounds like a rough time of it, though... you definitely did what was best for both of you with the section, which is what mothering is all about.

Now, go snuggle that cutie-pie!

11:12 PM

 
Anonymous whitecap nurse said...

Oh - he's beautiful - what a wonderful picture. Your birth story sounds very similar to mine: 42 weeks, lots of pushing with no progress and finally a C-section. No wonder you're exhausted - you went through all that labor and then surgery! For years, I was disappointed that I didn't get to do the whole vaginal delivery thing - but trust me, you'll get over it. The most important thing is that you are OK and your baby is healthy.

12:07 AM

 
Anonymous CarrieWannaBePA said...

Dr. Couz, he's adorable! Congrats. =)

1:38 AM

 
Blogger DrShroom said...

Congrats.

And he is beautiful...

3:33 AM

 
Anonymous Anonymous said...

Congratulations, what a beautiful baby!

9:51 AM

 
Blogger Jenny said...

Congrats on your beautiful little guy! I'm sorry you didn't get the birth that you wanted. :/ And a pat on the back to Mr. Couz, who deserves it for being such a good support person for you.

12:46 PM

 
Anonymous Anonymous said...

Hooray, you're back! I was really hoping that it was 'just' the usual postpartum exhaustion etc. keeping you from posting and that you and Bean were all ok!

And what a beautiful boy! Congratulations!

Do hang in there -- I had a rough time coming to terms with the circumstances of my daughter's birth (induction, epidural, no section, but baby in the NICU with GBS sepsis). Luckily she recovered completely. I was really disappointed in myself and felt like I should have done things better or differently, but eventually I figured out that things had gone how they had gone and that it hadn't really been under my control or up to me. Getting out of the period of postpartum hormone milieu also made a huge difference.

I'm sorry things didn't go the way you'd hoped or planned, but it sounds like you made all the right decisions given the circumstances to end up with you and Bean in the best shape possible. Best wishes for continued recovery and great enjoyment of your handsome little man! How amazing that in 42 weeks you made a whole human person!

2:25 PM

 
Blogger scalpel said...

Awwww, he's adorable. Congratulations.

6:02 PM

 
Blogger med neophyte said...

So bright eyed!
Congratulations! It is great to hear that everything is okay, if not quite as you hoped.

6:05 PM

 
Anonymous medrecgal said...

He's awfully cute, Dr. Couz! Glad to know that after all of that, you're both OK.

7:44 PM

 
Anonymous Anonymous said...

Congrats Dr Couz!
I am so glad to read that nothing beats new mom exhaustion. I thought it was just me.

9:40 PM

 
Anonymous Anonymous said...

I've been wondering when you'd post, but knew you must be busy with your little bean! He's adorable! Very cute :D

Sorry you didn't get the birth experience that you wanted...but it looks like the end result was worth it :D

11:56 PM

 
Blogger JeanMac said...

He is beautiful! thanks for updating - I was checking in regularly!

12:34 AM

 
Blogger isles said...

Oh, Dr. Couz! That is one of the cutest babies I have ever seen. Enjoy him now and always!

1:41 AM

 
Blogger MedStudentGod (MSG) said...

Couz,

I'm glad that you're recovering. What an experience! I for one am quite glad that you gave us an update - I was getting worried about you and the lil one. I'm glad that your husband was there with you and provided lots of support - I've seen one too many guys just get out of the way and not be involved at all in their kids birth.

The Bean is a beautiful baby! Adorable.

7:33 AM

 
Blogger Xavier Emmanuelle said...

Awwww... he's adorable! Congratulations!

12:44 PM

 
Anonymous Anonymous said...

Oh, is he ever cute!!!

I can relate...I had 12 hours of back labour, contractions 1.5 to 2 minutes apart, each lasting for one minute (all for 12 fun filled hours) only to end up with a section as well...it took a while to come to terms with it and deal with the feelings that I had failed but it's all good now. When I look at him (and his brother), I don't feel at all like I've failed.

Get rest (ya, right!!) and enjoy your new baby!

1:50 PM

 
Blogger Joy said...

He is a beautiful baby! What bright eyes and perfect little round head. I'm so glad to hear you're both doing well... well as can be expected given that you just had him anyway!

4:42 PM

 
Blogger Jen&Brent said...

Congrats on making it through what sounds like a very tiring delivery. He's absolutley gorgeous! Best wishes for your recovery.

7:08 PM

 
Blogger Tiny Shrink said...

Congratulations on a beautiful healthy son! I wish you a speedy recovery from your ordeal. I'm glad the "healthy Bean, healthy Couz" requirements were met, but I'm sorry it was so rough. Thanks for the update!

3:55 PM

 
Blogger adventures in disaster said...

I have only one suggestion and depending on your taste it could be awful or great. After my daughter was born emergent section after 39 hours failed labour (3cm) and one arrest (me)..yup I couldn't resist after getting pit bolus right at the same time I got epidural bolus right at the same time I vomited and vagaled right on out..heh
Like you I was still throwing up in OR and I did throw up on my gas man..well I got most of it on his BOOK...I too bled and couldn't tolerate the iron pills. I was told to drink stout ale..the dark, thick beer like drink of the English. It has a ton of iron and the benefit of bringing your milk on like crazy.
I hated the taste but I made it a bit of a project every day for two weeks.
I can honestly say after three days I felt stronger, less tired.
My OB was the guy who recommended it and I can say it helped.

1:16 AM

 
Anonymous Anonymous said...

