Since the moment I found out I was pregnant, I had every wish to experience labor unaltered and without any modern day intervention. I was drawn to the idea of letting my body do what it knows how to do, pulling from the strength of many ancestors who did the same before me. I wanted to be fully present without any mind altering medications. I wanted to be able to utilize alternative pain management techniques and I did not want to be bound to a bed. I am young and healthy and had no doubt that I would be capable of it.
I sought out midwives for my prenatal care and found a doula. Both which are statistically proven to lower rates of interventions including inductions and cesarean sections. In a perfect world, I wanted labor to happen on my own terms with as few interventions as possible, and while utilizing alternative pain management techniques instead of opioids and anesthesiology. I created my “birth wishes” with the assistance of my Doula and hospital.
My pregnancy had been uncomplicated and relatively easy. I had no medical issues and no pertinent medical history. I did experience quite a bit of emotional trauma when my Mom passed away on June 30, but my prenatal appointments were still going well and everything was on track for a healthy delivery. The only issue at this time was mild swelling in my legs and hands which did seem to be worsening, but this appeared to be a fairly common symptom in most pregnancies.
The days leading up to Raya’s birth…
Wednesday, July 31, 2019
I went for my weekly prenatal visit. I was 37 weeks at the time. My swelling had worsened by this point to 2+ pitting edema. The nurse practitioner told me that my urinalysis was showing more protein than normal, and that I would need labs to make sure I didn’t have preeclampsia. My blood pressure was still in a normal range at 122/84 which was reassuring.
Preeclampsia: a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and usually the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.Treatments include medications to prevent seizures (magnesium sulfate) and to lower blood pressure (antihypertensives). Ultimately, delivering the baby is the most effective treatment, although some mothers will get worse before they get better and an even smaller number will develop preeclampsia for the first time after delivery. Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year. (preeclampsia.org)
Saturday, August 3, 2019
I returned to work for the first time in six weeks since returning from Illinois. Being a nurse, and a generally anxious person, I decided I should check my blood pressure before my shift ended. I did this thinking that would be normal— and a way to ease my worries about my last prenatal visit and the possibility of preeclampsia. I was in disbelief when it read 168/98. I wasn’t symptomatic. I wasn’t experiencing headaches, visual changes or right upper quadrant pain — all the things they screen for with preeclampsia. But I could tell my swelling had gotten worse. I decided to check my blood pressure a few more times only to find that it remained consistently high. After a few hours of high blood pressure and back and forth texts with my friend who is a labor and delivery nurse, I decided it was time to call my midwife. I knew what she was going to say, and I was right. She advised me to come straight to the hospital on my way home from work. According to her, the best case scenario would be a few hours of monitoring, and if my blood pressure returned to normal, I could go home. “Worst” case scenario would be a diagnosis of preeclampsia and an immediate induction. I quickly texted Brian a list of things to bring to me, got in my car to head to the hospital and called my Dad. When he answered, I instantly broke down. I was not ready for this. I had just recently returned to Colorado. We had nothing ready for the baby. Our house wasn’t ready— it was scheduled for a deep clean and priming/paint job that following week. I was not remotely emotionally ready— I was still actively grieving the loss of my Mom and felt so unprepared to become a Mom myself. The idea of being thrown forward into a new reality was terrifying to me. Especially a reality that I seemed to have no control over. I already felt like I was failing my child by being so unprepared.
1600: When I arrived to the labor and delivery unit, they hooked me up to continual fetal monitoring and drew labs. I appeared to be having contractions, but I couldn’t feel them. Shelley, my midwife, came in and discussed the plan with me. My blood pressure was not coming down. My urine protein levels were much worse than they initially expected. It was decided that I needed to be treated for preeclampsia immediately and be induced. I was going to have my baby whether I was ready or not. I was handed a box of tissues as part of the “preeclampsia starter pack” and cried some more.
Just a few nights before this all happened, I had a prenatal appointment with my doula, Mandy, where we discussed some common things that may come up during labor. And one of those things was induction. Because of this, I was prepared for what would come. I was familiar with all the different medications and techniques used to induce labor. They were going to start with several doses of an oral medication called cytotec to soften my cervix, followed by a foley bulb to dilate, and a pitocin drip to strengthen my contractions.
But something I didn’t realize, or even think about, was the treatment for preeclampsia— a magnesium drip to prevent seizures.
