Serge Constantine, a few hours after he was born. Called by his middle name or “Costa” for short.
My son was born at 6:10 PM on Sunday evening. I had been in labor for just around 8 hours, and had only been on the 1-2 ml/hr Pitocin drip for the first 5 hours. Beyond that (and the attendant continuous fetal monitoring), the only intervention that was used was the vacuum extractor.
Constantine was placed on my chest immediately, snuggled up under my hospital gown skin-to-skin with a warm blanket placed over us, and he stopped crying almost instantly. He was very awake and alert. They waited for the cord to stop pulsing, then clamped it and asked my husband if he would like to cut it. My husband is rather squeamish about blood, so he kind of surprised me when he said yes and did the cutting. He came around to the side of my bed to look down on the two of us, and I noticed that he had tears in his eyes. As for Costa, I thought he looked like a little cherub, so chubby and with golden blonde hair. (The blonde hair really, really surprised me. My husband and all of his siblings have dark brown or black hair, and my natural hair color is medium golden brown. But all of my siblings were blonde as babies, so Costa seems to have gotten those genes or something.)
The shower was heaven. There was a chair in the shower, and I sat on this backwards with my legs straddling it, leaning on the back of the chair and letting the hot water roll over me. Having pressurized hot water sprayed on my back while I was contracting made it so much easier to work through my pain. I did feel my contractions slow down a bit now that I was off the Pitocin, but they did not stop or decrease in intensity. I immediately decided that if they wanted me to stay in the shower for only 10 minutes, they would have to come and tell me to get out themselves. I wasn’t going to time myself for them. I could still feel my baby moving while I was in the shower, so I felt pretty sure that he was okay.
I’m not sure how long I was in it, though I’m sure it was somewhat longer than 10 minutes, but I did get out when they came and told me it was time to get out. We tugged a new gown onto me and they said they wanted to check me again. I had one contraction while I was laying on my back being checked, and it was torture. My doctor announced (sounding a little surprised) that I was a 7 now. “Told you I was fast,” I said. He said there were two other things to discuss with me. One was that they had decided that it would not be necessary to put me on magnesium for my high blood pressure, so that was good news. The other was that they wanted to give me the option of breaking my water and putting an electrode on my baby’s head. They said this would “improve [my] mobility,” and I just thought, “say what??? How would an electrode coming out of my vagina improve my mobility?” I think they were really just tired of my monitors sliding around and falling off and wanted to keep my baby soundly monitored for the rest of the labor and delivery. I declined the AROM and the electrode just the same.
I noticed that they did not hook the Hep-lock back up to the IV cart (I’d already had two doses of GBS antibiotics by this point). I was off the Pitocin and on my own for good. My doula later said that this really surprised her, that she almost never sees deliveries where a patient is taken off of Pitocin once it’s been started. I think it goes to show that my team really was trying to respect my wishes for a natural birth, even though some interventions were needed.
My doula arrived quickly, probably between 10:30 and 11:00 AM. I brought her up to speed on the Pitocin, the continuous fetal monitoring, and the conflict over eating. None of it surprised her. She said we would still move around the bed as much as possible and do all of the pain relief techniques we had discussed before, minus walking the halls of the labor ward and using the shower. My contractions had started not long after the Pitocin had started, and it wasn’t very long before they were only 2-3 minutes apart, though they still weren’t very hard. I could still talk and joke around them and sometimes through them. Over the course of that morning I watched an episode of Breaking Bad, most of a Korean film called The Good, the Bad, and the Weird, and maybe half of Happy Gilmore.
Meanwhile, my doctor had left for church, saying he would be back around noon. I was fine with this. We’d talked about religion enough for me to know that he was teaching senior high Sunday school that day and it was kind of important to him, and it was unlikely I’d deliver within 2 hours of being on a 1 ml Pitocin drip. I think he had also come in on his day off to deliver my baby, having not pushed me to induction the day before when he was scheduled to be there. Around 12:30 PM, my contractions were getting a little more intense and I said, “Where the hell is Sark? Tell him church is over, time to play doctor!” He came in around 1 PM to check my cervix, and he also brought me what I thought was a piece of Eucharist bread in a napkin. “I didn’t think you Greeks were supposed to give this to us heterodox Protestants,” I joked. (I later found out from my very high-strung Orthodox pal that it’s called the andidoron — Eucharist leftovers — and they’re allowed to share it with anyone. So that was a nice gesture on his part since I couldn’t go to church that day.)
He wanted to check my cervix, and it’d been over three hours since the last check, so I went ahead with it. I was only just past a 3. He said that was fine though, we were seeing cervical change so that was good. Inside I was a bit discouraged. 3 hours of contractions had only gotten me a lousy 1.5 cm? Then I reminded myself, Just get to a 4 like last time and see what your body does… We increased the Pitocin dosage to a 2 mL/hr drip just the same. It never got higher than that.
