natural (prodromal) labor -> cesarean birth (malpositioned baby)

My baby is over 4 months now, but I just found this board and thought I'd share my experience.  I had a 6 (yes SIX) day prodromal labor - I wish I had known it was possible before I was in it because it was the most frustrating thing not knowing what was going on... so here's my story:

 Baby girl was due July 13.  On June 30th, my BH contractions were occasionally more intense, leaving me wondering if they were more than BH - I also lost a big chunk of my mucus plug that day.  The next day I had my 39 week appointment and my doctor said I was 1cm and 75% effaced, which we all know doesn't mean much.  She seemed to think, though, that with the contractions and loss of MP, I'd have the baby sooner than later.  We went over my requests for my birth, which she said I was "the perfect candidate" for - I wanted as natural/intervention-free as possible, no IV, no epi, allowed to move around, limited monitoring, shower, etc. I had prepared through prenatal yoga (I also teach "regular" yoga), natural birthing classes, talking with doulas and others who went med-free and lots of reading.

The afternoon after that appointment my contractions started to get stronger.  Nothing too alarming, but noticeably different than BH - I'd have to stop talking, but they weren't terribly painful.  I think I was so excited to finally be in the labor process that I actually didn't mind. They continued about 2-3 an hour all day and woke me up a few times during the night.

The contractions continued for the next 3 days (July 2-4th), increasing in intensity, but irregular in time.  They would get as close as 6 minutes apart for a while, then go back to 15-20 minutes apart.  This lasted all day and ALL NIGHT, too, I did not get a break at all. I called my doctor on Sunday, July 3rd and that's when she told me that "sometimes this happens" and I seemed to be "stuck in prodromal labor".  It could last a few hours, few days, few WEEKS, but usually people would get a break from it, I however, did not.  

After a very difficult day on 4th of July, spending much time on the labor ball, trying to walk, and breathing/moaning through contractions, I went to the hospital at my mother's and husband's request.  There was NO ONE there - so we were checked right in.  2cm, 100% effaced, nothing to do.  The nurse said they could give me a four hour morphine drip to try to stop the labor, but they didn't recommend that unless my doctor requested it. She also said they don't induce unless there is a medically necessary reason, which there wasn't, and I didn't want an induction anyway.  They sent me home saying to have a glass of wine and a warm bath.  I tried - but couldn't get past 2 sips of wine, though the bath was nice.

July 5th everything got more intense - my contractions were lasting up to 90 seconds pretty regularly, but still inconsistent - it was awful not knowing when the next one would come.  I tried to walk outside a bit, I spent more time on the birthing ball and in various positions trying to find comfort.  I reached out to friends who had experience with natural birth and both led me to others who had gone through prodromal labors.  It made me feel a bit better knowing others went through it, but at the same time, it was frustrating to hear that some people labored for weeks - but again, theirs would usually stop at night, mine did not.  I was amazed that the body could fall asleep for 5-8 minutes at a time, and loved when I got to sleep a full 20 minutes. I spent the whole night of July 5 into the 6th in the living room, laboring with some contractions lasting close to 2 minutes, waiting for 9am so I could call my doctor at the office, and praying that the contractions would stay a consistent 5 minutes apart, but that never happened. I told my mom I was done and changed my mind about a natural birth, I was ready for an epidural.

The morning of July 6, I called the office at 9am, but of course had to keep calling 'till the answering service was turned off.  When I finally got through to my doctor she said to go back up to the hospital - if I was 3-4 cm, they'd break my water to try to bring on active labor, but if I wasn't, she'd recommend the morphine.  I really did not want the morphine, but was at my limit and exhausted. 

We got to the hospital around 9:15 and it was PACKED.  We had to wait almost 45 minutes just to be seen, I was the only one in the waiting area actually having active contractions.  When the nurse finally called me in to be checked, she handed me the hospital gown to change into and just then my water broke! I was SO excited and thought, "They can't send me home now!"  They checked me out and I was already 6cm!  The nurses kept saying that they didn't understand how I got so far with my contractions still up to 8-12 minutes apart at times. It was also at this point that I got a burst of adrenaline and decided to hold true to my original plan.  No IV, I told them, one nurse gave me a hard time and said if I decided I wanted an epi, it would take longer because I would have to get an IV first, I said that's fine, I had discussed it with my doctor, taken the "required" natural birthing class at the hospital, and I understand.  She wasn't happy about it, but just gave me a hep lock, which I was fine with.

The contractions definitely started to get stronger and I was moved to a birthing room.  The first nurse kept referring to it as a "Lamaze" birth, even though that was not my intention and I had no experience with Lamaze. She also gave me a REALLY hard time about the monitors, even though my doctor and the class at the hospital said it would be fine to have intermittent monitoring.  I moved around anyway, I took a shower (which felt good to clean all the gunk from my water breaking), MH, my mom, and my sister all helped massage and fan me down (it was SO HOT in that room).  And I labored unmedicated for about 8 hours. 

