Labor / Delivery

Wednesday August 25 due date:

3:30 AM YW water broke, but just a stream
5:30 AM  more water discharge, like a gush.  YW called nursing line, and told to go to triage.
7:00 AM we go to the Texas Women's Pavilion hospital with YW mom after eating food and gathering supplies.
7:30 AM to 9:30 AM in triage (only 1 visitor allowed).  YW did not feel any contractions at this point, but contractions had started.  Resting and conserving energy for a long day. 
9:30 AM we are admitted to room.  It is large, with a private bathroom, recliner and couch.  2 visitors are allowed.  Since water is broken, YW has an IV lines in arm, and a fetal heartbeat monitor on her abdomen.  Inserting the IV was painful, since a vein broke on first attempt.  YW's going to the bathroom is difficult, since the monitoring machines must be unhooked and re-hooked each time.  Also amniotic fluid was leaking.  
11 AM cervix is only dilated 1 cm.  Doctor starts administering pitocin to dilate cervix.  Doctor says labor can continue up to 48 hours after water breaks, if fluids are administered.  And dilation from 6cm to 10cm is often fast.  YW is only allowed to eat clears, but was allowed jello and apple sauce.  AB and YW's mom eat food from hospital cafeteria.  
4 PM cervix is only dilated 2cm.  Nurse advises to start pain medication, but says it is too soon for an epidural, since effectiveness may weaken after 18-24 hours.  AB does back massages and encourages deep breathing, but pain worsening.  
6:30 PM YW asks for an epidural due to increasing pain.  
7 PM is shift change, so a new anesthesiologist must come.  Contractions have increased in severity and frequency (now every 1-3 min).
7:30 PM epidural is administered, and YW feels much better.  AB and YW's mom wait in a separate room during the procedure.  
8 PM cervix is only 3.5 cm dilated.  When YW changes positions, or pitocin is increased, the fetal heartbeat decreases.  All of us can see the fetal heartbeat declines on an overhead monitor, which increases our anxiety.  The night-shift OBGYN doctor suggests a C-section may be unavoidable, since the baby will not tolerate stronger contractions and pushing.
11 PM cervix is dilated 5 cm.  
1:20 AM cervix is dilated 7 cm.  While that is encouraging, the fetal heartbeat continues to decline during contractions.  YW is afraid to fall asleep, since her deep breathing and use of oxygen blow-by mask seem to increase fetal heartbeat during contractions (we could be imagining things).  AB sits in chair next to YW bed, encouraging deep breathing and resting to conserve strength for pushing later.
3:30 AM cervix is still 7 cm dilated, pitocin is restarted at a low level.  Nurse is optimistic that C-section can be avoided, but doctor suggests C-section is likely.  
6:50 AM cervix is 9-9.5 cm dilated.  Good news, since the resident and nurse say that YW will at least be given the chance to avoid C-section.  
8:00 AM next day's OBGYN doctor (Crabtree) assesses situation.  At 10 cm dilation, she says vaginal delivery is possible.  But fetal heartbeat decelerations are concerning, and baby will not tolerate pushing very long.  At this point, we do not know if a C-section is 10% likely or 90% likely.    
8:30 AM many staff enter room: delivery nurses, neonatologist.  Dr. Crabtree says vacuum will be used if possible, for extraction.  But after 3 failed attempts with vacuum, will do C-section.  Room is prepared on 4th floor for emergency c-section.  

Doctor moves to base of bed, 5 others prepare around bed.  Doctor says to push 3 times with each contractions, for a 10-second duration each.  Nurse and AB count aloud.    

1st contraction: Some nurses encourage YW pushing, others communicate need for tools or body positioning (legs/chin).  Doctor says good progress made.  All are worried when they hear the heart rate (beeping) fall after contraction.  Desperately hoping to hear the beeping go faster.
2nd contraction: Doctor said she liked the way baby turned.  Heartbeat falls again, and does not rebound as quickly.  We are worried that heartbeat won't recover: would a C-section be needed, or a birth complication result?  The heartbeat does slowly recover over an agonizing minute.  Doctor says do not push next contraction.  AB thinks this can not continue for much longer.
4th contraction: Doctor tells a nurse to prepare a table.  This is the first time we start to have hope: could everything be ok?  YW pushed, the doctor applied the vacuum.  The vacuum falls off, but the last push is enough. Tears of emotion from AB and YW seeing the baby, and knowing emergency C-section is not needed, and baby appears OK.  8:40 AM is official time of birth. 

9:00 AM Nurses say baby appears fine, and YW gets stitches.  Both eager to see what he looks like.  His measurements are taken, and APGAR is 8 & 9.  He is purple, but nurses say that is normal.   Doctor says baby would have been born without vacuum in 2 more pushes, but she didn't think baby would've tolerated 2 more pushes.  She says no obvious reason for previous heart decelerations, maybe old placenta (calcifications)?  Did not have nuchal cord (around neck).  

Pathology report came back for the placenta: the cord was hypercoiled (associated with non-reassuring fetal heart tones/decrease in heart rate). The placenta also had some calcifications and fibrin clots. The chorionic villi had increase syncytial knots and intervillous hematomas, also associated with older placenta. So in short, older placenta with some issues that may have contributed to the decrease in heart rates.