Attempted inducements

Dearest Ruthie:

You have a name! Ruth Tara Barkley. You arrived on August 25th at 1:54am. Before I tell you your birth story, I want to tell you about the days leading up to it. Convincing you to come out occupied my time for a good week. But it was only when we finally gave up trying to induce you to come out that you decided then was your moment, and once you decided, there was no escaping the force of your arrival.

To back up, I had reached 41 weeks, blissfully on cruise-control in my pregnancy with hardly a worry that labor hadn't come. I went in for an appointment on Thursday, a week after your due date, and Elizabeth greeted me with "We gotta get this baby OUT!" It shook me from my reverie. 

The clock was ticking. Our midwives could only deliver you at home up to 42 weeks. Anything after that required a consultation with a doctor. If the doctor determined you needed to come out, then we would need to induce in the hospital, and doctors are notoriously conservative about that kind of thing.

At that appointment, Elizabeth laid out the plan for the next week: first up was a round of mild encouragements for hormone production; if that didn't work, we would try more serious herbal inductions; if that hadn't worked by the 42 week mark, we would need to see a doctor. 

We first re-examined my due date. It goes by when the first day of your last period was, which for me was 10 months ago, back in November. I struggled to re-remember whether my estimate at the beginning of treatment had been right. If anything, it was off by only a couple of days. Now I believe that's what the problem was - I was off by two days, and you in fact, arrived just shy of the 42 week mark. Because being off by just a bit created such a huge effort on the part of everyone, I will forever mark the first dates of my periods, just in case. Or, alternatively, estimate on the other side next time I have to give a health care provider information about an estimated due date. Being considered late term is no fun. Regardless, it was too late now since it would look suspicious to change my due date.

Elizabeth's first round of labor encouragement focused on getting my body to produce prostaglandins, the hormones that ripen the cervix. Elizabeth had a ton of tricks to get the prostaglandin effort going and we tried all of them.

First up was a membrane stripping. This involves reaching up through a partially dilated cervix and gently running the fingers around between the amniotic sac and the uterine wall to detach the sac from the wall. This doesn't break the waters, it just encourages the feedback loop between softening cervix and contracting uterus. But she wasn't able to do it yet because even though I was effaced, I hadn't yet dilated enough to allow her fingers to reach the amniotic sac. Dang.

She then prescribed a slew of things, herbal and otherwise, that are prostaglandin stimulants. She noted that none of these things actually induces labor, but they all stimulate the body to make the hormones that are needed to bring about labor. She said none of it would work if my body wasn't otherwise ready, but that it was a good first wave of encouragement to see if I was ready. Here is her list:

Midwife's orders.

For the herbs, I was to drink a quart of partridge berry infusion every day; take doses of a concoction called Mother's Cordial, which Elizabeth makes herself; and take two capsules of evening primrose oil every day and insert two into my vagina every night, getting it as close to the cervix as possible. My body would dissolve the capsule and the oil was, like everything else, a prostaglandin stimulant.

We were also to have sex twice a day. Elizabeth said it was important both people orgasm - semen has prostaglandins in it, and a woman's orgasm prompts uterine contractions. Holy moses, does it ever! I mentioned that recently, it burned to have sex, and she said it was because the tissues are thinning and sensitized from all the hormones. She suggested using oil, any type of oil, olive oil, lanolin oil, etc, to help the burning and because oil on those tissues is good now anyway - they will have to do some stretching soon. The oil did the trick.

A steep hike was also on the list. Steepness works muscles in the uterine floor that prompt production of prostaglandins. Eating spicy food encourages production of prostaglandins. I also needed to spend a lot of time on my hands and knees, which drops the baby into a favorable position - scrubbing floors, picking up lint by hand from the carpet, anything that kept me in that position for a while. I needed to get in for a couple of acupuncture appointments immediately for labor encouragement treatment.

Finally, I needed to talk to you often and remind you that it was time to come out. When she said this, I was surprised to realize I actually hadn't wanted you to come out. I enjoyed being pregnant, having you with me all the time. I supposed I was unconsciously holding you in. I could tell my stomach muscles remained tensed around you, and I recognized a bit of anxiety and fear in me of the impending birth and becoming a mom. It seemed easier to postpone facing it and just keep you with me indefinitely. With Elizabeth's reminder, it flipped a switch in me that I needed to accept you have to come out. So I started mentally chanting "open the gates, open the gates" and "time to go" to encourage my muscles to remember their job now was to relax and open to let you out. I could seriously feel my pelvic floor muscles relax and open when I mentally thought that. It took a lot of work to overcome my habit of holding you in.

