Friday, September 09, 2005

I can see why it's called labour

I could write several thousand words about the labour but I will try to keep it relatively brief. Time is precious now – as we always knew it would be! – so I will try to make good use of it. Maybe I’ll fill in extra detail later. (Please excuse the grammar – this is more for the record than for reading pleasure!)

At about 10pm we met Sally, the midwife who would be with us through the night. As soon as I met her I felt re-assured. A well-spoken, polite, middle-aged woman from Buxton, she was very calm and warm. She listened and didn’t talk over me, unlike too many medical professionals. At the time we first met her Hayley had been waiting for 6 hours to go into the delivery room when she had been told 6 hours earlier she would be taken in immediately. She was becoming more tired and I told Sally I was worried about this. She got things moving straight away. Later I noticed that whenever I expressed a concern, if she couldn’t address it herself she immediately sought a clarification or solution from the senior midwife or the senior doctor. That was to prove very valuable and re-assuring as the night progressed.

At 11pm we moved into the delivery suite where we hoped Hayley would give birth. I remember thinking “this is going to be the place”. I set up the CD player to play the calming music Hayley used during her yoga classes. It would turn out that Hayley would want it played over and over almost to the time of the birth. I only turned it off occasionally when we were trying to get the CTG to find the baby’s heart-beat.

An examination (VE) was performed and showed the cervix was fully effaced and soft.

At 11.10pm the syntocinin drip was started. The dosage of this is increased perdioically to bring on the contractions.

By 11.30pm the contractions were starting to heighten as the drugs started to really work. Hayley used the tens machine, boosting it during contractions. Then she was offered gas and air. With Sally’s help she mastered the best way to breathe it to best effect. I also helped by watching the CTG for it to indicate an increased tension in the uterus. I could see this slightly before Hayley felt it so I was able to help her to get some gas and air into her system early. This was important as it takes about 15 seconds to take effect.

As the pain started to get worse we changed to the strongest Tens programme. Nominally this is intended for “just before pushing”. But the sentocinin was bringing contractions hard and fast. Hayley was feeling a failure at this point and thought that Sally and I would think she wasn’t coping well. She even apologised to us! I told her that she was doing great (which she was) and Sally re-assured her that she was doing very well in light of the strength of the drugs inducing the contractions.

At 12.55am Hayley we discussed having an epidural but Hayley decided to try to continue.

At 1.05am Hayley decided it was time for the epidural! This was the toughest time. She was really suffering. About an hour after this we would discover that she had progressed from 1-2cm dilated to at least 6cm dilated in about 3 hours. No wonder she was suffering!

The anaesthetist came about an hour after Hayley said she needed the epidural. My recollection is that it didn’t seem a long time but Hayley assures me it seemed a long time to her! He talked her through what he was going to do and what the risks were. Bear in mind she is still experiencing strong contractions at this point. He could probably have told her there was a possible side-effect of her head exploding and she would still have wanted the epidural at this stage.

Hayley very good during its insertion – very still despite being leant forward and contracting - which took longer than it should as he checked where some blood was coming from. At one point the anaesthetist asked Sally to move Hayley’s left shoulder. She went to move her right shoulder. Hayley, who had been woozy and apparently “out of it” through pain and gas, suddenly piped up to Sally ”Who’s on this gas and air, me or you?!”. We all laughed.

It amazed me how she could keep her sense of humour like that right through the labour. She chatted away to our midwife and would come round from contractions and continue her conversation as if he had just taken a breath, not undergone a minute of painful, moan-filled contractions. She never snapped at me once despite having pain (before the epidural) that was taking her to the point where she thought she would faint. The worst she did to me was to hold my hand so tight I thought she might crush it, but I didn’t mind at all. Holding her hand and stroking her hair were as much a comfort to me as it gave me something to do apart from watch for the contractions and tell her when to breathe. Her bravery through the whole experience just filled me with admiration for her. At one point, to my amazement and amusement, she commented on her labour that “at least the next one should be easier”!

The epidural helped but Hayley still had a spot low down that was not numbed. She continued with the gas and air. The anaesthetist returned and increased the epidural dosage to cover the blind spot, but Hayley still got some pain. However, her level of discomfort and stress after this were noticeably reduced.

After this things seemed to slow down a bit. There was a feeling of calm progress with just Sally and me in the room with Hayley most of the time, with low light and yoga music playing quietly.

By 3.30am Hayley was very nearly fully dilated. A VE showed she was fully dilated apart from a small rim on one side! She had gone from 1cm to over 9cm in 4 hours! (The average rate is said to be 1cm per hour.) I’m sure this was down to the strong drugs being used to induce her.

