Wednesday, December 1, 2010

Ava Brooklyn Plyler {12.20.08}

It's fitting to introduce my sweet, precious baby girl who will soon be two ( though the terrible two's have LONG been here...).

Here's her birth story.

Ava Brooklyn Plyler
December 20, 2008
6lbs 13oz    19.75"

I had planned on a natural childbirth including usage of the Jacuzzi tub to ease my discomfort, other relaxation measures, but no medication. I had also planned on breastfeeding past infancy with my daughter Ava. Our goal was two years old, but I had intentions on letting her self-wean at whatever age she desired. Unfortunately reality came crashing down, as did my hopes and dreams of a wonderful birth and nursing experience.

The day started as any other day, and I headed to my OB for a routine visit. During my pregnancy I had episodes of high blood pressure, but more borderline than worrisome. However at this visit it was discovered that I was spilling protein in my urine, I had extreme pitting edema, and my blood pressure was elevated as well. Because of this, I was sent to the hospital for some lab work and to receive a collection container to do a 24-hour urine test to see how much protein I was spilling in a 24 hour period. I didn't see what all of the fuss was about, I felt fine, but went along with the testing. I was over at my mom's house that evening and remember feeling overly tired and just "off". I actually wondered if I was in the very early stages of labor and secretly hoped that was it! I had planned on not letting anyone know though because I wanted to labor at home for as long as I could before heading to the hospital. I decided to lay on the couch and rest for a bit. I remember starting to feel a bit woozy and appeared pale and "off" to my husband and mother. My mom suggested it might be my blood pressure and for me to let her check it. Expecting it to be low judging by how dizzy I felt, I was shocked when it was actually topping off around 190/95. At the urging of my mom and husband I called the hospital to let the on call OB know what was going on. He very non-nonchalantly told me that it didn't sound like anything was wrong and that I had just been seen in the office that day. I told him that I just felt "off", that I couldn't put my finger on it, but my blood pressure was elevated and I'd like to be checked out. He reluctantly told me if I felt it was necessary I could come to labor & delivery.
By this time I was starting to feel rough and piled into the car with my husband while my mom drove us an hour and a half to the hospital where I would be delivering at. The nurses were very nice and chatty while I filled out paperwork after paperwork. A nurse took me back to the triage area and hooked me up to the monitor to listen to Ava, monitor any contractions I may have been having, and started checking my vitals. Blood pressure was 240/175 and she appeared shocked. I explained I wasn't feeling well and she had me give a urine sample and said the OB would be in shortly. When he came in, he looked at my blood pressures which were all hovering at the 200/100 point, my urine was showing a +3 for protein, I was having some visual disturbances, and I was hyper-reflexive. All of these symptoms were indicative of pre-ecclampsia. At this point, although he didn't say it, I could see compassion in his face and remorse for blowing me off when I had called to voice my concern earlier. He admitted me for observation that night with the intent to consult my regular OB on what to do regarding an induction or treatment.  They also did some lab work to check my liver and kidney functions which were both elevated which was indicative of HELLP syndrome. I was admitted and an IV drip of magnesium sulfate was started to keep my blood pressure from reaching a critical seizure inducing level. I was also kept on the monitor all night long to watch Ava closely. Early the next morning my OB came in, she was on call that day, and I was thankful at the time. We discussed what was going on, and after reviewing my blood work and realizing that my liver enzymes were elevated, we made the decision to begin an induction. I was 37 weeks, 5 days and they anticipated no problems since I was full term.

