Where Are My Pain Meds When I Really Need Them?

Ryan.

Sigh.

I don't know that I can adequately describe the intense inner turmoil and severe emotional pain my ten year old daughter causes me on an almost daily basis. Just writing that line was hard. But, since I am trying to prove myself worthy to be called a writer, I am going to give it a try.

Let me begin with labor. It sucked. I wanted natural childbirth; they strapped a continuous stress monitor on my belly and kept me on my back the entire time. Noone listened to how I wanted it. Nothing went the way I wanted it to. I was so angry I threatened never to marry her father, and never ever to give her his last name. When I hadn't dilated past 3 cms after over 24 hours of labor I overheard them discussing the possibility of a C-section. And I told them right then and there that if they were going to cut into my stomach after all of this then they might as well just go ahead and tie my tubes while they were in there. They had apparently heard this before and followed routine procedure.

They asked Damon if HE'D like them to give me an epidural.

Blissfully tanked out of my gourd, I drunkenly proceeded to council the lady screaming in agony behind the curtain next to us not to be a martyr and to go for the epidural. Since she came in begging for one, but already 10 cmns dilated, I wasn't helping anyone in that department either.

Honestly though, anyone who dilates to 10 cms without knowing it and then delivers within two hours of mild cramping doesn't deserve pain relief. (You KNOW who you are, Laura, Cindy and Tracy and yes, I am so jealous. Although, Karen, delivering in the car doesn't count in this category; for that you deserve our sympathies - and a life-time supply of narcotic relief.)

Back to the pain. I did learn, after the first one, that it does end and that it ends in joy. But the first time you're going : when will it end? Will it get worse? Will I be able to stand it? Will I be strong enough - and good and worthy enough - to see this through and to do it well? How could I do this better? (Okay those last two might be just me, the result of having an overcritical father who also happens to be an ob/gyn.)

And I'm still there - in labor - trying to bring my daugher into the world. And it still hurts and I am still wondering if it will ever end. Or just get worse. And if I am strong enough to be able to stand it, good and worthy enough to deserve joy as an outcome. Or could I be doing something better? (Thanks Dad, for that last one.)

It's harder now that she can speak and resist andfight back. At least in the hospital we were working together.

Doesn't she understand that I am trying to help her? That I only want what's best for her? Why is SHE strapping me to the bed when I want to get up and do it my way?

I brought her into THIS world. Why does she now insist on creating her own?!

Life hurts. And brings us joy.

If someone would just give me an epidural until she's out of the house, please.

Twin Birth

The obstetrical nurse on the other end of the phone line just wasn't getting it.

"I'm 39 weeks pregnant with twins, and I just saw a little tiny bit of orange and thought it might be the mucus plug, and so I'm coming in."

"Oh honey, " she tried to reassure me, "how far along dilated and effaced were you at your last checkup?"

"Not at all" I replied "see you in about an hour."

"No no dear" she continued. "It could still take hours to days. How far apart are the contractions and how strong?"

"No contractions. No dilation. And I'll still see you in about an hour. And I'm not leaving without my babies - outside of my body."

It had been a long month. I'd held off on a C-section at 37 weeks. But enough was enough! I mean my SINGLE babies had been born earlier than this! I knew I was fortunate; I'd seen the other twin moms at the hospital, 27 weeks along, groggy from medication to stop early contractions and just praying that they'd keep them in just a little bit longer. Or mothers of preemies born at 26 weeks, weighing in at one pound, while I lumbered along the corridors with TWO perfectly healthy full-term babies in my swollen belly.

I knew I was lucky, but I also knew I wasn't doing this anymore. C-section was fine with me. My next appointment was tomorrow and the doctor had said she wouldn't let me go much past 39 weeks anyway, so I was ready. MORE than ready.

I got to the hospital three hours later. Still no contractions. Just a determination to get this over with. To my relief I was 3 cms dilated. Looked like labor. I was still worried they would send me home, but then all of a sudden I had the urge to vomit. Damon pressed the emergency button frantically as I held my hand over my mouth - there was NO WAY I vomitting into the clothes hamper at a German hospital as he'd suggested! 5 nurses rushed in - Damon was really pushing frantically - and I made it into a kidney pan.