Initially, I was making progress, but I was stuck at 9-9.5cm for close to 2 hours. That was the worst. My contractions were lasting 90 seconds - 2 minutes apart with less than a minute to recover.  At one point, the new nurse (who was very supportive, but still, we were in a hospital) put the blood pressure cuff on me to check and I ripped it off and threw it on the floor, and I'm sure an f-word or two may have been yelled, even though I was trying to keep my composure.

The attending OB, whom I had met, but wasn't my doctor, finally said she knew I really didn't want it, but that because I was stuck so long at so close and clearly I was exhausted after DAYS of labor, an epi might relax me enough to get to 10. This was the first time anyone mentioned it (thankfully), and she really did it in a way that didn't make me feel it was forced or necessary, I honestly feel it was with compassion. And I went for it. She said they'd do it very light and turn it completely off before pushing.

Getting the epidural, for me, was worse than any contractions I had. And not having the IV did NOT make a difference because they started one as soon as I decided to have it and by the time the anesthesiologist got there, I had enough.  Even the nurse attending my birth said the other nurse shouldn't have said anything - it really didn't matter.  The whole experience of it was just awful, HOWEVER, once it kicked in, I have to admit it was damn nice.  I was able to move my legs (though they were heavy) and could still feel pressure, but to be out of pain for even just a little while after the past few days was truly a relief. Within less than half an hour I was fully dilated and the epi was turned off.  I was so excited to push, I didn't even care about the pain of the contractions coming back.

I started pushing! The attending OB checked several times and said she could feel the head, size/space was not an issue, but the baby was posterior and malpositioned. I pushed on both sides, I pushed squatting, I pushed on hands & knees - they were wonderful, especially my nurse, but I was getting so tired and making no progress. Even with the burst of adrenaline, pushing was more work than I anticipated, especially because I needed the baby to turn first.  My OB stopped in to check on me, I had been pushing for nearly 2 hours and the baby was not any closer to crowning than it was when I started.  I was beyond exhausted. 

My OB said first time moms are expected to push for 1-2 hours, with a malpositioned baby (like mine), I could push up to 4+ hours - first to turn the baby, then to get her out, however, she couldn't guarantee that after all that time it'd definitely go that way. She also said that 10 years ago they would have used forceps in this situation, but they don't use them at all now.  She was incredibly supportive, but I just looked at her and said, "I'm done, I can't do this anymore."  She told me she thought I could if wanted to, she knew how much this meant to me, and she said she didn't want me to make a decision I'd regret in the morning.  I said no regrets - I was done, after 6 days of this and 3 days of no sleep at all, I just didn't have the strength/energy to push for another 2-3+ hours.

That was that.  She said she'd put me on the list for a c-section. I cried, a lot, but I also felt like it was really my decision and the best one for me and the baby.  They turned my epi back on (again, which WAS nice), and I tried to rest. 

My baby girl was born at 10:01pm on July 6th. They had to call someone from the NICU to help push the baby back up - the doctor said she was truly stuck in my pelvis and all the pushing in the world wouldn't have gotten her out - poor baby girl had a cone head, too. The cesarean wasn't too bad, until my husband and baby left - I hated being on that operating table alone and missed my baby, I cried a lot and probably annoyed the doctor because I kept asking if everything was okay.  I didn't get to see my baby again until almost 1am, but she latched on and nursed like a pro. 

I had a difficult recovery with complications - about 2 1/2 weeks postpartum, I was bleeding non-stop and rushed to the ER. They checked everything out and sent me home saying sometimes this happens, usually in vaginal births, though, and it was the uterus expelling whatever was left over.  It happened again the next day, only that time I passed out. I ended up with a blood transfusion and an overnight stay in the ER (I pumped the whole night - baby girl got her first bottle before I intended, but it was fine).  They found a hematoma on the incision in my uterus, which my doctor said she never saw in 23+ years of practice.  It was undetermined if the excessive bleeding was due to this or not, again, I got a, "Sometimes this just happens."

When all is said and done, I'm sad I ended up with surgery, especially after everything I went through, but I believe this was a situation where it was truly necessary and I felt empowered that it really was MY decision - it didn't get to the point that the decision was made for me. My doctor said that even with the complications she believes I'll be able to VBAC naturally (which would be ideal for me - no, I would not opt for an epidural again), but they will closely watch the position of the baby to make sure I don't go through that whole experience again.  The irregular labor pattern was probably due to the baby's position all along.  Despite all that, I have a beautiful, healthy (17+ lbs at 4 mos!) baby girl, and I'm quite close to being back to pre-pregnancy condition.