My induction began at 6 o'clock in the morning with the insertion of Cervidil to help soften my cervix. Immediately I was discouraged because I was told that due the magnesium sulfate and of course my blood pressure itself, I would be unable to use the Jacuzzi to labor in. I'd also require constant fetal monitoring which meant I was confined to bed. I couldn't walk, sit on my birthing ball, move, or anything - I had to lay in bed and deal with the contractions the best I could. Several hours into the induction process, around 9 o'clock, my OB came in to check me. 50% effaced and 1-2cm dilated. At this time, she started the Pitocin. Hour by hour the Pitocin was increased. By noon I was into a really good contraction pattern every 4-5 minutes and was dealing with the pain well. I began to become increasingly more uncomfortable. The Pitocin was at its maximum dose and my contractions were literally on top of each other - coming every 1-2 minutes and lasting over a minute each. One contraction hardly stopped before the next one began, some were as close as every 30 seconds. Still, I was able to hold my own and deal with the pain. Around 2-3 o'clock in the afternoon, my OB checked me and I was at 4cm - just now technically in active labor. I had been dealing with hours of artificially induced contractions that were back to back and I was at a breaking point. I wanted to keep going, but my OB said that I wasn't dilating very quickly and that Ava was still very high in my uterus. She suggested I get an epidural to help me relax and that should help to bring the baby down and help me dilate. I consented. I was prepped and given the epidural. A catheter and internal fetal monitor was also placed. Very shortly after I received the epidural I started feeling extremely tired, woozy, and found myself virtually unable to speak to let anyone know what I was feeling. Thankfully my mom realized this and also realized my blood pressure was completely bottoming out to about 55/30 due to the combination of magnesium sulfate + the epidural. At that time I received my first injection of ephedrine to bring my blood pressure back up to normal. My pressure stabilized once again and I continued on laboring. Unlike me, Ava was doing great - she seemed happy as a clam and was tolerating the induction well. Unfortunately, things are kind of hit or miss for me for a few hours as I had several episodes of near fainting and had to be given multiple injections of epinephrine to bring my blood pressure back up. I labored for hours longer, not feeling much because of the epidural. I started feeling increased pressure and also started feeling slightly sick to my stomach. I mentioned this to the nurse and she said I could be in transition, or even complete, so she would check me. A surge of energy and excitement ran through my body as she checked my cervix and declared that she felt absolutely nothing, no cervix, I was complete which meant I was ready to push!! I couldn't believe it! I did it, I was ready to push this little girl out into this world and meet her for the very first time.

She paged my OB to let her know and a little before 8 o'clock that evening my OB came in to check me and prepare the room. Suddenly my world came crashing down as my OB said that I was not fully dilated, in fact, I was 6cm, not even in transition yet. She said that at this point, after hours of labor I should have progressed more and that if I didn't show good progression in the next hour we would need to discuss other options. She came back shortly after 9 o'clock and checked me again, my world stopped yet again when she declared I was still 6cm dilated. I broke down. I didn't want to have a c-section, I wanted to birth my baby. However, my judgment and feelings were heavily clouded by the medication's side effects, and pure exhaustion. I tried reasoning with her, asking if another hour might help. She explained to me that the baby was still at a high station, that in fact she was still floating in the uterus and had not even come down into the pelvis which was most likely causing the slow dilation because there was no internal pressure on my cervix to help me dilate. She also mentioned some potential distress.  She said Ava had been anticipated 9lbs 6oz She didn't expect one hour would help, and I trusted her.  I signed the consent forms.

The operating room was prepped and I cried as I explained over and over to my mom and husband that I had failed. I had failed myself and I had failed my daughter. I was scared.  I was wheeled into the operating room alone while my husband was instructed to wait outside and my parents were ushered to the waiting room. I vaguely remember being asked to move from the bed I was on to the surgical table and I remember having trouble because I was completely numb from the chest down from the epidural. Once I finally got settled the drapes were placed, the divider was placed so that I would be unable to see the actual procedure, and both of my arms were strapped down to the table. I felt like I was an animal being dissected. My OB did a few test pricks on my abdomen to ensure I was fully numb, which I was. She told me she was making the initial incision, and I began to become upset because my husband still had not been allowed in yet. I asked for him, and she said a nurse went to get him and continued on with the surgery. At last he took his place by my head. I was shaking violently from a combination of the epidural, nerves, and pure exhaustion. I felt so torn. So excited to be meeting our beautiful daughter, but so defeated that it had come to this. I felt no pain at that time, but did feel extreme tugging, pulling, and pressure. I listen closely as a nurse was instructed to tug gently on the baby upwards while another set of hands actually pushed the baby back up and out of the pelvis.  It didn't sound like you would need to do that to a 'floating' high station baby.  Around this time I also started feeling horrible, burning pain.  I voiced my concern and it was ignored - they said it was pressure.  Seconds ticked by and I could feel myself starting to hyperventilate - it wasn't pressure, it was searing pain.  As my heart-rate started to increase more and more and I claimed over and over that I was feeling pain, the OB started to believe me. Finally a large pop, some extreme pressure, and I heard her tiny cry.
During my cesarean delivery, a very emotional picture for me as it really shows in my face the failure I was feeling.

