if you missed the explanation of why multiple people are telling this story AND for lena's version, go here.
this one's for the scientists in the crowd. and for those who don't mind HD anatomy and birth details. this one may be really good or really bad for expectant mothers to read since its so fact-filled, but no matter what your birth story shapes up to be, you will be one happy camper if you have someone as amazing at her job as adrienne to walk you through it. adrienne was my L&D nurse when i had judah and ended up delivering him (though i wasn't sure about her at first). because of that bond she is now my friend. this time by design she was hands-on (or hands-in, really) for layla's entire pregnancy and birth. adrienne knows her stuff y'all.
i will be throwing in some pics and captions, but the story is all hers. take it, adrienne:
So first, let me preface with an apology to K8’s regular blog readers/fans. This will NOT be the usual well-written, witty prose you are use to reading from her. In fact, by the end of my story you may in fact wonder how I ever manage to stay gainfully employed as a nurse.
Forgive me in advance for comparing and contrasting to Judah’s birth, but really it was very much on the forefront of my thoughts the day Layla arrived, and so I had to include it in Layla’s story. And like Lena said, I know this is supposed to be all about K8 and Layla, but (as you will soon see) there will definitely be parts of the story where my thoughts/feelings play a larger role than perhaps they should. So, on that note, I will begin my story of Layla’s birth day.
Background: Since Judah’s amazing birth, K8 and I have stayed in contact to some extent. I am totally one of the stalkers of her blog, and every now and then we would shoot each other a text or email. I was thrilled when I learned she was pregnant with Layla and immediately sent her all my contact info because I totally wanted to be there for the repeat performance.
there be judah. after unexpectedly going to war alongside adrienne the first time to get him out and get me repaired
I should tell you, I am known as the “crunchy granola nurse” on my Labor and Delivery unit. This is for two reasons: a) I prefer to labor and deliver unmedicated (for my own 3 deliveries) and b) I LOVE getting the unmedicated patients! The wilder/louder/crazier the better. There is something so insanely rewarding about guiding an unmedicated woman through labor, I think because it’s a journey you both go on together and as a nurse you truly feel you are making a difference in your patient’s life. That being said, I also am a HUGE advocate of letting women labor they way they want. If that means being numb from their toes to their nose or screaming and kicking without pain meds, more power to them.
Okay, back to K8. During K8’s pregnancy we talked off and on, and she discussed her thoughts on laboring and delivering unmedicated again. Just as before, she had a very firm plan about what she wanted, expected, etc. The plan was something like this: an unmedicated labor and delivery, I was to be there as the nurse if at all possible, if she ended up having another long labor ordeal and felt she had reached her breaking point she was open to an epidural and finally, if pitocin was needed I must get K8 an epidural before I started the infusion or I would be found 6 feet underground.
It sounded like a good plan to me. I love when patients are open to possible changes occurring to their birth plan because they usually end up being successful in having the delivery they were hoping for to begin with. It is the patients that have the most detailed birth plans that end up with at least two situations they were hoping to avoid. Okay, so you won’t find that statistic in any evidenced based peer-reviewed journal, but my anecdotal evidence is further helped by Judah’s delivery. I had never had a patient write in their birth plan “if I tear, I prefer to tear down and not up”. Guess whose birth plan that was in, and guess who not only tore “up” but “down” as well?
To help K8 achieve her goal of another fabulous unmedicated birth, I suggested she try evening primrose. It’s an all natural supplement that when taken ORALLY (yes, there is another route and I don’t recommend it) will ripen the cervix (or for you non medical folks it makes the cervix mushy and squishy) and makes it like butter (yes K8, I just compared a cervix to butter). It does not put a woman into labor, but when the woman does go into labor the cervix opens like school doors on the last day before summer vacation. K8 started the regimen at 36 weeks.
During K8’s last trimester I slept with the phone on my night side table to make sure I would be ready for the “alarm”. I was so worried about not being able to be there for her and missing what I knew would be another awe-inspiring birth.
The day finally arrived. My husband and I were heading up to the city when K8 called and said she’d been having some contractions that were progressing in intensity. She was worried about it being a false alarm. I talked to her for several more minutes. This is totally an L&D trick (loved by both doctors and RNs)-if the woman can talk normal through the contractions she usually is not in labor. While K8 was able to keep talking to me I could hear the change in her voice when she would get a contraction. We decided it was the real deal and that she should call Jesse back from church. We headed home so I could grab my work stuff and K8 would call me when they were on the way to the hospital.
