Saturday, 13 July 2019

Beano's Birth Story





Beano D. Ding-South
aka "BABY DINGDINGSOUTH"
29/6/2019 2.45AM
40+3 Weeks
Planned water birth that turned into an Emergency c-section
A Positive C-section Story


In the run up to the birthing of the DING-SOUTH Baby, I read a lot of birth stories, especially the positive ones, because all too often we only see examples in the media which portray birth as a very white-knuckle hair-pulling scream-y ordeal, so reading lots of different accounts of birth helped.

Here is our own birth story! Although this wasn't exactly the water birth that I planned, I was very happy with how everything went and most importantly I felt that we were informed at all times of our options and our wishes were respected every step of the way and George was able to take control of the situation and help me make decisions at the critical moment.

Choosing a hospital and gynae in Singapore


I was originally referred to KKH via the polyclinic - this is kinda like the default public (subsidised) healthcare that Singaporeans will receive if you don't make any specific choices on what kind of healthcare you want. KKH does what they call "team-led care" so you get seen by whichever totally random gynae happens to be on call that day. There are pros and cons to this - you get to see a lot of different gynaes and ask different doctors for second opinions on things, but you also don't have a fixed doctor, and if you have preexisting conditions you'll find yourself explaining them over and over again, and some staff may not be as understanding about certain circumstances (eg: I encountered staff who were dismissive and not very accommodating about my emetophobia and inability to swallow tablets).

KKH is known for being the best for neonatal care in the country but they also seem to treat the birth process entirely as a "medical event" and in general the hospital seems very risk averse (eg: apparently will only allow women to labour in one of two approved positions on the bed, no water birth, no birthing balls, etc). Also, when I showed one of the team gynaes my birth plan, they looked at me and said rather earnestly "In all my years here (presumably at KKH subsidised), no one has ever presented me with a birth plan..." So welp, I knew I was in the wrong place being someone with many opinions on what I wanted to do when it came to the BIRTH OF THE DINGDINGSOUTH.

My overriding concern as an emetophobe (translated: fear of vomiting) was to avoid any procedures that might cause nausea or vomiting. Fortunately I did not get morning sickness (neither did my mother when she had me) but I soon realised that other phases of pregnancy and labour involved some more nausea-inducing moments (eg: nausea and vomiting as a side effect of a lot of the pain relief methods and meds during labour, etc), so I was determined to look into alternatives...

That's how I ended up taking a Hypnobirthing course with Yen, since mindfulness had really worked with me when I previously did a course of CBT and exposure therapy with a psychotherapist for my emetophobia. With the help of the hypnobirthing course that we attended, I felt informed about the stages of labour and confident enough to make informed choices about the birth experience that I wanted to have. We decided that if the pregnancy was going smoothly with no medical complications, I wanted to avoid any unnecessary pain meds and go for a natural birth that would avoid pain medication that might cause nausea (which would add unnecessary anxiety to the birthing process).

So at 30 weeks, I told KKH that I was thinking of switching to a hospital that would do a water birth. "In which case," the random overworked KKH team gynae of the day immediately said to me (almost a bit too eagerly), "most probably you'll never look back or return here. When I hear women say they want to switch hospitals for reasons like water birth, they usually will stick to it! So we'll discharge you and give you all your medical records today!"

I switched to NUH - one of the two hospitals in Singapore that would do water births - currently the only options are National University Hospital (NUH) and Thomson Medical Centre (TMC). There are only 4 gynaes who do water birth at NUH, and I went with Dr Anupriya Agarwal, who I felt was very respectful and read through my birth plan thoroughly and discussed every point with me. The only thing that we changed on my original plan was that she told me up front that the hospital's policy was 41+3 days max before they ask you do to an induction, and I was okay with this. I was also required to get a specialised midwife (EMMa Care) who would help me with the water birth.

I decided that I wanted to labour in a hydrotherapy pool, I got me some yoga balls to bounce on, I started doing a prenatal yoga class and tried all the spinningbabies moves, I tried to walk for at least an hour every day, I did the perineum massage and breast massage recommended by my NUH gynae, drank copious cups of red raspberry leaf tea for toning the uterus, eating dates - all the evidence-based methods that was recommended. At 39 weeks the baby was measured at the 50th percentile and everything was on track for a natural water birth. "A good size for water birth!" said my gynae then...

The Birth Story




23 June marked the start of the Show with some brown discharge but no contractions. Naturally I was alarmed because this was the first time during my entire pregnancy that I had seen any sort of 'bleeding'. Over the next few days, I had an increase in the lightening crotch scenarios that made me stop dead in my tracks whilst I was walking around. Cue the furious googling of "WHAT ARE SYMPTOMS OF LABOUR?"

