By Hook or By Crook: Septimus' Birth Story, Part III

(Don't know if anyone out there is still interested in this saga, but sorry for the delay.  We've got a nice, juicy upper respiratory visiting a number of the kids.  I've never gone through children's ibuprofen and vapo-rub so fast in my life.   As much as I wanted to finish it all tonight, I have some other computer work that needs to get done so this will most likely stretch into an absurd fourth installment.  click here for Part I and Part II.)



Whenever I've been in labor, I always recall what Rob says about obstetrics:  namely, that things go down FAST.  He has told me of many times where he has been presented with a difficult situation and he literally has minutes (or less) to make a decision.

To the woman in her 12th hour of labor, that might sound completely specious, but it's true.  It has certainly been proven in various ways during my labors, and this time was no exception.

Up until this point, I was contracting well, the baby's tracings on the monitor looked good, and we were moving right along . . . . and then, we weren't.  In less than a minute the whole scenario changed.

Right around 5:45 am, my doctor and nurse came into the room together, not running, but certainly not strolling in leisurely either.  The baby's heart rate had a big decel and they wanted to check out the situation and to see if I had dilated any more.  They had lost the baby's heart tones on the monitor - something that had happened many times during the night - so my nurse was adjusting the monitors while my doctor was getting ready to check me.   Talk about feeling your heart in your throat.

I was feeling the contractions by this point, so I was not concentrating on anything except gritting my teeth and keeping that dumb IV straight.  In a way, I am grateful that the IV was so painful and keeping me so distracted because I couldn't focus on the fact that the nurse kept moving the monitors farther up my abdomen in an effort to find the baby's heart beat.

But Rob was watching my doctor's face, and so he knew something was wrong. I'm sure he suspected the problem right away, but he respects my doctor and never pushes his own credentials in the delivery room.  He didn't immediately say anything to me, and I was still oblivious to the undercurrent in the room.  I didn't even think it odd when my doctor wanted another colleague to come in and double check what she was feeling.  I was too busy breathing and praying in my head.

The other doctor came in and checked me, and when I heard her say "where's the ultrasound?,"  I had my first inkling that things were not as they should be.  Rob was holding my hand and he very gently said, "They have to check the baby's position, honey.  The baby may have flipped again."  Right after that, I heard the other doctor say, "Yeah, that's not a head, I'm sorry."

Well then.  There we had it.

During active labor and at 7 centimeters dilation, Septimus had completely turned and was now in a full breech position.  And I hadn't even felt him move.  He was a baby ninja.

The deceleration in his heart rate was due to him turning and compressing his cord as he went.  No one in the room really said anything because no one could believe he'd actually gone and done it.  We'd gone through the version and a full night of labor only to end up in a worse position than when I'd checked in the day before.

To say I was disappointed was a mighty understatement.  I felt completely defeated.  Even though I knew there was no guarantee that a successful version would result in a natural labor and vaginal delivery, I still felt like the rug had been pulled out from under me.  I really thought I had escaped a situation I feared terribly, and then to be thrust into that very situation?  Hard.

I remember saying, "Oh no, no!" right before I burst into tears and Rob leaned over to hold me.  I could feel my nurse grip my shoulder and squeeze it, and I heard my doctor saying, "Aimee, I'm so sorry.  I'm really sorry."   Although it was certainly not the worst thing that can happen in labor and delivery, and I'm positive it's not the worst thing they have actually seen during labor and delivery, it was comforting to know that they were disappointed too.

I knew it was decision time.  My doctor said that she was willing to do everything she could to help me have a breech delivery or I could go right in to c-section.  She left the room so I Rob and I could talk it over.

Instead of talking, I just cried on Rob's shoulder (since I couldn't move at all, thank you, stupid IV).

I was exhausted, disappointed, scared for myself and the baby, and I looked at Rob and asked him to give it to me straight.  He never treats me as a patient, but I wanted to know his honest medical opinion of the situation because I trust him the most.

I had no amniotic fluid left, so I would need an amnioinfusion to even try a breech delivery.  Plus, the baby's heart rate was showing the stress he was under  and he might not have been able to tolerate turning up the pitocin.

This was it.  This was the moment when all my joking-not-joking about a c-section was put to the test. Had I faked it enough to convince myself?

It comes down to this, Rob said, do you want to try for the breech delivery which would be less physical stress for you but much more stressful for the baby?  Or do you opt for the section, which is undoubtedly more difficult for you but much less stress on the baby.