I think Jesse and K8 actually arrived at the hospital before me, but K8 decided to labor a bit with nature and they took their time coming in. When they arrived on the L&D unit I was already dressed in scrubs and had her room set up. Oddly enough, they actually were put in the same room that Judah was born in (this was not my doing, the charge nurse had already assigned the room). It was like déjà vu! Keight walked in all calm and Jesse was grinning and had the second-child-I-am-a-pro-at-this dad look on his face. You could tell he had complete confidence in K8 and what was soon to transpire and he was totally stoked. This was a stark contrast from the eyes I remember when Judah was being born, the eyes that begged me silently to somehow make things better for his wife because he couldn't fix it.
K8 was totally chill and relaxed, taking her time to get dressed in our fashionable hospital gowns. In fact, she’s so relaxed and calm that I start thinking “maybe she’s not really in labor” and “she is so going to kill me if I have to send her back home”. Everyone, regardless of if they are staying or not, must answer the novel-long admission questions. I can’t remember if I checked K8 before or after the admit Qs (I’m thinking before), but somewhere during that time I do an SVE (sterile vaginal exam) and record that she’s 5cm.
dude, check out how great adrienne's booty looks! though to be fair, anyone's might look almost as good standing beside kirstie alley. oh is that not kirstie in that pic?
I’m going to try hard not to be too technical here but I’m sure I will fail. There is something we OB folks call a “laboring cervix”. The best way to describe this is silly putty (K8-this section is going to be more for you than anyone, so PLEASE feel free to omit this so the whole world doesn’t think I’m a freak). Although K8’s cervix wasn’t as mushy as I would have expected it to be with the evening primrose, it was definitely a laboring cervix-a little firm to the touch but the more I tried to ascertain the dilation the softer it became and more stretchy [editor/k8's note: you're welcome world. and there plenty more cervix where that came from!].
After doing my admit Qs, exam, etc- I go and call Dr. Carter to let her know she has a patient in L&D. I explain what K8’s exam is, contraction pattern and how Miss Layla is looking on the monitor. Dr. Carter arrives on the unit, pops into K8’s room, and promptly tells her “Well, I can’t keep you if you don’t make any progress and you’re not going to let me do anything to you”. Thanks Dr. Carter! Way to scare the crap out of my patient. K8’s face was priceless! And of course, this is on the heels of me touting Dr. Carter and her practice philosophy to K8 and Jesse and how she will let her patients labor how they desire. Thank goodness Dr. Carter clarified her first statement and it was decided that K8 would have a few hours for her body to “declare herself”. I let K8 and Jesse know that I was available if they needed anything but I also wanted them to have their space and enjoy this awesome moment. And, truth be told, they really didn’t need me at that moment. K8 was breathing through her contractions, leaning up against the same wall in the same spot by the computer that she had with Judah, and Jesse was right there with her, supporting and coaching her through the contractions. Talk about déjà vu!
i. hate. that. wall. there's a pain scale smiley-chart posted above my head. i was full blown frowny at these points and wanting to smack the line and 2 dots off of the pain=1 happy smiley man.
I remember thinking, it’s like a dance. The first time we did this with Judah the principal dancers were K8 and Jesse (and eventually Judah) and I had a guest-star appearance. And with Judah, it was as if we had all learned the steps separately and so it was a little uncoordinated until the very end where it came together beautifully for the finale. This time, with Layla’s birth, it was as if we had practiced numerous times and was choreographed so seamlessly it was surreal. The principal dancers were again Jesse and K8, but this time Lena and I were background dancers in the corps; very minor roles, just cheering Jesse and K8 on, and helping to beautify the main event.
So K8 had her “couple hours” and I came back to check her cervix. Hot diggity, she was 7cm! I have mad L&D skills, and totally knew she was in labor (and inside I’m totally thanking G-d that I didn’t have to send her back home). At this point, I’m kind of feeling useless. Of course I’m doing my RN duties- assessing the FHT (fetal heart tones) and contractions, making sure everything is set up for delivery and all equipment is working properly, but K8 is just such a darn good birthing gal and Jesse is such a great coach that there wasn’t much for me to do but watch, take it all in, and let them know I was there if needed. Occasionally I might have to remind K8 to relax her extremities, but pretty much I just observed as unobtrusively as possible. On, and on a side note, Lena is a VERY good birth photographer. I was super impressed that not only did she manage not to faint (although she was grey a few times) she also somehow managed to make me look much slimmer than I really am in the pictures. Bless you Lena!
getting my port put in. not sure why i was smiling at 6 cm. i don't remember smiling at all for those last few hours. my theory when examining this super flattering picture is that i am happy because i just swallowed jonah.