The OB held her over the curtain for us to see and I remember looking at her very elongated head and thinking to myself that there was no way she was still floating in my uterus, she had to have been already in my pelvis to have such a molded head. Thoughts of what my OB had said to me rushed through my head. What if I had waited? She indeed had descended quite far into my pelvis, that was very obvious. If I had waited that one extra hour, would I had progressed quickly and been able to vaginally delivery her? She was whisked away to the other side of the operating room for her APGAR and as my motherly instincts immediately kicked in, I ordered my husband to accompany her. Her 1 minute APGAR was 8 and her 5 minute was a 9. She was beautiful. Her cry was the most precious sound I had ever heard in my life, yet I couldn't find it in myself to cry tears of joy, only of defeat and sadness. My husband was able to cut her umbilical cord (of course it had been severed from the placenta, but he was allowed to trim it to her belly button) which was his first proud daddy moment. She doesn't look huge, I thought to myself. An ultrasound previously that week had estimated her 9-9.5lbs. She is nowhere near their estimate. She's a tiny 6lbs, 13oz and 19.75" long. 

Ava immediately after birth, severely molded head, proof she was not floating but had indeed descended and was trying to come.

Finally, nearly 10 minutes after her birth she is brought close so that I can see her. I look at her and feel nothing. She's mine, I know I do love her, but all I can feel is regret and failure. I wish to touch her, I think to myself if I can touch her, maybe I can connect with her. I want to feel her soft, warm skin against mine. I long to be able to reach out and brush her soft cheek, or allow her fingers to grasp mine, but I can't. I'm strapped down to a table. They won't release me, and I can't touch my daughter.  Not even with a finger. By this time I'm starting to feel nauseous from the intense pain. I realize that my feet and legs are no longer numb, I can move them. I also realize I have an intense burning sensation in my abdomen and I am in extreme pain. My husband is preoccupied with our daughter, and rightfully so, so I get the attention of a nurse  yet again and explain what I feel. She brushes me off and says my epidural is still in place and I'm receiving medication, what I'm feeling is pressure still. I feel very sick to my stomach. I exclaim louder that it is not pressure, it is pain and a burning sensation. My OB hears me this time and again says there's no way I'm feeling any pain, to just relax and breath, it will be over soon. So I go on to tell her when I feel each and every staple as she's closing the surgery site. Finally they believe me and I'm given an injection of morphine and demerol. As I begin feeling woozy I look around and realize that my husband is gone. He didn't tell me he was leaving. Another startling realization - my daughter is gone. I frantically ask where they have gone, and the nurse tells me while I'm being sutured up that a nurse is escorting my husband and daughter to our room. I breath. I try to calm myself down. Inside is a world of emotions, most of which I'm having a very difficult time processing. As the drapes are taken down and my belly is bandaged a nurse congratulates me. It puzzles me. What for? I did nothing. I didn't birth my child, she was taken from me. I don't verbally express these feelings, I hold them inside my heart.

As I'm wheeled into my room to recover I'm reunited with my family. Another surge of disappointment goes through my body as I see that not only has my husband been able to touch and hold our daughter before I did, but also my mom and dad. I love my parents, I love that they were there to support me and to witness Ava's birth, but that's not how it should be. I carried her for nine months. I loved her. I protected her. I sang to her and read her stories while she was still in my belly. I may not have birthed her, but I did labor my hardest for her and go through a pretty tough surgery for her. I deserved to be the first one to hold her. It is forever burned into my mind that mommy wasn't the first connection she made. Her first connection was the OB, multiple nurses,  daddy, followed by Papa and Grammy, and finally Mommy. At last I'm able to hold her and touch her soft skin, over an hour after she was born.

