Here he is! Zephyr Isaac Khouri, born at 2.21am on Tuesday March 1st, 2011 at Invercargill Hospital.
Zephyr is the most beautiful, sweet, gorgeous little baby in the history of the world. Seriously, I'm pretty sure I'm not biased. After a few days of unsettled behaviour (expected when you get thrust out into the world from a nice comfy place before you are really ready), he has relaxed into home life and is feeding nicely, putting on weight, and we are loving him.
I feel that we were definitely ready for this, because we have coasted into the first week, happily exchanging sleep and whatever else it is that we used to do for the sweetness of hours spent gazing at his little face. At night when I go to bed I actually look forward to him waking up for his feeds. I love the milk-drunk look on his face when he lies back contented. I love his little hands grasping my fingers. I love the way he stares at me when he's awake, his little dark eyes all wide and serious. I love him.
However, this post is not going to be all sweetness and maternal love. I have to warn you that I am about to use this blog as both a record of what happened last week and a way to gain some personal closure. If you are either squeamish or pregnant, I suggest you don't read on from here.
Zephyr's Birth
We arrived at the hospital for our induction on Monday 28 February around 9.30am. I had been having contractions since around midnight the night before, but they were very mild, about half an hour apart and had not increased in intensity or frequency over that time. These runs of contractions had happened twice before that night, once on the preceding Saturday and once, more intensely, on the Wednesday, but both times the contractions had stopped and nothing more had progressed. I thought maybe this was third time lucky, so I was hoping that a small dose of the induction drug would be all it took to get this labour on the road.
We met Dr H, an American doctor who wasted no time in telling us that I was a good candidate to try Misoprostol, an induction drug used overseas but not commonly used in New Zealand. She arrived with four of her colleagues, including the midwife who would look after us that morning and a British doctor who just seemed to stand there and take notes. Misoprostol came in a tablet form that would be inserted vaginally that morning, then again at 3pm, then again at 7pm. She assured us that it was the same as the commonly used prostaglandin, but it worked faster (sometimes an induction can take up to three days), and that the team working that day were all experienced with the use of it, as they had all worked overseas where it was commonly given.
What she failed to mention is that there would likely be a shift change before things really kicked off, and that she herself wouldn't even be around that afternoon or evening.
Anyway, we asked a lot of questions, dubious about trying a drug that wasn't commonly used here. We called our midwife and she told us that if they say it's going to have the same effect, but work faster, we should go for it. So we said yes, we would do it. They then got us to sign something to say we were consenting to the Misoprostol, since it is not a licensed drug here.
So, the Misoprostol was administered and I was attached to a CTG machine for an hour to record contractions and the baby's heart rate. There were already some contractions at that point - as I mentioned, there had been contractions all night - but they were still pretty far apart. Baby's heart rate was hovering around the high 150/ 160 bpm. He was doing fine.
They detached me and we were left alone. We played a game of Scrabble, watched an episode of It's Always Sunny in Philadelphia on the laptop, then, on the advice of the duty midwife, got up to go for a walk around the hospital grounds. We walked for around twenty minutes before I started to feel contractions more strongly. They were getting noticeably closer together and making me feel that I needed to be somewhere where I could sit down. I could still walk and talk through them, but they were definitely starting to make themselves known.
I was excited – it was working already! So we headed back to the hospital. By this time it was around 2pm. I am a bit hazy about whether they put me back on the monitor before they administered the second dose (we have requested the hospital records to check up on this stuff) but I do know this: The doctor who came in to give me the second dose was almost certainly inexperienced and was not one of “team” that Dr H had flouted as being on board with us for the duration of this induction. In fact, aside from the midwife, who we had for a few hours more before she changed shifts, we never saw those people again (except for Dr H when she was called back in, but I'll get to that).
This doctor, or intern, checked my cervix at the same time as administering the second dose of the drug. He was rough and seemed embarrassed by the procedure, and left quickly without telling us what would happen next. The midwife asked if I was okay – she seemed to be acknowledging that he had been a bit awkward and perhaps not followed hospital procedure. I wondered why he hadn't first checked my cervix and asked about any contractions I was having before he put the next lot in, but being a patient and not a medical expert, I did not question this. Plus, it was too late.