26 June which was the original estimated due date came and went and nothing happened.

27 June Evening we went for a long walk around the Bayfront and Gardens by the Bay - there was a light show and its funny to think of us ambulating about randomly - since it seems like a lifetime ago - when we got home I had a lot of pinkish discharge (part of the Show) and later that night I lost the mucus plug which looked like a lot of dark red gooey snot. I also began having these cramps that were akin to a menstrual cramp but pretty irregularly timed.



In the mirror: my maximum fatness before poppage, on a walk around the Bayfront

28 June 2AM in the wee hours I was pretty sure these were what you'd call surges now as they were lasting about 60 seconds and 4 minutes apart. I also felt that sitting on the birthing ball really sped things up whereas lying in bed slowed things down.

28 June 3AM after an hour of 4-1-1 surges (4 minutes apart, 1 minute long, 1 hour), we went to the hospital and proceeded to drop ourselves off at the wrong spot so we walked (or rather, I waddled) quite a distance to EMERGENCY. Looking back on this, the surges couldn't have been that terrible if I could waddle so far on my own. There I was seen by a nurse and monitored for an hour with a contraction and fetal heartbeat monitor strapped to my belly. The doc on call examined me and told us I was only 2 cm dilated, so we were given the option of going home or being admitted. Since we did not live so close to the hospital, we opted to be admitted and I was given a room upstairs first in the ward.

28 June 8AM - after a fitful sleep (being woken every few minutes by the surges) I was pleased to find out that since I was not in the delivery suite and in a room upstairs, I was allowed to eat as much as I wanted, and food service magically appeared in my room. Housekeeping also changed the sheets which was handy because I was starting to bleed everywhere into the sheets I was sitting on!



LOOK AT MY PLEASED FACE

28 June 10.30am - dilated to 4cm
28 June 12.00pm - was fed lunch
28 June 2.45pm - dilated to 5cm, so they put a contraction and fetal monitor on me again to track for another hour. I was politely asked by my gynae if I wanted a membrane sweep but I declined it and they did not ask me again about it.
28 June 3pm - was fed tea - a green bean soup
28 June 4pm - dilated to 6cm and complaining of a lot of pressure down below, I asked to be able to use the hydrotherapy pool so they moved me back down to the delivery suite below. First I was tracked on a contraction and fetal monitor for another hour to ensure the baby's heartbeat was good, and then I was allowed to use the pool at about 6pm.



The Hydrotherapy Pool in Room 12

The pool! It was a bathtub of water that was exactly body temperature (a small thermometer floating about) and I had two midwives who came in to help scoop water and pour it over me. I also had to wear the contraction and fetal monitor in the pool, but as the device does make a lot of noise (the heartbeat sound being particularly alarming, especially when it dipped or rose for no reason), we asked them to turn the sound off so it wouldn't be so distracting. I really really loved this pool - on land the surges were so strong that I was involuntarily contorting my body off the bed a la exorcist style, but in the pool I was calm, I was peaceful, I was able to do the up breathing and relax quite calmly.

I came out of the pool to be checked that I was progressing fine (and also so I wouldn't get overly pruney and wrinkly from sitting too long in the bath), but back on land the doc assessed that I hadn't really progressed so much since then. This was always a possiblity, as being in the pool might slow progress, but it also relaxed me a lot compared to when I was on land.

Since it wasn't progressing very fast, I was asked if I would accept Intravenous oxytocin, which I was indeed happy to do if it would just help move things along. Not long after that, I found that the surges had doubled in intensity. This wasn't so good as I found myself really flailing about each time the surges hit. I was reaching what my gynae had jokingly described as the phase of labour where the surges get so strong that you become completely unreasonable and want to rapidly bitchslap your husband on the face. The breathing exercises were very hard to keep to.

28 June 8PM I was checked again and it turned out that I still hadn't progressed much so they offered to break the water. At this point I was keen to get things moving as I hadn't really slept in well over 24 hours now and was getting very tired so I agreed to breaking the waters. When they did, we discovered the water was tinged with meconium (baby's first poop), which changed our plans a lot. It meant that I wouldn't be allowed to continue to labour in the pool in case of aspiration of meconium, so my pain relief options were more limited. George took the lead in asking what were our options at this point. They offered gas and we asked them what was the side effects of this, and it included my worst fear, so George insisted that they also put an anti-emetic into my IV first to make sure that any progress we had up to this point wasn't all offset by anxiety or terror.



The Nitrous Oxide

I have the feeling the gas was more of a placebo because it is meant to only take the edge off things (-30% apparently) and I don't really feel if that it had much of an effect. Or maybe it was because by this point I was becoming so tired that I was spontaneously falling asleep between each surge and thus not inhaling the gas prior to the surges, so this was all quickly becoming very excruciating. I must confess that some more flailing and contortions happened despite best attempts to focus on breathing and keeping the appearance of inner calm. Throughout this the nurses would tell us the good news that at least the baby was doing very well and the heartbeat was still very strong.