Memories are very clouded unfortunately as I was still receiving IV morphine due to the immense pain of major abdominal surgery. I held her close and snuggled her and told her I was her Mommy and that I loved her so much, but that I was sorry I had failed her. She was finally here and to everyone else in this world, all that matters was that she was healthy and alive no matter how she was brought into this world. If only it was that easy for me to feel the same way. Deep down inside I held a resentment about the way she came into this world, and although I'm extremely ashamed to admit it, I think there was a small part of me who felt a resentment to my daughter even though did nothing. Her severely molded head was proof in itself that she was trying her hardest to come down and into this world. I just couldn't accept it though. I couldn't accept why I wasn't able to do the most natural thing, birth my child. Little did I know this grief and feelings of failure would follow me around like a ghost forever.
uch pain medications and I could hardly hold her steady to nurse. The nurse basically lat
Shortly, a nurse came in and asked if I would like assistance nursing. I quickly agreed and we searched for a way I could nurse. I managed, with help, to turn onto my side and nurse in a side-lying position. We did this because I was under the influence of so mched her on for me, and she began sucking. Although my memory is severely clouded, I remember feeling proud that I was nourishing my baby and had no reservations. I had my husband snap a picture, and I'm so thankful I did because it turns out it would be my one and only nursing picture. I didn't allow her out of my sight, she roomed in with me, and I held her most of the night. I remember thinking it was odd that she wasn't waking up every hour to eat, but the nurse assured me it was fine and she was just getting used to the outside world and also the effects of the pain medication I was on could be making her sleepy as well. 

Breastfeeding my precious gift.

The next morning a lactation consultant stopped by to offer assistance and I gladly accepted. As I unclasped the hook to my nursing camisole and reached to latch my daughter, the LC stopped me and exclaimed that I had "odd" nipples that were extremely flat and that I would need to use a shield in order to nurse. She's the expert, I trusted her. She placed a silicone shield over my breast and explained that it would help Ava draw the nipple out and be able to nurse. Ava didn't seem to like that very well and fussed and wasn't easily latched. The LC explained that she didn't seem hungry and that I should try later. All during the day I had problems. She didn't want to eat. When I tried to nurse, she fell asleep at my breast. I was confused and worried, yet the nurse kept reassuring me that it was normal, especially for a c-section baby. Twice I asked for an LC to come for help and no one ever came. That day Ava was taken to be weighed and she had lost 6oz. The pediatrician wasn't worried and said it was completely normal. That night, again, she didn't wake up to eat. Upon the nurse's recommendation I woke her up every 3 hours and tried to nurse. She would latch with the shield and proceed to suck several times and fall asleep.
The next day that pattern continued. Finally, another LC came to help me, only her help was not what I had expected. She also said I needed to nurse with the shield if I nursed at all, pump both breasts every few hours, and also recommended that I start supplementing with formula because of Ava's weight loss. At this point, the pediatrician also recommended supplementation because of her weight. I was frightened over such a tiny person losing weight, so I agreed. The day we were discharged from the hospital I was sent home with a case of formula and a prescription for a hospital grade pump. I also was sent to meet with another LC. I meet with the LC and she asked to watch me nurse. As I try my best to latch Ava on, the LC explains that Ava is just too small and too weak to nurse. She's now under 6 lbs, weighing in a 5lbs 10oz on her discharge date. More than a pound less than she weighed just 3 days prior. I'm given instructions to never put her to the breast for nourishment. I could put her to the breast to allow her to comfort suck, but not to feed her. I needed to pump and bottle feed to allow her to gain weight and strength. I rented a hospital grade double electric pump and am told to pump for 30-40 minutes every 2 hours around the clock. I go home very disheartened. Not only is my body broken in the respect that it can't birth a baby vaginally, but my breasts also cannot nourish that baby.

Once we are home, I begin. I pump religiously. I pump 30-40 minutes every 2 hours, day and night. My newborn sleeps while I pump during the nights. I get little to no sleep. I get up every 2 hours, pump for 40 minutes, feed her the pumped milk and 2oz of formula as well, and then put her back to sleep. By that time, it is nearly time to pump again. I pump and someone else feeds her during the day. I can't bring myself to do it. If I can't feed her the way God intended, I don't want to feed her at all. 3 days go by and she's gaining weight thanks to the formula, but I'm not doing well. I put her to the breast multiple times a day and she wants nothing to do with it. She looks at my breasts as if they are a foreign object, yet gobbles the milk down from a bottle. My milk is still not in 6 days postpartum. I attribute this to multiple causes:  my induction and cesarean, the fact that I was being artificially stimulated by a pump rather than a baby, and my emotional state at that time. Finally, 10 days postpartum my milk comes in and I can tell it's extremely low in supply because I'm not pumping a normal amount. Never once was I engorged or even felt full.