From there on in, things had apparently started to go quite badly. I was attached to the machine again and the midwife promised that I would not be left on it for more than twenty minutes (it was getting very uncomfortable to lie on the bed – I had spent so much time while pregnant preparing myself for these moments, and I was ready to move around the room, sit on a Swiss ball and put into practice the breathing techniques I had been teaching myself for the last few months, and lying on a hospital bed was not a part of any of this).
Over the next three to four hours, they refused to take me off the machine, but finally brought me a Swiss ball and allowed me to get off the bed. They also attached a drip as they said my muscles needed the hydration.
The drip was faulty and I spent a lot of time looking at it and trying to hold my arm at the right angle to get it to flow. The midwife knew it wasn't flowing properly, but didn't fix it. The wires from the machines meant I had to stay near them, and the very fact of being plugged into them caused me extra stress, as I couldn't help watching the contractions come and go and seeing how strong and close together they were getting.
While I believe I was doing really well at coping with the pain – breathing through the contractions and trying to keep my head in a positive space – the machines weren't helping. Neither were the staff, who kept telling me to wait just a few more minutes before they unplugged me. We were told they were waiting to see the baby's heart rate show more variance, as it was “too steady” and not reacting to the contractions. The logic behind this wasn't explained – we thought it was surely a good thing to have a steady heart rate, so took it as a positive and waited patiently for them to unplug me so we could get on with this labour and hopefully have a baby before morning.
They never unplugged me, except to go to the bathroom, which I was also needing to do quite regularly as the contractions became stronger and as the drip coursed through me, when it was working.
I have to take a moment here to acknowledge my husband who rubbed my back at all the right times and told me stories about how happy we were going to be when this was all over. He was amazing, and was not afraid to speak up when things started to look ridiculous.
Eventually, after a few painful hours attached to these stupid machines and with no one telling us what was really going on, we finally saw Dr H again. She had been called back in to the hospital to see what was happening. I have no recollection of this, but my husband says she looked at my notes and said quietly to herself, "It should have been 25 milligrams," or words to that effect. I remember that she seemed very concerned almost immediately upon viewing the ECG machine readings, but I was trying not to worry until she said something concrete.
She finally explained that the baby's heart rate should be reacting to the contractions. She explained that when you are in pain or distress you tend to stay still to conserve energy, and it seemed that this was what the baby was doing. She also said the contractions were too close together and too strong, and she wanted to give me something to make them slow down.
At this point I was tired of all the intervention and still felt like things were working, so surely we would be able to have a baby soon if they just left me alone. I asked a lot of questions about the medication she would be using to slow the labour. She seemed exasperated by my questions. She repeated this statement many times: “We don't need to shoot this baby out of you.” As if I was the one who wanted that.
That sentence has caused me many hours of sleepless anger since the ordeal. I wish I had told her that propelling my baby out of me was never my intention, and that I blamed her for the fact that we were in this mess. I had read so much about the 'cascade of intervention', where one medical procedure causes the need for another, and another. I had been warned so much about this and it was what had terrified me about having the induction in the first place, and now they wanted to give me a drug to counteract another drug, so I could see it was happening. I couldn't believe it.
I asked if it was possible to take a bath – I asked this a few times over the course of the night – as I knew that a warm bath could cause contractions to naturally regulate. Each time I asked I was ignored.
So, having no other option, we agreed to the medication, as it seemed to make sense to get these contractions further apart – there was almost no gap between them at all and they were very uncomfortable. And we were too deep in it at that point to stop.
The drugs used to slow the labour were called Nifedipine and Salbutamol. We had both, one when the other didn't seem to be working. Both made me shake uncontrollably and feel nauseous, and neither had the desired effect. The uterus had gone into hyper-stimulation, they said, and it didn't seem to be able to settle.
Dr H came in and offered me Pethidine, which I cannot believe, considering the fact that she was apparently worried about my baby's slowed heart rate and it is a known fact that Pethidine causes baby's heart rates to slow within the womb. She said it would calm me down and help me rest as I was only 1cm dilated at that point and still had about ten hours to go. I felt that the way Dr H was speaking to me was very condescending. She seemed to be accustomed to patients who didn't have any knowledge of the drugs they were being offered. She didn't actually offer me Pethidine straight up, she offered me "a little shot".