Magnesium sulfate: Used to prevent eclamptic seizures and stroke in pregnant women with preeclampsia. Increases the length of labor, risks of cesarean section and postpartum hemorrhage. Magnesium crosses the placental barrier and causes flaccidity, hyporeflexia and respiratory depression in the newborn.
I’m familiar with magnesium as I’ve given it to patients before, but never at the dosage or rate that preeclampsia patients receive. “This is going to make you feel really hot so we’ll get you some ice packs. You might feel like you have the flu. It will make you really dizzy too, so you’ll need to be on bedrest and high fall risk precautions. Because of this you’ll have a catheter in your bladder” they told me. One hour prior I was working a shift in the ER, managing several high acuity patients at once, and here I was being placed on bedrest for the duration of my labor. So many things were happening that I had absolutely no control over. After 30 minutes of receiving this medication, I quickly understood what they meant. My skin was on fire. I felt like I got hit by a bus. My vision was delayed and I had trouble tracking with my eyes. I could hardly see my phone. My body felt heavy like it does from laughing gas at the dentist. When I’d get up to use the bathroom (since I rebelliously declined the catheter), it felt like I was walking with someone else’s legs. It was without a doubt the worst feeling I have ever experienced, and it was to continue throughout the duration of my labor. I texted my doula, Mandy, to let her know what was happening. At this point I was 0 cm dilated… which meant this would likely take a few days. One of the most helpful tools to help labor progress is walking, and this was out of the picture for me, so Mandy suggested I sleep and rest as much as possible. So I sent Brian home to get the house “ready” and took a Benadryl to sleep in between the several doses of medication that I received throughout the night.
1900: Dose of oral cytotec.
1100: Dose of oral cytotec
0300: Dose of oral cytotec
Sunday, August 4th:
0700: Brian arrived back at the hospital. The oncoming midwife performed a membrane sweep and at this point I had slightly progressed to 2 cm.
0800: IV Pitocin was started.
1300: I had not progressed with the PItocin so the midwife attempted four brutal attempts to insert a foley bulb to dilate my cervix with the goal of reaching 4 cm.
This was without a doubt the most painful part of the entire process. Although an epidural was never my initial plan, I decided that I would not make myself suffer through an induction but I wanted to hold off for as long as possible to prevent any adverse reactions to myself or baby such as prolonging labor or impacting baby’s heart rate. I mentioned earlier that I wanted to be in a clear mind during labor, which is also a reason that I never intended on getting an epidural, but my mind had already been altered by the magnesium. I was already delirious and confused, thinking I had been moved to several different rooms when in reality I had never left my own room.
But I was nowhere near ready for the epidural yet. Within the next hour, my contractions increased immensely. The side effects from the magnesium were also worsening. I could hardly move myself around in the bed. With help from Brian, I got myself into a few more natural positions but found it difficult to manage with all the cords, lines and tubes. My vision and mobility was getting worse so my magnesium levels were rechecked. Those results indicated slight magnesium toxicity so my infusion rate was decreased, and this helped a little with those symptoms. I clung to the back of the bed with a moist warm towel while trying to deal with the intensity. I had already reached the maximum infusion rate for Pitocin by this point so it was a waiting game to see if the foley bulb would work.
1630ish: Evening rolled around and I was starting to run out of pain management options that were compatible with bed rest. Brian had been texting with Mandy, and she sent him over some different techniques to try including counter pressure on my hips and low back. I found those to provide such a relief from my contractions.
2230: I began to feel like I needed Mandy there. I was losing hope and patience and the intensity of my contractions continued to increase. She arrived and provided additional support and allowed Brian the opportunity to rest while providing counter pressure every 3-4 minutes throughout my contractions, as well as helping guide me through them and allow my body to relax.
Birth Day, Monday, August 5th, 2019
0100: The foley bulb was removed. I had only reached 4 cm by this time, so the plan was to continue Pitocin, which had been stopped and restarted to “reboot” my system.