George began to ask them about our options again and the doc on call recommended an emergency c-section because of failure to progress (this also was the final outcome written on my medical report) and because of their concerns with the meconium stained liquor. We discussed this and decided that a c-section might be the best call at this point, and that it would be better to do it before the baby was very happy and not in any distress, and also because the operating team was available to do it. George also prompted me to start trying to remove my somewhat complicated cartilage and tragus piercings between surges in case we had to go to surgery. The midwife nurses also asked me to prove that I could stop flailing about so the anaesthesist could do their job - this I did the best I could, but George later said it was like all the energy was compressed into my face then. Thanks to Nurse Swan Di for maintaining the calm in the room despite all my flailing about and my increasing volume of shoutiness.

Again my worst fear in all this was of the possibility of nausea and vomiting and we had a conversation with the anaesthetist who said they could do a spinal anaesthesia instead of general. We agreed to proceed with the emergency c-section. Things got moving extremely fast from that point - they verified that the last time I ate was at tea time (many hours ago), someone came in and quickly cleaned me down and shaved me, many a form was given to me to read and sign, and then many a form was also checked again by nurses "CAN I CONFIRM THAT THIS IS YOUR SIGNATURE?" pointing to my horribly illegible squiggles made in the throes of a surge.

29 June 2AM?? Right before I was being transferred to the operating room trolley I was given a small tiny cup of something intensely sour which they told me I had to drink to neutralise stomach acids and ensure that I would not throw up. Ironically, because it was so sour, I had great difficulty drinking it as it triggered a massive gag reflex (comes with the territory of my emetophobia unfortunately). There came a point where several staff were around the bed encouraging me to chug this pitifully tiny cup of goo to help me avoid any nausea or vomiting later on. Failure to chug ensued (Not getting crunk on this Friday Night), and I could only sip at it very excruciatingly slowly with about a half dozen hospital staff watching on, ordering me to just drink it quick in one gulp. After what seemed like an eternity of awful sipping of this horrible sour thing (probably the only truly unpleasant anxiety-inducing part of this entire birth experience really) I was finally ready to go to the operating room. Someone had taken off my glasses so it was quite blurry but the room was very white and bright. I was worried that I would not be able to control myself from not WILDLY FLAILING when the anaesthetist came to do their job, but fortunately there was another nurse to help hold me in place whilst they applied a local anaesthetic before they did the spinal anaesthetic. Within 5 minutes I could no longer feel the surges which was actually a big big relief.

The surgery itself was very fast, it doesn't hurt because of the anaesthesia, and all you feel is a lot of tugging and pulling, and one's arms might shake uncontrollably. Suddenly a cry was heard and not long after THE BABY was presented in my face! The gynae also told me that it turned out that this baby was a very big baby indeed, which may have explained why I had difficulties progressing in labour. Perhaps my awesome diet of the extra days past her due date had packed on the pounds - this was a baby in the 99th percentile for height (54cm) and over a kilo heavier than the average baby born in this hospital (she was 3.9kg, i was told the average baby born at NUH was 2.7kg)



THE BIRTH OF BEANOOOOO

George later followed them up to the nursery to have her weighed and to have some skin-to-skin time with baby - whilst they stitched me up and took me to the recovery room with some fancy leg massagers. Once baby got the medical all-clear, she was brought down to me for some skin-to-skin and for me to attempt to feed her. The midwife who had aided me all night came over and explained to me how to hold her in bed.



Thanks to the Emmacare midwives and Nurse Swan Di who were there at the critical stage of my labour and maintaining calm during this full-on process! Although I didn't get to finish my labour in the birthing pool, I appreciated having the chance to try to labour in it and I felt in control of the entire process the whole time even though we had to do an emergency c-sect in the end.

Post C-Section Recovery


I felt awesome after the surgery and very much awake and happy whilst the anaesthetic had not worn off. Although I know I was meant to sleep, I was very excited and I felt like I could stay up all night and listen to baby's weird snuffly sounds. As George slumbered on the weird sofa next to me, I watched the sun come up on Saturday and marvelled at my new baby! What a strange big baby! The foot that had been kicking me! The toes I could feel squished up against my belly! The strange being which had been hiccuping inside, now hiccuping outside! And all the tiny creaky sounds!

AND THEN.... all of the anaesthetic wore off!!! It is still major surgery which does takes a long time to recover from. Plus I had a terrible racking cough due to a pre-exisiting cold (I shake my fist at you, old person who kept coughing so virulently in my direction when I went for my endocrinology checkup at SGH!). Each time I coughed this gave me a lot of shooting pain near the incision site, and I also have de quervain's disease which meant my wrist tendons were inflamed and I could not seem to use my thumb or wrist to do a lot of things that were pretty much fundamental to baby handling or getting out of a hospital bed. AHHH! The pain!