I refused the Pethidine. We called the midwife and asked her what we should do. She said to ask for a sleeping pill if I wanted to get some rest, so I did that and was given one. We felt pleased that they were still talking about the birth being possible, even if it was in ten hours time, and we turned out some lights and tried to settle in for some rest, difficult when the staff wouldn't stop walking in to check the progress on the monitors. In fact, Dr H turned the lights back on almost immediately. It seemed our feelings and my comfort were no longer a factor, if they had ever been.
Next up, my waters broke. I think it was about midnight by then. I was lying on the bed, unhappily, and the current midwife (we had been through about four by that point) had just introduced herself and said she needed for me to lie down with the monitor on for a while. Up until then I had mostly been able to hover near the machines with a Swiss ball, which eased the pain greatly. I felt a big kick inside my belly and something started to trickle out. I told the midwife and she had a look and told me I was wrong, nothing was happening.
“Well, it is,” I said, “either that or I'm peeing my pants.” I tried to stand up and she finally got the machine unplugged. She saw what was going on and told me to run to the bathroom. I got there just in time for the full flood. I had no idea there would be that much liquid. The bad news was, it was stained green with meconium – the baby had literally shat itself inside me, that was how much fun he was having.
At this point I knew what was going to happen. Every time they left us alone (which was almost never) I tried to discuss it with my husband. They're going to suggest a C-section soon, I said, what are we going to do? We both knew we had no option. If we refused the C-section and our baby died...well, there is no need to finish that sentence.
We were reattached to the machine and the doctors started to point out drops in the baby's heart rate. We knew we were done for. I wasn't even listening to what they were saying any more, just waiting for Dr H to be brave enough to actually utter the words 'C-section', which she did.
We agreed to it – we had to – and suddenly the room was filled with people who were urgently preparing us for what was to me, a nightmarish outcome. We were so far from the idyllic birth experience I had envisioned and prepared for. I felt so low and empty. I tried to focus on the baby, but I was just so disappointed that it had gone that way. I was also still shaking from the drugs they had given me and only half conscious from the sleeping pill. Looking back, they shouldn't have allowed me to take a sleeping pill if they considered I was likely to be a candidate for a C-section in the next couple of hours. And they must have known.
The people who had invaded our room started to go about getting us ready to be taken upstairs to surgery. A woman was trying to get me to put on some tight stockings that prevent blood clots or something, but the finality of having to wear them caused me to burst into tears. My husband was being given a set of blue scrubs and we were told to sign here and here on some forms attached to clipboards. Some slightly sensitive nurse suggested they leave the room and give us a moment. I had a good cry for about two minutes before they were back. A nice, young British intern crouched in front of me while the socks were being fitted and the hospital gown being put on and explained that it was totally possible to give birth naturally after a Caesarean, and that I shouldn't worry or blame myself for what had happened. She was really understanding and I wish I had gotten her name.
I was told to get back on the bed and wheeled down the dark, empty hospital corridor to the elevators, and upstairs to the surgery room, where the anesthetists were waiting. These guys were a jolly lot, apparently having been woken up especially for our C-section and probably pretty stoked on the extra few thousand they were making that hour.
One of them happily explained to me that because of my low platelets - which he wasn't concerned about, he had seen much lower - there was a risk that the effects of the spinal injection they were about to administer would somehow reoccur in the next 24 hours, causing me to go numb again and then - and these were his actual words - "die an excruciating death". But, he added, it was very unlikely, he just wanted me to be aware of the possibility. I just stared at him. He seemed to think he was being funny.
In between contractions, they got me to sit on a bench and lean down as they administered the spinal anesthetic. It sent electric shocks down my legs, which then went numb. They did the whole 'one, two, three, lift' thing and got me onto a bed, which was then wheeled into another room. There was quite an amiable conversation going on between all the doctors and anesthetists in there as they prepared me for the surgery. I felt completely detached from the scene and started crying again. I remember hearing Dr H say, "Oh, how sad, she's crying on the operating table for the birth of her baby." I hated her at that moment.