Sally pointed out to me that most of the baby’s heart-rate decelerations were “early” i.e. occurring with the contractions, which is a good thing!

Sally noticed “a large show” - which really meant “a lot of blood” - and quickly went to consult Mandy (senior midwife). The doctor was called and Hayley was examined by the doctor who was not overly concerned but mentioned taking a blood sample from the baby to check he is not too distressed.

I then popped out of the room for 30 seconds to speak to Mandy about the amount of blood and was re-assured by her that it was not a problem. I returned to the room to find Hayley had come round from a contraction to find herself alone. “You all left me”, she cried, understandably a bit upset!

The next thing I recall is that the doctor returned. He examined Hayley at 4.20am and said there was still a very small lip, so she was not quite fully dilated. She was also laid on her side to try to lower the baby’s baseline heart-rate which was slowly rising. It was also to help eliminate the “lip”.

By this point there were several people in the room, coming and going (Sally, Mandy, Doctor, Anaesthetist & assistant). Hayley then suddenly (but mistakenly) suspected we were keeping something from her because of conversations going on that she could only partially grasp in her woozy state. She got very angry. Thinking there might be talk of a c-section, she told the senior doctor “I’m not having a pissing section after coming this far!” This was her only real outburst.

By 5.15am there was just me, Sally and Hayley again and no-one had been in for a while. I was frustrated at the lack of progress. Hayley was almost asleep between contractions and I asked Sally to get the doctor back in to examine Hayley as she must surely be fully dilated by now. By now Hayley is now experiencing some heavy pressure on her bum as if pooing: it’s the baby’s head pushing down. At one point Hayley interrupts a suck on the gas and air to say “excuse me” when she breaks wind. One of the midwives later commented she was the politest labouring woman they’d ever known.

5.30am(ish): The doctor came back in. (He was rather unintelligible, even to Sally.) Concerned about possible distress, he takes a blood sample and attaches an electrode to the baby’s scalp to monitor the heart rate directly (instead of through the abdomen). Hayley is fully dilated.

5.40am: Hayley is pushing now with contractions (no gas or air). Baby is slowly moving down the birth canal.

From here on the exact times are a bit hazy.

6 - 6.10am: The doctor returned and said he didn’t like the blood results and was going to use a ventuse cap to assist Hayley get the baby out quickly. He also had to do an episiotomy. The Paediatrician was then called as he has to examine the baby first when ventuse is used.

6.15am: It was hectic in there by now. I remember being in the thick of it and didn’t feel out of place or in the way, but more a part of the team. To their credit the professionals in no way pushed me aside. The Ventuse cap was applied and Hayley pushed. The cap comes off. It is re-attached and the doctor pulls as Hayley pushes again. I am holding Hayley’s hand and telling her when to push and encouraging her. It’s the classic labour scene by this point. The cap comes off again! At the thirds attempt the head is delivered. I look down there over Hayley’s legs (in stirrups) to see a head with a large lump on it where the cap was. I remind myself what a good idea the ante-natal classes were, otherwise I’d have been alarmed by this.,

6.19am: One more push… and baby is out!

The baby is placed for a few (10?) seconds on Hayley’s tummy, then lifted off by Mandy to go to the Paediatrician. At this point we haven’t seen what the gender is! I ask Mandy and she turns our newborn towards me. In surprise, and with a bit of a quake in my voice, I tell Hayley “it’s a boy”! I am amazed and surprised but delighted after still expecting a girl even as they started to turn him towards me. I feel excited, emotional but thankfully am too busy to cry! Hayley gets a bit weepy now.

The Paediatrician then took the baby to a table next to Hayley’s bed and examined him. He took an agonisingly long few moments to do this and there appeared to be some concern. Hayley became concerned and started to cry slightly. I re-assured her as I know logically he must surely be OK. I see Mandy flicking the baby’s foot. I ask “He is breathing though…?” I am told yes. A few seconds later a little cry. Phew! He was apparently shocked. Later when we read the notes we found his HR was below 100bpm and he needed a few assisted breath and cardiac massage to get him out of shock. He is then swaddled and returned to Hayley.

We took a few photos of the three of us and of Mandy and Sally, our midwives.

Meanwhile, the doctor delivers the placenta. It looks like something between a giant piece of tripe and a giant squid. He then stitches Hayley up and we are almost done.

After that there’s not much to do beyond tidy up – the doctor left a right old (literally) bloody mess for the midwives to clear up. Hayley is tired and can’t move her legs due to the epidural, but by the time she is sitting in a clean bed with Oliver in her arms she has a grin a mile wide.