I gowned up and let the nurse come in and strap me to the monitors. At some point, my doctor did a cervical check and said I was only about a 1.5 and 50% effaced, so the plan was still to start with a Cook’s catheter and then do Pitocin later on. I assumed that the monitors were just for another NST and that I’d be getting off of them later; shows what I knew. The nurse said something about starting my IV, and I asked her if I could do a Hep-lock in case the induction went well so that I could be off the IV later on. She said “no,” and I asked her to talk to my doctor about it. She came back and put something in my arm; I didn’t learn until later whether it was an IV or a Hep-lock.
Sometime later I was still being monitored and they had not started the induction yet, and I was getting hungry, so I began to eat some of the snacks in my labor bag. That’s where the trouble started. The nurse saw me snacking on a protein bar and a bag of trail mix and said, “Okay, but you can’t eat when labor starts.” I asked why and her answer amounted to “because I said so.” We argued about it until I finally blurted out, “Who’s going to stop me? Talk to my doctor about it, it was in my birth plan.” She left the room.
Around 9:45 AM, my doctor came back, accompanied by his attending and one of the other residents. “Did the nurse tell on me?” I asked. He kind of shifted uncomfortably, then said it was okay if I wanted to eat in early labor, but they didn’t recommend it and they really, really recommended that I not eat at all in active labor. I said I wasn’t making any promises. Then I said, “Non-stress test is over, can we get these monitors off me now?” And that’s where more trouble started.
[Though this is part 1 of Constantine’s birth story, the story really begins with the discussion leading up to my induction.]
I spent the day before my induction trying to do all of the following:
- Clean the apartment. It wasn’t in too bad of shape, but I wanted to come home to beds that were made, clothes that were folded and put away, a sink that was not full of dishes, etc.
- Praying, meditating, and trying to relax. I called my pastor and she came over to my apartment along with one of the female interns from my church, and my pastor prayed for me and blessed me. I reflected on some passages in the Bible that I’d found inspiring (maybe more on those later). Much later, at 3 AM on Sunday morning, I woke up and read through all of the accounts of Gethsamane in the Synoptics. Never had I felt closer to Jesus’ admission, “My soul is overwhelmed with sorrow to the point of death.” Or to his prayer: “My Father, if it is possible, may this cup be taken from me. Yet not as I will, but as you will.” By that I mean that I really, really did not want to be induced, and was still holding out hope that maybe my labor would start on its own or my blood pressure and protein tests would return to normal and I would be allowed to wait a few more days. However, barring that, if induction was the recommendation I was going to accept it.
- I called the people who were going to watch our daughter for us while we were in the hospital and told them that our daughter would be dropped off the next day at around 6 AM. We’d drop her off earlier on the off-chance that I did go into labor spontaneously that night, but otherwise Sunday morning was the limit. I double-checked my daughter’s overnight bag to make sure it was all ready for her.
- I finished gathering everything I needed into the labor and delivery bag.
- I kept a religious eye on Constantine’s kicks and movements and watched out for all of the signs of pre-eclampsia that my doctor had told me to watch out for. I knew that he felt like he was taking a bit of a risk letting me go home for one more day, and I didn’t want to let him down.
- I did my share of bouncing on my exercise ball, and I even went ahead and tried sex with my husband that night (even though I don’t believe sex helps induce labor, I thought what the hell, we’re probably not having it again for six weeks at least).
- I put my doula on notice that it was probable that I would accept the induction the next day.
I did have weak contractions 10-15 minutes apart for about 1.5 hours that night, falling asleep to them, but when I woke up at 3 AM the next day, they were gone. I was also beginning to lose small globs of mucus plug, though it was all white and yellow, no pink or red.
- “Full-term” (37+ weeks) yesterday. Yay! (The word “full-term” is in quotation marks because “term” is really more of a spectrum, and many babies are not really ready at 37 weeks. But from here on out, I can now say that my child was born full-term and not as a preemie.)
- Tested positive for GBS. Boo.
- My hot doctor says he’s perfectly fine with me having a Hep-Lock installed and only being tied to the IV cart when the anti-GBS antibiotics are being administered. Yay!
- Hot doctor is going out of town for his sister’s wedding from September 13th – 22nd. My due date is September 20th. So there’s a very real chance that he is going to miss my delivery. Boo.
- Hot doctor is lining up two possible back-up doctors for me and he swears that they are natural-childbirth-friendly and will be fully advised on my birth plan. One of them I have seen a few times this pregnancy (the other hot doctor) and one of them I have never met before. Yay?