I began researching all I can. I start taking countless herbs and supplements to increase breast milk production. I take upwards of 20 pills daily to help increase my breast milk supply. I'm even given a prescription medication to boost breast milk production. The weeks go by and I watch my supply diminish. I go from a combined 2oz per pumping session, down to 1oz, and by 3 months postpartum I'm only pumping around 1oz during an entire day. That's twelve 40min pumping sessions that only yield an ounce of breast milk each day. Obviously my daughter is predominately formula fed by this point, but at least she is getting some of mommy's milk. During these months I visit the LC weekly and each week it's the same story. Don't put her to the breast, the pump does a better job. Keep pumping, keep supplementing, keep taking your herbs. I continue. I see no light at the end of the tunnel. Ava doesn't care. She wants nothing to do with my breasts or with nursing. She's content with her bottle. She's now five months old and thriving. She's getting maybe 1/2oz of breast milk daily. I, on the other hand, am not thriving. I'm depressed, anxious, exhausted, and most of all I feel just as bonded to my baby as I feel to a rock. I am much more connected with my breast pump than with my newborn daughter. After weeks of soul searching, I decide that it's time to just stop. I have to find a way to move on. I have to find a way to bond with this little child I feel like I barely know. For five solid months I pumped 12 times a day, for 40 minutes at a time only to yield minuscule amounts of breast milk. I just couldn't do it any longer. I didn't just feel like a failure, I was a failure. I made the gut-wrenching decision to quit. I threw away all medication and herbal supplements. I threw away my nursing bras. I packed away the $300 pump I purchased. I went out and bought a new stock of bottles, and I accepted fate. Ava thrived. I took over the responsibility of bottle feeding her, even though it hurt my heart each and every time I gave her that bottle. Slowly, I bonded with her. Through my pain and disappointment, came accusations. Accusations of friends and acquaintances who, in their own way, accused me of not trying hard enough. So many things I did wrong were pointed out to me. Questions about why I trusted that LC, why I didn't search out another one, why I wasn't more of an advocate for myself. Why I didn't try longer. I tried a solid five months, but should have and could have tried longer. I don't have an answer to those questions. I failed. I failed myself and I failed my daughter. There is no other explanation.

Fast forward, nearly two years later, and I'm still dealing with the pain and heartache associated with the delivery of my daughter, and our failed nursing relationship. I blame myself, and myself only for the failure. From what I know now regarding birth and breastfeeding, I wish I would have stood up for myself more. If I would have been more pro-active, surely things would have been different. I was so uneducated in both aspects of birth and breastfeeding, and if I would have educated myself more, I fully believe the outcome would have been different. Thankfully, I did bond with my daughter. So strong in fact, that she is a total and complete mommy's girl, and I'm so incredibly thankful for that. No one can make it better but mommy in her eyes. There is still a twinge of hurt when I watch an amazing, natural childbirth, and there are certainly moments where I find myself sinking back into depression when I see a mother tenderly breastfeeding her child. I am still not over the birth of Ava, but I have managed to find good in it. Because of what I went through, I have become a huge advocate for myself and for others regarding childbirth and breastfeeding. I have educated myself tremendously and know so much more now than I did then. For that, I can be thankful.
One of my favorite pictures of Ava and myself together.  Really speaks volumes of the bond we share.  Was taken on her 1st birthday.

1 comment:

  1. Your story is both tragic and beautiful. Thank you for sharing your heart like this.

    The most terrible thing of all is that this story is not only yours. SO many women experience this same bullshit... YOU are no failure! It is the birth culture of modern society which is a failure. And it is mamas like you, who have suffered from the broken system, who will bring on the revolution.

    Whether or not you birthed vaginally or breastfed, you CREATED LIFE. You are a Mother Goddess, don't ever forget that.