Hyperemesis Part IV: Birth and Baby

This is the final post of my pregnancy story with hyperemesis gravidarum. It’s the best and worst part. I’ve told the story by trimester and if you need to catch up here are links to Part I, Part II and Part III. Just a disclaimer, while I do actually have several pictures of my labor, you don’t want to see them nor do I want you to, so just enjoy the pics of my babe when she is just a few hours old.

Labor is when one of my greatest and most painful HG lessons occurred. I will preface this story by telling you that my goal was a labor and delivery with as little intervention and medication as possible. I had a detailed birth plan, involving all kinds of good feelings and  absolutely no drugs.

My water broke around 9 p.m. on a Tuesday night, following a day spent at the doctors office and then the beach. I was 9 days overdue. During that day, I didn’t feel spectacular or eat particularly well. I was stressed because as I was approaching 42 weeks, and that morning I went in for required fetal stress testing and had to make an appointment for induction. I was delivering at USCF, which thankfully is a hospital happy to handle pregnancies that are past 40 weeks.  All of the people involved in my care, from my NP Midwife to the various OB’s monitoring my ultrasounds, were very kind and supportive of my desire to have labor begin on its own. But at 42 weeks they require induction, and the thought made me very uncomfortable; I had done all the reading about the slippery slope of interventions and heard my share of  complicated birth stories.

working mom 41 weeks at baker beach on i am a working mom blog

That evening I ate a bowl of stir-fried vegetables for dinner, and I distinctly remember it was kind of gross. I went to bed around 8:00 p.m., a totally normal bedtime for my HG pregnant self. About an hour later I got back up for the first of about 27 peeing trips I expected to make that night, and surprise! I heard a pop; my water broke when I sat down on the toilet. For the next few hours I was just abuzz with excitement. I climbed back in bed to wait for contractions to kick in, and never really thought about eating or hydrating again. (Spoiler alert: huge HG/labor mistake. Typing this I can’t believe I was such a dummy. )

I “slept” off and on the the whole night, and the next morning, around 5:00 a.m., things started to get going. Contractions started. Common sense started to kick in and I did my best to hydrate, but I was at the end of a 41 week+ battle with water and it was too little too late. I started to vomit. I wasn’t too worried at first, I always barfed aggressively in the mornings. But it was the first time I had barfed pure bile in awhile, which I knew was not a good sign. During my pregnancy, bile barfing was usually symptomatic of dehydration from the hyperemesis gravidarum. I kept trying to get some water down as I puttered around my living room laboring, but it wouldn’t stay in my body. I called in my doula.

After my doula arrived and I had been barfing in between contractions for a good couple hours, I decided I wanted to get to the hospital. The car ride felt nearly as long as the third trimester itself. I was keeled over the back seat, heaving into a bucket while my husband acted as my seatbelt. We arrived, and I insisted on walking the very, very long hallway to the elevator, up to the labor triage. I had to pause for a few contractions along the way, and lots of curious passers by gave my husband dirty looks. “Why isn’t she in a wheel chair!?” Poor guy, I was too busy being in labor to help him tell them that I refused to sit.

baby girl fingers i am a working mom blog in san francisco.jpg

I triaged (6 cm dilated), and dutifully refused a hep-lock because I didn’t want easy access to drugs. (This also turned out to be a poor decision.). I was sent to a birthing room where I immediately climbed in a tub to continue laboring. I would contract and sink into the water, and then come up and barf in a garbage bin my doula was holding.