I left Elizabeth's with a sense of urgency, even emotional. The easy ride had come to an end and we needed to start working for this birth! I went by the apothecary's and got the partridge berry, and Vitamin Cottage to pick up everything else. I called and made my acupuncture appointments. I went for a hike and thought I felt contractions stirring, and I had mild contractions all night. Maybe things were heating up!

The next morning the contractions had waned. I went in for the first acupuncture induction. The acupuncturist felt my energy for a while, with me sitting on her couch and her hands on both my knees. Ahh, I was very high in energy. We needed to pull it down around the uterus. She stuck a few needles around my sacrum, and attached an electronic stimulant machine to them with miniature alligator clips. The electricity made it feel like someone was tapping gently on the needles. A few minutes went by and I slowly stopped being able to feel the currents; she upped the voltage. This process went on for a half an hour, and she said I got the voltage up pretty high. Sweet! The channel she was working on went on a 24-hour cycle, so the effects wouldn't be for a while, maybe even the next morning. I could reassess then and come back in for more if nothing had happened. I remained high energy all afternoon, went for a strenuous hike, then crashed that evening. I took a two-hour nap, and slept soundly all night. Nary a contraction stirred. I woke in the morning, and you weren't moving much. 

I went back to the acupuncturist. She felt my energy again and declared that everyone was quiet, sleeping and low on energy. True enough. So now the mission was to reinvigorate my system, stir up some labor energy. She put pins in the notorious labor-inducing points on my ankles and wrists, where books warn pregnant women to not get massages because it could stimulate contractions. She then hooked me up again to the electronic stimulant machine, and started the current. My pointer fingers started twitching with the waves of electricity, and all was going well. She said my shoulders and neck were tight, that we needed to unblock the energy there, so she inserted a couple pins. The instant one went into my right shoulder, all the blood flooded out of my head and I felt nauseous. I said as much. A cold sweat broke out on my forehead and it felt like my right shoulder muscle was cramping. She quickly removed all pins in me and I laid my head down. She said it had been a massive shift in my energy, the direction and type she was aiming for, but that it happened much faster than anticipated. Treatment over for that day since mission was accomplished. The whole point had been to get my energy aligned and flowing in the right direction for labor, and I'm not so sure it worked. I felt more energized after my visit and I knew it wasn't meant to actually induce labor, just create a favorable backdrop for it, but I'm skeptical. 

We stayed on this regimen of hiking, sex, and mild herbal inducements for three days. I had one night of mild contractions but they evaporated in the morning. I could stimulate contractions by walking briskly uphill, but that was just false labor. Nothing stuck around to make me think I was moving into early labor. I slept soundly for two nights, which was great for prepping for labor but disappointing every morning when I would wake up and realize nothing had happened. It was like waking up on Christmas morning, having fallen asleep with oodles of anticipation, only to find they had moved Christmas up a day. We then did the same thing over again.

Hiking at 10,000 feet to encourage labor.

By Monday morning, I was having regular, minor contractions, but you seemed reluctant to move on to labor, so we started more serious herbal treatments. As instructed, I had bought a tincture of blue and black cohosh, and a bottle of castor oil. Janelle gave me the dosage instructions over the phone to start the herbal induction. I was to take doses of the herbs every half hour for eight hours, and two doses of the castor oil in the morning. I made your dad test the castor oil to see how awful it tasted, but he reported, surprisingly, that it was tasteless. It was true! However, Janelle had recommended I shoot it and follow it with a chaser, which I tried to do, but my gag reflex was so strong I immediately threw up a bit. Starting over, I mixed the ounce of oil with a bit of juice to get it down. 

After two hours of herbal dosing, Janelle came to our house to check on me. We had a normal appointment, and she did an internal examination. I still wasn't dilated enough to allow a membrane stripping, but she manipulated my uterus some and got me to 'barely' dilated. She instructed that I start hooking up to my breast pump for 10 minutes every hour to stimulate contractions. I was thus kept busy the rest of the day between herbal doses every half hour, regular trips to the bathroom to work out the laxative effects of the castor oil, and breast pumping every hour.  

