Given my obstetrical history, with Vivienne's pregnancy, I never really made plans for delivery. We knew it could be anytime, though we'd taken precautions (a cerclage placed at 12 weeks, weekly 17p injections, high-risk monitoring, etc.) to try and reach full-term this time. While I had previously been all about unmedicated birth, there were simply too many variables for me to be really hung up about anything and too much fear for us to feel comfortable making plans or taking classes.
My birthplan consisted of - healthy baby, healthy mom, both alive. Whatever was necessary to make that happen. My blood pressure was constantly under scrutiny throughout my pregnancy, high, but never high enough to require medication or further monitoring. We reached 36 weeks and the cerclage was removed easily enough, with no dilation. My doctors were clear that due to my high-risk status, I would not be allowed to go past 40 weeks, so we just waited. . .
My regular OB herself went on maternity leave and I was assigned to another doctor in the practice, though I ended up seeing every other doctor at some point or another because of scheduling. I went to my weekly appointments - a non-stress test on Tuesdays and OB appointment with biophysical profile on Fridays. The baby always looked good, but my blood pressure continued to creep higher and higher. At 37.5 weeks, I had to do a 24 hour urine collection and bloodwork to rule out pre-eclampsia. At 38.5 weeks, I had the highest b/p that I'd ever had, and was sent to triage for monitoring. I had come to expect that I would be induced, and was surprised when the doctor admitted me to the hospital overnight for observation and released me the following day (my bp went down overnight, and then crept back up and there was protein in my urine during that 24 hour collection). I suspect it was because I was not her primary patient and was not favorable for induction (baby was high, I was 1 cm dilated and 50% effaced, and the doctor thought the baby was malpositioned). I was to see my new regular OB (who had been on vacation for my 38.5 week appointment) on Monday (39 weeks even) for a follow-up.
When I went in, I still had high blood pressure and the labwork indicated mild pre-eclampsia. Dr. B immediately said her recommendation was induction. Since I'd repeatedly been told that I would not go past 40 weeks, I expected to be induced that week anyway, I was ready to go. She asked if I had my bags with me (I did) and if I could go straight next door to the hospital (I could).
Since it was about 3:00 and I had not eaten since 9:00, I asked if I could first get some lunch, as I knew I would not be allowed to eat once I was admitted. We compromised - if I would go over and get admitted and get the first labs drawn (the OB was worried about increasingly dangerous pre-e), then I could order dinner. They called and informed L&D that I was on my way and off I went, calling DH and my mother on the way.
On paper, I was still not favorable for induction. I was barely dilated, about 70% effaced, with baby still up high. I wasn't having regular contractions (or so I thought), and so the plan was to go as slowly as possible to give my body the best chance to adapt and have a vaginal delivery.
In short, we were going to do a round of cervidil overnight, and I'd be allowed off the monitors for an hour and a half in the morning to bathe and walk around. If I was dilated more than 2 cm, then we'd begin Pitocin on the slowest possible drip, increasing every 20 minutes. I'd be allowed off monitors again the following evening for 2 hours to eat and rest. Everyone stressed that I needed to rest as much as possible that night because the following day was going to be a long, arduous one.
So the cervidil was placed, and monitoring indicated that I was having contractions roughly every 4 minutes, though I wasn't bothered by them and in fact only noticed every third or fourth contraction. The orders to allow me dinner got lost in translation, so I ended up eating graham crackers, jello and broth, but in the end that was ok. There was really nothing to do, and with the plan that the next day would be the action-filled one, I sent Dh home to tend to the animals and get a good night's sleep.
The doctor and nurse came to visit around 9 pm, and reiterated the importance of me getting as much rest as possible, and encouraged me to take Ambien, which I agreed to. I took that around 10:30, and tried to sleep. Between the uncomfortable bed, the constant monitoring and the increasing (in frequency and pain) contractions, I couldn't really sleep. When the nurse next checked on me, nearing midnight, and found me still awake, she asked if I wanted IV narcotics to help with the contractions. She told me that she could give me fentanyl mixed with phenergen. My experience with phenergen is that it would make me very drowsy. I wasn't in a lot of pain, but as everyone kept reminding me, I felt I needed to get sleep if at all possible and the nurse assured me that between the Ambien and the IV cocktail, I should be knocked out, so I agreed.
It worked for awhile, but then I found that I was waking with each contraction and having a difficult time getting comfortable. I unplugged from the monitors and went to the restroom, and the nurse came to check on me, and I was a little loopy. I really didn't think I was in labor (haha), and kept thinking 'I have to sleep, I have to sleep' but I was so uncomfortable. The nurse asked if I wanted an epidural and I said no. She asked why. I vaguely wanted to try to go naturally, but Dh wasn't there and honestly, I was tired and finding it very difficult to think (thanks, drugs!) and be at all comfortable - and since I was tied to the monitors, I couldn't move around much to try and alleviate the pressure I was feeling. And of course - I needed to get some sleep! Because the next day was going to be the really long one . . .
I agreed to an epidural, and the nurse checked me, surprised to find I was between 3 and 4 cm. And from this point, things get really fuzzy. It was about 1:30 at this point, I believe. I have no recollection of the anesthesiologist, though I remember his voice. My water broke while they were putting in the epidural. I remember telling the nurse that I thought I had peed on myself, but no - it was in fact the amniotic sac (and I was now over 5 cm dilated - the cervidil had come out when my water broke). I remember the anesthesiologist telling me to lay down and then saying that I shouldn't feel the next contraction . . .
and that was about it. I vaguely remember the nurse asking if I wanted her to call my husband. In my head, I could respond, but physically, I was too tired/sleepy. I nodded, and she got my phone and asked what my husband's name was - I could only tell her "Two" which is the speed dial his number is on. Apparently, they got hold of him around 2:30 and he was at the hospital by 3:00. I have no recollection of him arriving. I slept until roughly 6:30 am, and even then, I was pretty out of it. I remember conversations going on around me, and my husband tells me that I was responding to questions as early as 5:30 (I apparently asked him when he got there), but I don't remember.
I really only remember that they checked me (I couldn't feel anything but some pressure with each contraction), and I was 9+ cm, with a little lip and there was a conversation about what the doctor was going to do, since she had a scheduled c-section and I was near delivery. Then the doctor arrived and I was at 10, so they had me start pushing.
Because of the epidural, I couldn't really feel much. I think it made my pushing stage a little longer. I didn't love pushing, because they kept telling me to push harder or longer. I know I told DH once or twice that I couldn't do it, but apparently I made steady progress. I pushed for about an hour, and Vivienne was born at 8:17 am - about 40 minutes after I was supposed to have started Pitocin in my long day. Heh. Apparently, despite not looking good on paper, all I needed was a jumpstart to get going.
My intention had been to try and labor naturally for as long as possible, to have Dh there to help me. The reality was that because of the plans (and not realizing when I was in active labor), I ended up taking drugs that knocked me out and let me sleep through pretty much all of it. I think if I'd thought about it, I might have felt unhappy about missing out on labor, but as my friend T told me - given what a worrywort I am, sleeping through labor is about as great as I can imagine. And honestly, I can't really argue!