Damon has never been more disgusted. I never felt better. "YAY" I thought "there is no way they can send me home now, contractions or no." And I was right. They immediately inserted an IV catheter and prepared a room. Relief.

Trying to be accomodating, I also felt the first twinges of what MIGHT have been a contraction, at 5PM, about 6 hours after first calling and informing them I'd be a staying guest, like it or not.

Having been through this twice before, I knew EXACTLY what to do. I sent Damon out for fried chicken and fries. As the contractions increased pretty regulary, I snuck in as much chicken as I could before the nurses could tell me I really shouldn't be eating anything anymore. It felt great. Once again, Damon was less than happy, when I vomited a second time somewhere about five hours after the chicken, but I have never regretted anything less.

This was like my best delivery ever, thoroughly disgusted husband or not.

The staff also asked if I would like something to speed the labor along; some homeopathic concoction whose only ingredient I remember is something alcoholic. Now this was my kind of delivery! I didn't really expect it to work, having labored for two days with my first child and 24 hours with my second, and so I sent Damon home at 8PM so that he could sleep before the birth the next day.

By midnight I was pacing the halls and hoping I could hold them in before he came back.

I did. It took five hours total, a real breeze in comparison to the first two. I did get my epidural. Although it took a good deal of swearing and threats to get the nurse to actually insert any pain medication INTO it!

And at 5 AM, honestly just as the sun was coming up and I was noticing that the birds were beginning to sing, the little guys decided to come. Or the nurse decided I could start pushing. The epidural having FINALLY taken effect, I really could have waited as long as they wished.

Aidan popped out so quickly - as the nurse was rallying the medical team and the student nurse was alone in the room with us. Nice. Poor girl literally held him in until help arrived. Thank goodness for epidurals.

And within seconds you heard a stampede in the hall and the room filled as the obstetrical team arrived followed closely by two perinatal teams. I think the nurse handed Aidan to the doctor - probably just so he could get paid - and then Aidan went off to his team while the rest of us - the doc and at least 4 hurses - focused on getting Matthew out.

There was a bit of playing with the U/S and fetal monitor. Two nurses were pressing on my abdomen to keep Matthew from doing flips in my now spacious uterus, another was on the U/S, another at my feet and another apparently monitoring the heart because after a few minutes of fumbling - I believe the plan had been to turn Matthew from breach to head first - the doctor firmly called everyone off and told me I needed to sit up and push, NOW! In retrospect, there was some real concern with a rapidly dropping heart rate, but I was blissfully unaware at the time.

All I remember thinking, along with the U/S nurse, was "Hey, wait a second, didn't we skip a part here? Isn't his HEAD supposed to come out first?" BUt there was a note of seriousness in the room, and a couple of the nurses spoke to me softly about REALLY needing to push HARD and to do it NOW. They sat me up - and out he came. I really wasn't worried about pushing out baby number four - I'd had TWO come out before the doctors were fully in the room - and butt-first made no difference.

It was quick and I never learned what had happened. Although Matthew's APGAR was only 5, so I can well imagine it had been a heart concern.

And the doctor fairly kissed me with relief. "You can do that again any time you like" he told me before even cutting the chord.

I was wheeled out of the room two hours later - with two bundles in my arms - and the first thing I could think to ask Damon was whether we could do this again.

"I'll think about it." he answered. "But there will be NO fried chicken EVER again!" Wimp.

Pain Management and Delivery

A friend of mine, another American living in Germany permanently, recently blogged about homeopathic pain management. She wrote about being offered Arnica, a homeopathic pain pill, while in labor at a German hospital. As if these people had never heard of an epidural?

I know. I know. It's a beautiful process. It's so much more rewarding to go through it naturally.

For the first five or six hours maybe.

My first labor took 48 hours. Intense for 12. Then it stopped for 12. 12 more intense. And then the REAL part. I was totally prepared to do it naturally. I was adamant I would not need drugs. But when they strapped me to all the machines, the permanent stress test, and forced me to lay on my back indefinitely, all bets were off. Where was the bouncy ball? The walks along the hall. A warm water bath maybe? Due to earlier complications in the pregnancy, a femoral deep vein thrombosis at week 28 and subsequent anticoagulant therapy, noone was taking any chances.

And strapped to your back, with no ability to move, is NOT natural childbirth.