Abdominal support after a c-section: the doctor will recommend that you do at least 5-10 min of walking as soon as you possibly can. It may seem difficult to imagine at the very start but it does get better day by day. NUH also gets patients to buy an abdominal binder - this is meant to help support your abdomen which has internal stitches that take longer to heal than the external stitches. I did not find the given binder comfortable, so I later switched to another binder I bought online which was made of bamboo fabric which would not irritate my skin as much.

Coughing after a c-section: Right now the pain of the cough is fast fading but I know that in the moment it was truly seriously ailing me. I remember asking my gynae several times for reassurance that it was okay to cough. Because it hurt so much, I didn't want to cough, so the phlegm would build up into a HUGE COUGH, which was just horrible. To cope with the pain I found that sitting bent over with a pillow or hand supporting the incision site helped with muffling the sharp rude pains of coughing. Now at 2 weeks post surgery, I can safely say that the pain of coughing will subside truly and yes even a deep hacking cough will not bust your seams if you hold it all together.

Weeing after a c-section: During the operation they hook you up to a catheter and after they take it out the nurses will ask to see that you do a wee in a small cardboard bedpan - to ensure that everything still works down there. I wasn't sure if it was a matter of a shy bladder or something else, but this proved incredibly difficult for me. LITERALLY IMPOSSIBLE! The floodgates would not open! The river would not flow! The nurse recommended I turn on the sink tap and let it run so I could hear the water sounds, but this did not work. I had drunk many flasks of water and the nurse observed that my bladder was full yet I could not go! With the nurse periodically knocking on the toilet door to check that I was alright, I began furiously googling in the toilet for tips and ideas of what to do; it felt like I spent hours in there. After several very difficult wees (and worrying that the wires might have been crossed forever) I eventually found something that worked for me! - spraying some warm water over the lady parts with the hospital bidet inexplicably allowed the waters to flow although I didn't feel like I had much control over it. Anyway, I was relieved to observe that by the time I was discharged I had regained full control of my, ahem, weeing faculties.

Nursery Station on ward: The nurses and the Lactation consultant on the ward were super helpful, as well as the Nursery. Once the baby is born, it is in your room with you, you've got this little caddy on wheels with your baby and hand sanitiser and diapers and NUH swaddle cloths, and its kinda your call to figure out what to do with baby, or to ask the nurses for help with the various things you gotta do, such as BREASTFEEDING? DIAPER CHANGING? SWADDLING? EMERGENCY FORMULA FEEDING? The nurses however can also help take your baby away for a quick bath if you need a rest or sleep. TAKE THE OFFER WHEN GIVEN AND LET THEM BATH YOUR BABY UNTIL THE NEXT FEEDING TIME SO YOU CAN SLEEP.



Beano's mobile hospital crib

Afterthoughts


Why did labour fail to progress along the way? I suspect that the baby's position was a contributing factor in the labour's failure to progress accordingly. Beano was stuck in a Right Occipital Anterior position from about 30 weeks to SHOWTIME, and this isn't regarded as an ideal position - it is noted on Spinningbabies website that baby might rotate to the posterior and if so labour might have cluster contractions with slow downs and stalls (if chin is not tucked). I feel that even with the exercises a lot is left to chance - where the mother and her doula can only try to create room for the baby to rotate but the baby must actively rotate on its own.

Do some research on the possible outcomes: f I could do this all over again, I would also have spent more time looking up what were the likely outcomes, such as what a c-section would really entail. There were many things I didn't know about how a c-section worked, because I assumed that I would try my best to avoid a surgical procedure, but obviously an emergency c-section was still a possibility not to be ruled out.

Thank god for Maternity Leave!!!: Friends, colleagues and other work collaborators, I was clearly too gung-ho when I said that I was hoping to get back up and running as usual right after the birth. I haven't even figured out how to use the stroller or the baby sling yet!!! THIS IS GOING TO TAKE US SOMETIME TO FIGURE OUT!! HOW DOES I BABY LOGISTICS???

[Meanswhile the next door neighbour throws her two babies over her shoulders whilst she puts the laundry out to hang in the corridor plus she is also simultaneously able to keep a watchful eye on her walking toddlers and also have a leisurely conversation with other ladieees at the same time; next time you see a stay-at-home-mom with multiple kids don't take this kind of next level childcaring for granted, it requires SKILLZ and its VERY HARD WORK!]





COMING UP NEXT: HOW DOES WE DIAPER BABY? R WE QUALIFIED TO HAVE BABBY??? HOW DID PEOPLE KNOW WHAT TO DO WITH BABY BEFORE THE INTERNET??? HOW LONG IS IT BEFORE THE BABY LEARNS HOW TO VOICE CONTROL OUR GOOGLE HOME??? AND OTHER IMPORTANT THINGS WHICH NO ONE TOLD US...

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