The herbs made the contractions I had been having more intense. They came every 10 minutes or so for the rest of the day. I spent the afternoon contorted with gas and diarrhea pains coupled with mild contractions. Janelle called to check on me a couple more times during the day, but it was clear that I was not progressing into real labor. 

I quit taking herbs Monday night to see if my body would pick up on the cues and fall into labor. It didn't. Instead, I continued having intermittent, mild contractions every 10 minutes. They continued into Tuesday morning. Janelle again came by for an appointment and determined I was 2cm dilated. She was able to strip my membranes, which we hoped would encourage labor. She instructed me to start the herbs again, every half hour for the rest of the afternoon, and by Tuesday evening, my contractions were every 3 to 5 minutes, but still not very strong. I spent most of the night wakened by each contraction, sleeping in between. But by Wednesday morning labor still had not come. This was getting tedious and frustrating.

Lots of false labor but nothing seemed imminent.

Wednesday was my 42 week mark, and the date at which she could no longer continue to treat me without consulting a doctor. Janelle made an appointment with one of her doctor contacts for us on Wednesday morning. A little discouraged and worried about what he would say, we made the trip to Denver to his clinic. I rode in discomfort, contractions still happening every 10 minutes or so. Once at the doctor's, we did a non-stress test on you, and you passed with flying colors. The doctor himself did the ultrasound, and said your placenta, the most important component, looked fit to carry you another week. It was only a tiny bit calcified. The amniotic fluid was high, you were very active, there was no cord around your neck, and you were otherwise in fine health. There was no reason to not wait for labor to come on its own. His conclusion: we could wait another week before needing to consult with him again about your health. Excellent news! Janelle was particularly pleased, I think this was the longest time period she had received from him. Previous patients had been granted one or two days before needing to check in again.

It is rare in standard medical care now to allow a pregnancy to go past the 41 week mark, generally, I believe, for liability reasons rather than health reasons. Most docs won't even do a biophysical profile after 41 weeks, considering the birth to be late already and so worthy of a hospital induction. This was a particular doctor Janelle has partnered with in the past. Fortunately he adheres to the philosophy that sometimes, for whatever reason, maybe mistaken conception date, the baby just isn't ready and it's worth it to give it more time to fully develop and emerge on its own.

While there he did an internal examination and determined I was 2.5cm dilated, and he performed another membrane stripping. Then I was 3cm dilated. The only downer was that the ultrasound showed you to be face-up, with your back towards my backbone, not the ideal orientation for delivery. You had been consistently face-down for weeks, and now at the very end you flipped! It would mean a more painful delivery, but could still be done. 

After the appointment, we conferred with Janelle. She suggested we lay off induction attempts totally. I was relieved. I had spent the previous two days with the alarm going off every half hour for herbal doses, and plugged into the breast pump every hour, coupled with the few hours of bathroom trips from the castor oil effects. On top of all that, the contractions had been consistent enough to make me generally feel constant discomfort all day and night. All I had done was watch old episodes of Scrubs. It had not been the most pleasant two days of my life. The thought of not focusing any energy on inducing labor was delicious. Janelle did, however, want me to visit a chiropractor to try to encourage you into a face-down position. I was hesitant, anxious to completely abandon any manipulation to induce labor and just relax, waiting for it to come on its own. In the end, you decided the issue for me.

She also suggested I try to ignore the contractions I had been having. For a few of them at the doctor's office, I had gotten on my hands and knees to breathe through them. She coached me that early labor contractions, as I had learned before, are best ignored and tolerated if a woman continues on with whatever her activity was. Janelle encouraged me to see if I could breathe through them without getting on my hands and knees to deal with them. I said I would try.

With that in mind, your father and I returned home, breathing sighs of relief that we had more time to wait for labor to come naturally, and the rest of the day open to doing whatever we wanted. Fortunately, my dear Aunt Judy and Tio David had just arrived in town, and we made a date to meet them, along with Oma Ruth, Opa Pete and Uncle Grady and Aunt Jamie for dinner at Oskar Blues, one of our favorite restaurants. It was going to be a great night, spent with family and for the first time in a week, not focused on hoping for labor!