I had a fantastic, wonderful baby shower one week ago. There were a few disappointments, but overall it was lovely. The members of my church really went all-out for me and I’m overwhelmed by their love and kindness.
I’m done buying most of the essentials for baby. I’ll just be ordering my crib/changer combo this week. Still need to finish my cloth diapers; going to shoot for finishing just the newborn ones, and work on the other ones while on maternity leave.
I wish my daughter had not been born the way she is.
There. I said it.
What I was doing today.
Here’s how my amniocentesis went:
I arrived at the maternal-fetal-medicine clinic, which is in a different hospital from the one where I usually see my doctor. The first thing they did was to send me to the lab to have my blood drawn because I’m Rh-negative and they needed to prep my RhoGam shot. Had the blood drawn from my left arm and headed back to the MFM clinic.
A genetic counselor called me back to her office and we spoke for 20-30 minutes. We talked about the genetic problems in my family and my daughter’s diagnosis of 22q11.2 deletion syndrome. I said that, while I believed my daughter’s condition was a de novum appearance of the disorder in my family line, I had felt so much grief at my daughter’s birth with a new doctor coming into my room every few hours to tell me something else was wrong with my daughter, it had just been overwhelming. If I was going to have another child with special needs, I needed the time to grieve and adjust.
I mentioned in a previous post that on the night connecting January 4th to January 5th, I had a dream wherein my hot doctor told me I was pregnant. I left out of that post a significant component of that dream. This was part of my actual journal entry for Saturday, January 5th, 2013:
I had such a strange dream last night. I dreamed that [hot doctor] . . . somehow managed to do a pregnancy test without telling me–which is weird, because I don’t recall giving him any blood or urine. And he was so delighted and excited to tell me I was pregnant. But I was annoyed with him for doing a test without my permission.
I woke up and the thing that excited me most about the dream was that oneiric hot doctor had told me I was pregnant. I thought about the other part of the dream–the part where he tested for pregnancy without my permission–and thought, “Woman, you crazy. He can’t do a pregnancy test unless you give him blood or urine.” So I put that part of the dream out of my mind and only told people about the part where the doctor told me I was pregnant, especially once I got my first positive pregnancy test at 12 DPO.
I spent some time Googling up some information on sub-clinical hypothyroidism (SCH) and pregnancy today. It seems like there is a lot of debate among physicians on whether it needs to be treated or not. Some studies have suggested that SCH does increase the risk for adverse outcomes in pregnancy (though not nearly as much as overt hypothyroidism) and some have found that it doesn’t. This article sums it up pretty well:
Experts agree that overt hypothyroidism should be treated for both maternal and fetal benefit, but whether SCH should be treated is less certain. Although the risks for pregnancy complications and fetal neurologic damage are far from clear, available evidence suggests a possible risk for adverse outcomes. Levothyroxine treatment is relatively cheap, safe, widely available, and well tolerated; however, the 2 prospective interventional trials (ie, Negro and colleagues and CATS) had negative primary outcomes. This leaves the clinician who diagnoses SCH in a difficult position. ACOG recommends against “screening and treating” SCH in pregnancy, but does not directly address the situation if it is found incidentally or by means of risk factors. Other endocrine organizations, such as the Endocrine Society, and the American Association of Clinical Endocrinologists, do recommend treating SCH in pregnancy. Given the lack of clear guidance from the literature, it is reasonable to leave the treatment decision up to the individual physician and patient.
Physicians should exercise caution when interpreting maternal FT4 levels. Method and trimester-specific reference ranges should be used when available. Although some studies have found an association between SCH and pregnancy complications, including increases in abruption, preterm delivery, and pregnancy loss, others have not. Nevertheless, theoretical concern surrounds SCH and the risk for neurologic impairment in the fetus. More studies are needed to confirm and define this risk.
If SCH is diagnosed either by symptoms or by risk factors, insufficient evidence exists either for or against a recommendation for treatment with a low dose of levothyroxine. Universal screening of all pregnant women for hypothyroidism, overt or subclinical, is not currently recommended.
I called my health system yesterday to leave a message for my hot doctor and ask if he knows yet what dosage to put me on, and he managed to call me back just a few hours later. I’m now on 50 mcg of levothyroxine a day. I haven’t heard back on my Free T3 yet.
While the evidence is divided, in my case (and assuming that my FT3 is normal and I really am SCH), I’m glad that we’re treating with a low dose of levothyroxine given how much my TSH has risen in 4 months. Now I can understand why my doctor chose not to treat before I got pregnant, and knowing that my risk of adverse outcomes in pregnancy are much lower than it would be if I had overt hypothyroidism puts my mind at ease.