0500: The next few hours seemed to intensify. Eventually my midwife came back and rechecked me. I was 6 cm and she explained that she wanted to break my water to get things going. She explained that our time was running out to ensure a healthy delivery for me and baby. At this point I had gone through 35 hours of induction without any pain medication, and I had reached a point (6 cm dilation) where I felt comfortable getting an epidural. I discussed my remaining concerns with my midwife and she assured me that my biggest fears would not come to life: this epidural would not prolong my labor and I would not end up in the OR. After sitting with me through several cycles of contractions, she told me, “I know you could do this without pain medication. I have no doubt. But you need to realize that we are dealing with a disease and labor here. This isn’t a normal circumstance.” I needed to hear that. I needed to hear that I didn’t need to suffer. Mandy also told me about another client who opted for an epidural, and shortly after her labor progressed. The epidural allowed her to relax enough to let her body take over, and that’s exactly what I needed.
0530: It seems like we waited forever for the anesthesiologist to come. By this point, my fear of the actual procedure had seemed to dissipate and I was anxiously awaiting the relief it would bring. But if I’m being honest, I felt him hit bone. Apparently my swelling had spread to my back, too, making placement a little more difficult. The anesthesiologist administered an immediate dose of Fentanyl (opioid pain medication) through a spinal needle (CSE), then placed the epidural catheter for continual pain relief.
0630: The following hour was much different than the previous 35. The side effects that I dreaded from the magnesium seemed to lessen with the dose of Fentanyl I received. I could actually move easier. I felt “light” instead of “heavy”. Mandy and my nurse helped me utilize the peanut ball in a side lying position to help open everything up for labor. Once the first dose of medication wore off, it appeared that the epidural had failed. My nurse mentioned that we should call the anesthesiologist back but I was not interested in trying again.
0730: It was around this time that I started to feel differently. I asked Mandy how I would know if it was time and she told me I would feel an immense amount of pressure… It was time. I had previously joked that my baby would probably be a shift change baby, and right as day shift had arrived, the oncoming midwife, Karen, came in to check me and I was ready. They started to prepare the room for delivery.
Around 0800: I can’t quite explain the determination that came over me as I realized it was time for my baby to be born. I felt overwhelmingly calm and peaceful. I had Brian and Mandy in the room with me, as well as pieces of my Mom. I had a picture of her and I, and an angel figurine she gifted me. I had sage and sweetgrass above my bed. Brian asked if I wanted my birth playlist on, but I felt so content with the silence of the room. Karen helped coach me through each contraction, and after four cycles of contractions and approximately 24 minutes, our daughter was born. Before my last push, Karen told me “Your baby needs to be born with this push” and she was. Born at 8:38 AM, with natural sunlight lighting up the calm energy of the room. We watched her entire entrance through a mirror. As soon as she came earth side, Brian announced “It’s a girl!”
After Raya’s birth: Due to the magnesium infusion I was receiving, Raya was not breathing when she was born. Her cord was wrapped around her neck twice and she was blue, limp and unresponsive. She didn’t cry. Brian cut the cord and she was taken to the infant warmer where the NICU team was on standby. Also due to the magnesium, I lost three times the amount of blood for what is normal for a vaginal birth, and received three different medications to stop the bleeding. After we were both stabilized, I was able to hold my healthy daughter for the first time. Shortly thereafter, we had our first latch and were able to breastfeed.
Several hours after she was born, we decided on her name, Raya Kaye Wolf. My Mom’s middle name was Kaye (pronounced “K”) so she was named in memory of her grandma who loved her so, so much. I heard the name Raya (pronounced ray-uh) and loved how it sounded with the middle name Kaye. I googled it several weeks prior, and found that it meant “sent from heaven” so it was perfect for her. We also like to say she’s our little ray of light. My Dad arrived around 3:00 pm and got to meet his first grandchild, his granddaughter, who he loves so much.
For the first few days, it was hard for me to cope with how things happened. It still is a little difficult to accept. It was hard to hear people say “Glad Mom and Baby are healthy!” without knowing what we went through. It was hard to hear people talk about how magical birth is when I felt like my birth experience was robbed from me. Luckily I have photos to look back on, and I am able to relive the experience that seems so cloudy in my memory. And throughout it all, I had Brian by my side. I have always known that as long as he is by my side, I can get through anything.
With today being Raya’s due date, I can’t help but find myself wondering and longing for how things would have happened in a life without preeclampsia. All I know is that I was given two additional weeks with my daughter than what was initially planned. And as someone who realizes exactly how valuable that time is, I can look at her and be content with this reality. In these two weeks I’ve grown to love her little whimpers, her smiles in her sleep, the way she looks up at us and examines the world around her, the way she thrashes while rooting and the way she instantly calms down while listening to “Earth Angel”. Because that is what she is.