true labor, false labor, and that liminal space between

Hey there! Are you alive? Me too!

I'd been having a pretty rough week at work--on call over the weekend, later days, tough cases--and starting Wednesday morning,  I noticed a change in how my body was feeling.  First of all, Thing 3 felt much lower, like a bowling ball sitting on my coccyx.  I was also noticing an uptick of contractions accompanied by back pain, which is not the usual for me (Braxton Hicks contractions usually concentrate on the front, and I'm lucky that I haven't had much musculoskeletal back discomfort with this pregnancy at all) that would come and go--I'd like to say that I was scrupulous about timing these contractions, but I was at work and running around and I really didn't have time to attend to their frequency until much later in the afternoon, when I finally had a chance to sit down.  I will also say that there were a spectrum some other symptoms that I'm too polite (read: shy) to talk about but that you can read about after searching "signs of labor" in Google.  Something was different.  Something was happening.

I'm more of the type to sort of wait things out until something declarative occured, but the one thing is that for these past two pregnancies (three? I can't remember with Cal) I've been GBS positive, which means that I need to receive at least one round of penicillin prior to delivery.  The window for getting the antibiotics (I've been told--it's been a long time since I've done Peds and I don't purport to know anything about OB except what applies to the anesthetic management therein) is four hours, and my OB pointed out on my last visit, when I was 2-3 cm dilated on exam and 50% effaced, that this is my third child, and as a faster delivery could be expected, that with signs of impending labor I should high-tail it to the hospital sooner rather than later.  "Usually I say when the contractions are every 5 minutes apart," he said, "but for you, maybe every 8 minutes."  At the point in the afternoon when I could actually sit down and look at a clock, I was having contractions about every 5-7 minutes apart.

I sat and debated what I should do for a while.  On one hand, I'd been working all day, which tends to make the old uterus a little more irritable--it could all settle down once I got home.  But other the other hand...the other thing.  I thought some more.  The kids were at home, with our nanny.  The hospital where I work is directly across the street from the hospital where I plan to deliver.  Did I want to go home, relieve our childcare, and then find myself in a situation where I had to rush back in, with two kids in tow?  Also, Joe was working at an office location more than an hour away that day.  Did he need to rush back into town?  Did he need to reschedule any of his patients for the next day, or the rest of the week?  I had no real answers, and I figured the only way to get more data was just to go in to L&D and get checked, even if I did run the risk of being perhaps overly cautious.

On L&D, they noted that I was 4 cm dilated, 70% effaced, and contracting about every 5-7ish minutes. So they had me on a monitor, put me in a bed, and said they'd be back to check me again in an hour, to see if I'd progressed.  An hour later, the same nurse came by to check--I was now having contractions every 2-3 minutes, and by her exam, I was dilated to 5 cm.  She called back the OB on call, who decided to admit me to the floor.

"I guess I should call my people at work," I said hesitantly to the nurse.  "I mean, should I?  Should I tell them I night not be at work tomorrow?"

"Oh no, you're not going in tomorrow," the nurse said.  "You're having a baby tonight."

So...OK.  I got an IV.  I got my antibiotics.  I settled in for the night with a toco monitor and a fetal heart rate monitor strapped to my gut parts.  Our nanny stayed overnight with the boys.  Joe came in with the bags and slept on the most uncomfortable couch sleeper ever.  Since I was only 37 and a half weeks at the time (I'll be 38 weeks on Sunday) they actually couldn't give me anything to hurry the process along (I've gotten Pitocin aumentation for my prior two deliveries) and I guess that was fine, because overnight, the contractions started getting more irregular, spaced out, and then kind of petered out to every 10-15 minutes.  In the morning, a new nurse came in, the kind of nurse that I would have been terrified of as a med student but now as an attending I love--a gruffly, senior nurse, direct and to the point--and told me, "You know, I don't think you're in true labor."

I said I kind of wish I had been told that before our little slumber party, but I knew in actuality it had been a tough call.  3rd pregnancy, GBS positive, seemingly regular contractions with progression on exam on admission--I don't fault the original team for tilting towards caution and admitting me "in labor."  I think my OB was torn too.  "We have two choices here," he told me.  "The risk of fetal lung immaturity at this stage is really very low, but because it's a possibility, the literature tells us not flat-out induce prior to 39 weeks.  However, it's hard sending someone home who's 4-5 cm and contracting.  I guess if we gave you Pit it wouldn't really be an induction so much as an augmentation.  But then again..." he thought some more, "you're not contracting as much now.  You said you came straight from work yesterday?"  I confirmed that I did.  He kind of cocked his head, considering the options.  "It's a bit of a tough call.  I think we have two choices.  One is we can keep you here and watch you.  The other thing is we can send you home and wait until you declare yourself there."

Having already spent a night in the hospital, I was not crazy about spending another day there unless, you know, I knew I was getting a baby out of the deal.  Also, as a former Peds person, I knew he was right--that at 37 and 4/7 the likelihood of lung immaturity, especially for a baby girl, is very, very low.  Yet...we spend our lives minimizing risk for our kids, and if she wasn't quite ready to come out yet, then I didn't want to be the one making the decision to force her out.

Don't get me wrong, I'm as ready for this pregnancy to be over as the next lady, but also, you know, I want to be a rational person about things, not like those ladies who show up to L&D at 37 weeks on the dot demanding TAKE THIS BABY OUT OF ME NOW.  I could handle a little more discomfort and waiting.  The uncertainty I'm not crazy about, nor the idea of having a precipitous delivery in the car, but...we live pretty close to the hospital, and we have a pretty fast car.  I told him I that if it was OK in his judgement, I would like to go home.

So, that's why I'm home.  After some deliberation (and I know this will seem crazy to many of you, but my OB even said that medicine is the only field where he's encountered people that are determined to work up until the very second the baby is crowning) I have decided to start my maternity leave five days earlier than scheduled.  On one hand, it kills me to not be at work when, you know, I'm not doing anything else (I've always said that a single day spent on maternity leave without a baby is a DAY WASTED--yes, I get paid for work, but it's more than that, it's the idea of being at a place where people need you and you're useful and where you're sharing responsibility with others) but I think that at this point it's the best idea.  I have to remind myself that I'm not doing my patients or my partners any favors by weeble-wobbling in at 5 cm dilated with the omnipresent risk of having to leave their case unexpectedly and emergently right before, you know, the cross-clamp comes off the aorta.  I know it sounds like an obvious decision to most people, but believe me and try not to judge too hard the medical culture when I tell you: it feels a little like a cop-out to me.

So!  Here I am!  At home!  Contracting some, a little uncomfortable but feeling basically the same (they confirmed that Thing 3's head is at -1 station which probably explains why I feel like I have a baby coming out of my butt) and I'm hoping that we'll declare ourselves one way or the other and head back into L&D sometime soon.  Today my plan is to walk around, like, a lot, though yes, I will be safe and not over-exert and hydrate adequately, given that the 5 day weather forecast for Atlanta looks a little something like this:

Did I mention that I'll be 38 weeks on Sunday?  And the next time we feel the need to go into L&D for a little visit, we're not leaving without a damn baby?  Lord.

For the craft-minded, I made that skirt (love seersucker), made a pair of boxer shorts for Cal out of the same leftover fabric, and last night made a flannel fitted crib-sheet for the baby after I realized while in the hospital that if we'd actually brought her home today, she'd be sleeping on a bare Ikea mattress.  Might as well be useful somehow, right?