And in the end, I didn't have to convince myself at all.  I knew right then that I would have the surgery.  If I could spare the baby even a minute of distress by having the surgery, I was in.  I felt like we had done everything in our power to make a vaginal delivery happen, but we were at the end of that road now.  It was time to call it quits.

I only had one more question for Rob:  What if I die today?   Talk about a loaded question.

I don't think Rob was expecting that because he kind of chuckled before he said, Well, that is definitely not the plan for this morning.  

Even though I've delivered six other babies and anything and everything comes with a risk, that morning was the first time in my life where I came face to face with the real feeling that I could die trying to get this baby out.  I think my bad reaction to the anesthesia made me more aware of that than anything else.

I was scared, I was out of options except for the one I liked the least, and so I did what I always do when I'm backed into a corner: I turned to my Mother.

In all the times of my life when I've felt completely desperate and overwhelmed, I have turned to the Blessed Mother.  The Hail Mary comes faster to me than any other prayer, and I firmly believe it when we pray in the Memorare:

"Remember, O most gracious Virgin Mary, that never was it known that anyone who fled to thy protection, implored thy help, or sought thy intercession was left unaided."

"Fled to thy protection."  That was me.  Fleeing as fast as I could go.  There was nothing I could do  to change the situation, so I prayed to accept it as gracefully as the Blessed Mother accepted her crosses.  And I prayed for her protection, to be held and hidden under her mantle.  I prayed so hard for that.

Rob and I made the decision for surgery shortly after 6 am, and it was like someone hit the fast forward button on life because things really started to move quickly after that.  

My doctor went to get the OB on call because, as a family medicine doctor, she delivers babies but doesn't do c-sections. 

(For those wondering, family medicine docs can, if they choose, offer prenatal care and manage labor and delivery.  They can also do c-sections if they do an extra OB fellowship, but most family medicine docs in private practice are pushed out of obstetrical care because of astronomical malpractice insurance rates due to the litigious nature of the field. Rob and my doctor (one of Rob's partners) are employees of a teaching hospital that covers the malpractice insurance.)

The on call OB, knowing the whole story and seeing my puffy, teary face,  asked how I felt about having surgery that morning.  My exact words?  "Uhh, so NOT jazzed."  But I did have the wherewithal to not follow that with, "Duh."  He was just a nice guy who was trying to put me at ease before he dismantled my innards, removed a human, and then reconstructed my mid-section.   No need to be snarky.

The anesthesiologist who had pushed all the ephedra the night before was going off duty, so she was signing out to the doc coming on duty.  The epidural catheter was still in place, but the epidural had worn off to a great extent.  My right side was definitely fully awake, and the left side was just a little tingly.

I could tell that the oncoming anesthesiologist was nervous about the whole enchilada.  She didn't like that my right side was so much less responsive than the left, and she was also not very happy about the precipitous drop in my blood pressure during my spinal block for the version.

For obvious reasons, she wanted to make sure I had very even, strong pain control for the surgery, but she also wanted to maintain my blood pressure.  We discussed using a different combination of medications, but she was very forthright and told me that if she could not get me numb enough in enough time then she would go to general anesthesia.

I've had general anesthesia and been intubated for a previous surgery and while it all turned out fine, I was hoping to avoid that this time around.  Mostly because I would be knocked out when they took the baby out and I wouldn't get to see him right away.  Even though I was extremely nervous about another bad reaction to the spinal, I was really hoping we could make it work.

I signed consent after consent, and just let things happen around me.  Rob was right next to me, and I kept praying Hail Marys.  I was praying to remain calm, to be unafraid.

All of this took place in minutes, and before I knew it, they were moving me onto the gurney and we were traveling down the hallway.  The outgoing anesthesiologist had decided to stay, and she walked on my left side and said, "Don't worry.  We're going to take care of you."

I don't even know if I could say that I was worried at that point.  I was overwhelmed, I was trying not to freak the heck out and just drive myself home, and I was thinking how foreign this all was from my previous deliveries.

Usually, I would be taking a deep breath and listening to the nurse and Rob tell me to "push, push, push." Instead, I was flat on my back, attached to all kinds of monitors and wires, and watching the bright lights on the ceiling of the hospital hallway slip away.

I didn't look to the left or the right until we reached the doors of the OR, I just couldn't take anything else in.  Rob had to stay back to get suited up, so he kissed me and then they pushed the gurney through.   Now the die was cast.