Alright, here it’s going to get a little murky because things really started moving and so exact sequence of events and corresponding cervical dilation might not match up exactly. Not too long after I checked K8 her contractions really amped up in intensity. Unfortunately I think she believed the insane pain that accompanied her contractions between 7 and 10 centimeters with Judah were entirely due to the pitocin. So sorry I didn’t warn you K8. With pitocin it’s very black and white: you’re having a contraction or you’re not having a contraction. The intensity is consistent for the duration.
Without the use of “vitamin P” (as it is referred to on L&D), there is a natural rise and fall to the contraction. It slowly builds and the pressure is felt first, the peak of the contraction is the worst and you’re pretty sure you just want to die, and then the pain gradually recedes and you can breathe again. However, at the peak of the contraction and until it subsides, the pain is every bit as intense as if you were on pitocin. It seemed like K8 was not quite prepared for that and so I could see her struggling to take that in while laboring through her contractions. It didn’t take long for her to absorb this fact and regroup and master her contractions once again. Another huge change with Lalya’s birth is that she actually did most of the tough laboring in the bed this time. With Judah she leaned up against the wall and that was very much her zone. But with Layla she found side lying (and at one point she was almost prone-well, as much as you can be with a nine month pregnant belly) to be her position of choice. Jesse was right there with her, rubbing her back or feet.
K8 was moaning rhythmically with her contractions. I swear this is why many nurses and doctors try to talk their patients into epidurals, because, heck, if someone is moaning they obviously need pain medication and who wants to listen to someone moaning in pain if we can stop it?! In reality, this rhythmic moaning serves a couple purposes. One, it helps keep good oxygenation to both mom and baby because mom isn’t holding her breath and tensing with pain. Two, it becomes almost meditative and allows the woman to get into a zone which helps her cope with the contraction and not be consumed by it. K8 was in that place.
I could tell K8 was getting close to delivering. I performed an SVE again and she was 8cm, but her membranes were still intact (aka Layla still had a swimming pool). Around this time, K8 started bringing up an epidural. Let the inner turmoil begin!
As K8 and I had previously discussed, she was going to give unmedicated birth a chance again, but, if she felt she had hit her limit the epidural was just fine. It has been my experience that when a woman who has successfully had an unmedicated birth starts asking for an epidural, birth will occur in about 30 minutes or less. When K8 was in between contractions I explained that it was possible that all she needed was her water to break and she would be complete (10cm) and could push. Layla was already very “low” in K8’s pelvis so we were just waiting on rupture of membranes (ROM) and complete dilation. K8 consented to artificial ROM (I think after having an ESP conversation with Jesse because looks were traded back and forth before she said yes) and I went to fetch Dr. Carter and her amnihook [editor/k8's note: BAHAHAHAHA "amnihook!"].
not the first time this pic has been posted. but the first since i have known it is called an amnihook. also, this pic is so action-packed. and hot.
Dr. Carter ruptured K8’s amniotic sac, rechecks her and K8 is what we call a “rim”. This means the cervix is 9.75cm but there is the tiniest bit of cervix left all the way around. At this point K8 is no longer discussing the epidural, she is adamant about getting one. Here’s where the inner turmoil really kicks in. As a nurse, I am obligated to do what my patient requests (provided it’s not dangerous to the patient). For example, if K8 had said she didn’t want an IV that day, I would not have been allowed to put an IV in. If I did, I would be guilty of assault. So, as her nurse, my mission was clear-get K8 an epidural. However, as a fellow unmedicated laborer, I also knew that delivery would be in a few short moments and that K8 would probably berate herself later when she realized how close she truly was to the end.
I started running IV fluids in preparation for K8’s epidural (epidurals lower the BP so we give lots of fluid to prevent it from getting too low) and I had to explain to K8 that I would do my best to get her an epidural, but the reality was we probably would not make it in time. When K8 heard that news, I saw a fleeting shadow of a look of panic. She had another contraction in which I could tell she was involuntarily bearing down and beginning to push. Dr. Carter checked her again and she was now 10cm. Somehow K8 missed us saying that the first time, and I think she said something to the effect of “I can’t do this anymore”. I explained she didn’t have to, that it was about to be over, and she looked at me kind of bewildered. I said “you can push”, to which she replied “when?”, and we (me, Dr. Carter, and Jesse) said, “NOW”! So K8 pushes through one contraction and says again “I can’t do this” and Jesse, with a huge grin on his face replies, “you are doing it”!
With the next contraction K8 delivered beautiful Miss Layla! Once again, K8 did an amazing job laboring and birthing another miracle. This time though, she was the experienced mother who truly needed little guidance and delivered with every bit of grace and panache as before. And this time, there was no complicated repair to get in the way of her and Miss Layla bonding.
my thoughts: "i gave birth to a hairless pug." layla's thoughts: "find a happy place, find a happy place"