My husband stroked my hair and talked to me about how the baby would be here soon. When Zephyr was pulled out, I heard him cry and that made me happy. I was smiling as I watched through a little gap in the curtain they had raised in front of me and saw my husband weighing the baby and cutting the cord with the doctors. Zephyr looked really big to me and I couldn't tear my eyes away from him. He was brought to me wrapped in about eight towels and the three of us were taken to recovery, where Zephyr was unwrapped and placed on my chest and we tried to get him to feed. I don't really remember if he did or not.
We were taken downstairs after an hour and the three of us were put to bed, Zephyr tucked in next to me. I remember one of the midwives trying to explain breastfeeding to me in the morning, but I couldn't keep my eyes open to listen to her. I was totally wasted.
We spent a few days recovering at Lumsden Maternity unit, which was invaluable. When I arrived there, I was a complete mess. The duty nurse at Invercargill had given me a bunch of pills for the drive, including something called Tramadol, which caused me to hallucinate. I wasn't coping with anything. I couldn't even brush my teeth. The midwife at Lumsden put me straight to bed and taught the new daddy a few pointers about settling a new baby. Zephyr was brought in to me around midnight to feed. I felt a lot better then and we managed to get some colostrum into him.
A week on, the intensity of my emotions is fading, but I still feel very angry. I lie awake each night, wasting precious sleep time thinking these points over:
1.) Why were we offered a non-standard drug while lying on a hospital bed ready for a standard induction, with no opportunity to research it?
2.) Why did my midwife not suggest we opt for the usual drug instead, seeing as we had no idea of the effects of this one?
3.) Why did my midwife not come down to Invercargill to be our spokesperson when things started to go wrong?
4.) Why did Dr H not stay with me for the whole process and oversee the induction like she promised? She should have overseen the administration of the second dose, as I believe that was the key error – I hadn't needed the second dose.
5.) Everybody else who was involved in the birth came back to visit us and check on me in the twenty four hours following, except Dr H. I feel that I have a lot to say to her.
6.) I have guilt that my baby went through such terrible distress before entering this world. I feel that I should have listened to my instincts and not gone through with the induction.
7.) I am angry that we were given so many mixed messages. For instance, the original doctor who told us we need to induce said that if my platelets dropped below 80, no anesthetist would give me a spinal or epidural should we need one in an emergency. My platelets were 78 on the day of the induction and the anesthetist seemed to have no problem giving me the injection. The need for the anesthetic was caused by the induction, so it is a circular argument. I feel that without inducing, we could have had a normal birth. I don't think the platelets were as much of an issue as the doctors made out.
8.) I am angry that I am now recovering from major surgery. I can't drive a car for two weeks, I can't vacuum. It hurts to get out of bed. I have a permanent scar. For about four days my feet were swollen to about four times their usual size. This all makes me angry, and anger is not good for a new mother or her baby.
9.) I fear for next time. I was so well prepared for this birth, but I never prepared myself for a Caesarean. Perhaps that was stupid, but I thought it wouldn't happen to me. I don't want it to happen again, but I feel that the possibility for the experience of birth is now out of my control. I have heard quoted that you should be focussed on having a baby, not having a birth experience, and that is all very well, but I wanted a birth experience too. I am a woman and I am made for it. I think I deserve it.
But. They got my baby out and he is safe and healthy and doing really well. He put on 200 grams in the past three days! He is going to be a lovely chubby little thing soon (he is already lovely, of course). And I am grateful for that. I am grateful that I have a baby when a lot of people can't get pregnant – I bet those people wouldn't care how their baby came to them. I don't think the C-section itself was unwarranted. It was necessary. But I still don't think the induction needed to happen, and I think it was very poorly managed on the day. I hope that by writing this down, I am getting it out of my system and making room for more love for Zephyr.
I also hope that we can see to it that something is done to help prevent this from happening to anyone else. I'm going to stop there and try to shake this all off before Zephyr wakes up for his next feed.
Positive mother love post next time. :-)