Back labor HURTS! Labor and delivery never quite goes the way you expect. It is disappointing today, but trust me: It is what you do with that beatiful bean now that you have him and for the next 18 years that matters.

Read to him as much as you can.

Welcome to the mom's club.

3:50 PM

 
Blogger frylime said...

yay for mom and baby!

7:26 PM

 
Anonymous mamakay said...

Congratulations!

I'm glad you guys are ok. Sorry everything went so crappy at the time.

1:54 PM

 
Blogger Danielle said...

Congrats on your beautiful Bean!

7:25 PM

 
Blogger betsy said...

Congratulations! Bean is beautiful. Thanks for updating us.

9:34 PM

 
Blogger Sandra Miller said...

Congratulations!

Your little one is absolutely adorable.

On your feelings about the birth:

It's hard when things don't go the way you imagined they would.

But please remember-- you prepared well.

A baby in a funky position throws a huge monkey-wrench into the best laid birth plans.

Enjoy that beautiful little Bean!

12:09 PM

 
Anonymous Anonymous said...

Congratulations!!

6:13 PM

 
Blogger emergencyem said...

Very cute! Congrats!

1:36 PM

 
Blogger DrWes said...

Damn, you make good Beans!

Well done. Now rest and relax, will ya?

11:22 PM

 
Blogger Lisa said...

I'm so glad you checked in, lots of us were worried.

He is drop-dead gorgeous! Congratulations to you & your husband. :)

I had terrible panic attacks during labor for my youngest daughter. No one, and I mean no one, would tell me if they would knock me out completely if I consented to the c-section so I labored for 53 hours. I know how it feels to feel let down by how things happen during birth. But as long as everyone makes it through healthy, in the end that is all that matters. Don't beat yourself up. (((hug)))

Don't be a stranger and, for goodness sake's, nap when he does. Pure salvation, that. :)

10:49 PM

 
Blogger Midwife with a Knife said...

Congratulations!!! I'm glad that despite having the worst of both worlds (long labor followed by a C-section), you and the bean are both doing well. He's beautiful, by the way. :)

3:05 PM

 
Blogger ditzydoctor said...

awwww such a cutie! and lovely red hair! :) what an experience. mothers do really suffer for their children!

11:27 AM

 
Blogger Nawaz ALi Lakho said...

This comment has been removed by a blog administrator.

11:03 AM

 
Blogger Irene said...

Dr -
Congrats, he is lovely. I am a new reader, but love seeing you are a mom, as I am a single mom of a 2 year old in my last year of med school and getting ready to pick out residency programs. I am torn between ER and FP, so thank you for writing about ER. I look forward to your stories in the future.

5:08 PM

 
Blogger AtYourCervix said...

Aww! He's so cute! Just wanna nuzzle against that soft skin and breathe in his newborn goodness. Oh, how I miss those newborn days of my children.

I'm sorry that you felt so out of it at your son's birth. It's certainly not easy for you to have gone through all of that time in labor, only to have a c-section at the end. I hope you heal physically as well as mentally.

12:50 PM

 
Blogger Christy said...

Congrats to you all! He is beautiful.

6:31 PM

 
Anonymous Vorbau said...

Dr C -

Your experience sounds nearly identical to mine 16 years ago - 10 days post dates, PROM, pre-eclampsia, edema 2+, hypertension, followed by 36 hours of labor, double Pit, epidural, and finally I was the one arguing for a section - but the docs were great, and said, "well, we wanted to make sure you were able to try everything else first." Turned out The Kid, ornery from the start, was face up, chin hyperextended, and got his chin wedged on my pubic bone. But like you said, healthy child & healthy mom is really what matters.

Interestingly, my midwife (an older Italian lady, working at the Navy hospital where I gave birth) also recommended dark beer, just as Adventures in Disaster was told. I checked with the docs and they said it was OK provided I limited it to 12 oz/day, as I was breastfeeding. It really did help in milk production and getting my Fe counts back up (I can't do oral iron either), it also helped significantly with sleep and pain issues. Guinness not being available in Italy, I opted for a German import.

Best to you and yours!

1:54 PM

 
Blogger Kris said...

Conbratulations Dr. Couz! You probably don't remember me, but I started following your blog on a semi-regular basis back when you posted for while on Coolrunning.com(I was bard73). Your son is absolutely beautiful. I wish all the best to you and your family.

5:21 PM

 
Blogger Randolph said...

I have seen many babies that look as if they were stolen from the primate house at the zoo - - -
Your baby is indeed beautiful! Congratulations!

9:46 AM

 
Blogger Pharmer Jane said...

How are you both doing now?

10:24 PM

 
Anonymous patientanonymous said...

I'm still here but haven't been around in ages...

I'm really glad to hear that you made it through alright...well, apart from feeling kind of sick, throwing up and softball hip.

Okay, I'll shut up now but you did kind of make me laugh. Even though it's not funny.

Take care,
PA

7:59 PM

 
Anonymous Ivory said...

This is late and perhaps not terribly useful but try avoiding sulfated iron and see if that helps. There's some that are conjugated with gycinate and gulconate and I can take them. But the sulfate stuff makes me want to spew.

For what it's worth, I had a similar experience but with 36 hours of labor followed by a c-section. The worst of both worlds - except that baby is fine, and I am fine (one year later) and all is well.

9:02 PM

 
Anonymous discount pharmacy said...

This comment has been removed by a blog administrator.

7:11 AM

 
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