My doula brought LED candles and turned the lights off to create a calming environment. The tub did feel good- I stayed in there for an hour or two, but the vomiting really derailed me each time I felt like I could handle the contractions. It was in the tub that I started asking for nitrous, my “low-intervention” drug of choice. My doula encouraged me to keep going, told me how great I was doing. In the tub there were moments I was able to fall asleep in-between the contractions, and it felt like things actually slowed down a bit. But the vomiting. My doula and husband switched off holding a bag or bucket for me while I leaned over and heaved and heaved. Lots of dry heaving. It was so painful. And I was very dehydrated. Classic HG.
I finally asked to be taken out of the tub so I could have some relief. We went to the bed, positioned upright like a chair, where I climbed up and keeled over the back. The midwife on duty came in and we chatted about the nitrous and how I was doing. It’s a bit blurry, but around this point I distinctly remember being over the back of the bed, contracting AND vomiting at exactly the same time. Something explosively painful happened in my back which set off alarm bells in my head. It wasn’t a labor pain, it wasn’t vomit pain. (I swear it felt like a kidney exploding, but both seem to be intact so it’s really unclear what happened.) I tried the nitrous– it definitely created a distraction, but it wasn’t taking the edge off the way I imagined.
me and my girl
Finally someone medical in the room recognized that I was likely severely dehydrated since I was unable to keep liquid down. I consented to be hooked up to an IV, and they got a bag of sugar water and zofran pumping to my veins. But relief wasn’t coming fast enough, and I started asking for the other drugs. I remembering looking at my husband and saying “I don’t need to be a hero”. It was at that moment that I recognized that I could have all the plans in the world for how this was going to go, but I had to recognize my own limits. The moment when you believe one of your organs has exploded felt like a reasonable limit to me.
I was only dilated to a 7, so there was time to summon an anesthesiologist. This was the worst point of my labor– I needed to sit on the side of the bed and bend over slightly, and then hold still, so they could work in my back. This process was excruciating. I had a resident poking around back there, and he moved at a turtle’s pace. I believe I had at least 4 contractions waiting for him to get the stupid needle in. I appreciate that residents need to learn, but I will be opting out of resident anesthesiology care in the future, thanks.
Finally, the needle was in place and thanks to the previously mentioned  IV bag, the Zofran started kicking in and I wasn’t vomiting anymore. Suddenly I could breathe again.
It was late afternoon, I lay back on the bed as the epidural began to take effect and enjoyed the sweet relief of not feeling my very angry uterus. Here’s the hard HG lesson I learned, but could really happen to anyone: the thing about dehydration is that your muscles cramp up. My contractions had felt like they were 1-2 minutes apart for HOURS, but they were actually only 4-5 minutes apart. This was because my uterus couldn’t relax. It felt like one big giant contraction, for hours and hours on end.
 baby toes of my newborn baby, 2 days old i San Francisco. From iamaworkingmomblog.com
Zofran pumping through my veins, along with a crappy epidural that really only took effect in the right side of my body, got me through labor. I was able to enjoy some relief for a few hours until I was fully dilated, and then I used that mobile left side of my body to move around and get leverage for pushing. Eventually the nurses just let the epidural wear off- I was doing better when I felt the contractions to push.
(If you really want to know the details, I was a TERRIBLE pusher with the epidural. I couldn’t feel what to do, and so I spent hours, (specifically 5 hours) “pushing” my hardest with minimal progress despite my completely-dilated, fully-effaced and perfectly-positioned baby just waiting to pop out. Finally my doctor told me I was exhausted and going to need “assistance”, either a vacuum or forceps. If only she had said those words about 4 hours earlier: I was horrified at the idea, and requested just a little more time. My doctor acquiesced (because they needed time to prep the OR anyway) and while she walked away presuming I was going to require further intervention and probably a c-section, I resumed my favored over-the-back-of-the-bed position, ignored everyone else in the room except my doula, and pushed that baby out before anyone realized what was happening. My husband even got to catch her head because my doc hadn’t made it back to the room in time.)
Hindsight always feels so 20/20. But I have spent time rewinding everything about my labor and wishing, just wishing so much that I had focused on getting an abundance of nutrients and fluids in my body the moment my water broke. Or, that I had just accepted the damn hep-lock, because I likely would have been given a bag of fluids right away when I arrived– and a good bag of sugar water and Zofran prior to my contractions feeling totally out of control due to a cramped uterus could have been the ticket that kept my labor epidural free. (Did I mention I had an allergic reaction to the tape they used to keep the needle in place on my back? I did not have a good experience with that epidural. Strong dislike.)
 Ah well, lesson learned.
For the next couple of days my body felt like it had been hit by a train. (6 total hours of pushing will do that).  It was all kind of a blur, I felt almost like I was in shock for the next day or so. But I do remember how absolutely amazing not being pregnant felt. The hyperemesis gravidarum went away as soon as that baby was out of my body. It was as though the previous 42 weeks had just been a dream and that all of the sudden I was myself again. Drinking water felt glorious. Food took a little longer for me to trust again, but after a few weeks I was back on burritos and 7-layer-dip and eggs and donuts and just all of those stupidly normal things people eat that had brought me to tears during pregnancy.
I would take the sleep deprivation of a new baby over HG any day. Everyone has their tough spots in this journey of motherhood and for me the pregnancy was the trial not the newborn stage. But I know women who experienced the opposite- a fun/comfortable pregnancy only to be followed by horrendous challenges during the first several months of their baby’s life. Regardless of when we get hit by these challenges, I hope as moms we can just support and encourage each other.  There is so much comfort and reassurance knowing that you aren’t alone, and there are shoulders to lean on. I hope I can be that mom for someone. If you are struggling with HG, reach out. It’s real, it’s a big deal, and you aren’t alone.
 Copyright 2015 © i am a working mom blog

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