Funny enough, they never asked ME if I wanted the epidural. They asked the baby's father, now my husband. After an hour of telling him that we would never be married, that the child would never have his last name, and that if they had to end up doing a C-section after all of this, then they might as well tie my tubes while they were in there, the nurses asked HIM if HE would like to have me sedated. What a relief!

I was a little loopy at first - they really don't mess around with that stuff in the USA - but it allowed both of us to enjoy the experience; we still had about 6 hours to go at that point.

So, I NATURALLY opted for an epidural the second time around as well. (24 hours total labor, 12 intensive in the hospital) This time the doctor wasn't sure she could accomodate me due to my blood values - I still wasn't clotting - but she gave me a dissociative drug until the lab work came back. Okay - that was a really cool, legal drug experience. I felt the pain, but it didn't bother me at all. Hence the term dissociative: your spinal nerves receive the incoming pain signals, but they don't get transferred to your brain. Totally interesting.

I'd heard about the German aversion to pain medication during delivery, so naturally I was psyched I would be an exception. I'd need an epidural, even though I was delivering "naturally", just in case we needed a rush C-section at any time. In went the needle; I was a happy pro at this point. Interestingly, the Americans put the epidural in during a contraction, so that you are concentrating on the pain of the contraction and won't notice the needle. The Germans wait til the contraction is over so that you can concentrate on it. Whatever. I remember telling a little Asian-American anesthesiologist that I loved her, really and truly, during devliery two.

So. The needle is in the third time. And I'm still feeling the pain. A lot of it, in fact. I take the trouble to explain to the nurse that she is going to have to put some medication INTO the needle if it is at all going to work. "Didn't you practice your breathing?" she asks. This with that smug, holistic German superiority. "No, I did not practice my breathing." I less than patiently replied, "This is my third delivery, I am delivering twins, and I want my drugs." She took a look at Aidan's head trying to force itself out of the 6 cm dilation in my cervix and goes, "ooh...that does look like it might burn a little." "Pull out the catheter right now." I directed Damon in English. "Why?" he asked. "Because I am going to pee all over that lady if she doesn't listen." Apparently she understood English. I got my epidural. (Although I ony had 6 hours of intense labor this time around.)

Later, after pushing Matthew out in the breach position, causing a three layer tear that took 2 months to heal - because, you see, episiotomies aren't natural either - the nurse had the nerve to smugly come by and say, "See. That wasn't so bad now was it?" Come to think of it, the tear was probably caused by Aidan's head coming out before the medical team was assembled, with the student-nurse frantically holding it in so that he wouldn't come out before the doctor came in. (We had a similar situation with our first, but the doctor made it in with Coke can in hand, ready to catch the baby in the other.) In the case of twins, it was approximately 10 obstetrical and perinatal doctors and nurses who had to sprint down the hall, some rushing in after Aidan was already born, to handle the second shift.

Wipe that smug smirk off your face. When we tell you the kids come fast, we mean it.

I'll be honest. The German delivery was the nicest I had, maybe because I was less sedated. I actually felt Matthew come out, the first of four, and it was cool. Since he was breach, I had to sit up and I had to watch. I was way more of a participant than with the other three.

And I do feel the USA is rather careless in it's use of pain meds during pregnancy. I had a severe deep vein thrombosis with Ryan, and initially I did need some valium to withstand the pain. We later switched to Percusset, again because I needed SOMETHING. And no, Arnica wasn't going to cut it. But the doctors never informed me that the medication could cause heart defects in my baby, never explained the need for the frequent cardiac ultrasounds that final trimester. And they delivered that Percusset like it was candy. I took it every 6 hours at first, waiting until the pain in my leg became so intense that I was sweating and clenching every muscle in my body. But I was liberally ALLOWED it every 3 hours. I weaned down to once a day and then switched to Tylenol after 2 weeks. But they would have kept dispensing the Percusset indefinitely.

Would I like to try delivering without medication? There are no guarantees. If I dilate fast enough - none of this 24 hour nonsense - I think it'd be neat. I'm not against a natural childbirth. I just think that, like breastfeeding and male circumcision (another BIG no - no here in Europe), there is no right answer. Hey - maybe we can just have Damon catch the next one, and not worry about the doctor making it into the room.

I'm just tired of being lectured to on natural childbirth by smug mothers six months pregnant .....and sipping a Mai - Tai.