Pregnancy Over 40: Weeks Thirty-eight through Forty

Week Thirty-Eight

Those aren't Braxton Hicks contractions - those are the real thing! I've been continuing with twice weekly fetal non-stress tests.  During Tuesday's test, my OB/GYN poked his head in half-way through and asked "How are you feeling?  Are you in pain?"  I was in a little discomfort, but hadn't been thinking much of it, and said so.  Basically, it felt like really unpleasant menstrual cramps, but would subside and reappear throughout the day.  He pulled the print out off of the NST machine and it looked like a Richter scale.  He pointed to the bottom of the page, where a series of small waves bounced across the page with the reliability of any favorite ocean shoreline.  I was having *real* contractions, every two to three minutes. 

"Am I in early labor?"  I asked.  My OB/GYN shook his head and said "I can tell by looking at you that you're not in labor."  He was right.  That was exactly one week ago, and although the contractions have increased a bit in duration, intensity and frequency (and I've dilated to about 1.5 cm), I have no other signs of labor.  It would have been easy to pass these off as Braxton Hicks, but they are different for two reasons:  (1)  They actually come in a regular, "timeable" pattern - but then they go away; and (2) They are actually doing some work in terms of dilation, which genuine Braxton Hicks will not do.   I have basically entered into an early-early stage of labor sometimes referred to as prodromal (or "precurser") labor. 

My poor stomach

The contractions are not strong enough to dilate my cervix very much, but they are intense enough to give me a stomach ache almost every single night - at three in the morning.  There are no dietary changes to manage this, because it's largely brought on by the presence of prostaglandins in the body.  I ate rice for dinner with a little salt and pepper on it and might as well have entered a hot wing eating contest.  My stomach feels like confetti and this is an almost daily occurrence.  I keep telling myself that this is just part of my body's natural instinct to make extra room for the baby during delivery by, well, not letting me fully digest any food ever. 

Hello Darkness My Old Friend

For some reason, contractions like to hit at night.  It's not an Old Wives' Tale.  It has been over a month since I've slept past four in the morning.  Now, I reliably experience my most painful contractions around that time (hopefully the nurses on the early shift at our labor and delivery ward have a steady supply of coffee going!) I've actually adjusted to this new schedule and find myself with a decent window of energy between four and nine in the morning.  I'm beyond grateful to have taken a week of vacation from work prior to my due date, because this schedule was leaving me feeling absolutely exhausted and overburdened. 

Spinning Babies Daily Exercises

Since these are real contractions, they can get pretty intense.  I pull out the following stops to manage the pain.  First, I pull out an old fashioned heating pad and keep it focused on my glutes and lower back for about 20 minutes at the lowest setting.  If you use a heating pad, be sure to keep it away from your tummy and be cognizant of overheating.  Second, I get up and chug water.  Third, I pull out a yoga block and sit on it in a deep squat position, resting my back on the side of my bed  for extra support.   Fourth, I get my Tone it Up beach ball and sit on it, doing at least forty hip tilts and forty hip circles.  If I'm really in pain, I'll kneel and just wrap my arms around the ball, letting it support my upper body.  Then, I'll remind myself over and over about some article I read on Pinterest that said that having prodromal labor was associated with a shorter delivery time.

Sense of Humor

It isn't all that easy to be in pain on a daily basis with no way of knowing when your actual due date will be!  Plus, although I'm grateful to be finished with the burden of getting ready and going to and from work, I miss the distraction of it!  Humor puts everything in perspective.  It's pretty easy to find humor in these last few days or weeks of pregnancy.  My nesting instincts practically had me installing a Dewey Decibel system to our refrigerator.  My belly is so big that I have "sharms" (i.e. short arms) and can't even reach the lowest top cabinet in our kitchen anymore.  My maternity shirts have become crop tops, giving my wardrobe a sexy Winnie the Pooh vibe. 

NOW do you see why women need to be represented...???

Men still largely control government and that means they still largely control where a massive amount of government funding for research is allocated.   For real, ladies:  If men gave birth, believe me when I tell you that by now it would be a pain free experience, probably involving a drive through, and a pack of IPA and diapers.   People let the discourse around funding for reproductive health circulate so heavily around abortion and that's a genuine shame, because it distracts from the fact that the medical options for birth haven't really been updated all that much since my Mom gave birth in the 1970s.  The Doppler Fetal Heart-rate Monitor?  Created in the late 1950s.  The Epidural?  Created in 1909 and "perfected" over time, becoming popular in the 1940s.  The Episiotomy?  First mentioned in a medical journal in the 1800s.  Pitocin?  Synthesized in the early 1950s.  The areas of maternal healthcare that have actually experienced worthy innovation over the last decade or two focus heavily on diagnostics and genetic testing, which, while awesome, do exactly NOTHING to make the experience of labor and delivery less painful or more efficient.  Maybe we can all shift our discussions around reproductive health from topics like abortion to the fact that for ALL pregnant women, much of our prenatal care is not really any more impressive than that offered to our grandmothers. 

Thirty-nine Weeks (Spoiler Alert - I never made it to Forty Weeks!)

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My last day at work was on a Friday.  By Tuesday of the Thirty-ninth Week, my doctor confirmed (through a REALLY painful cervical check) that I was dilated to about 2.5 cm.  I had quite a bit of bleeding after that particular exam, and my contractions came on a lot stronger.  I used the Baby Tracker app on my phone to monitor the contractions I was having from Tuesday through Thursday.  They were coming approximately three to eight minutes apart over the course of that time.  They were painful enough that I had no mystery about whether I would be able to go into labor naturally.  I would never have been able to make it through the week of my labor and delivery without the extraordinary support of my doulas, my Mom and my partner.  Here are a few things that really stand out to me about my experience with labor and delivery.

Be Prepared to Send Your "Backup" Person Home...and then Beg Them To Come Back

I just happened to have an extended prodromal (i.e. "precursor") labor.  The challenge with that experience is that it was real labor and felt like it.  So, of course, I called my Mom over to watch our five year old son in the event that I had to head into the hospital.  At one point, I was breathing through contractions every three minutes for several hours.  I was absolutely convinced that I was going to deliver a baby in the car on the way to the hospital.  However, after getting advice from my doulas, I took an Epsom salt bath and found that the contractions subsided enough for me to get some sleep.  My Mom spent the night (which I didn't expect to make it through at home).  Amazingly, I woke up the next day and didn't experience such strong or frequent contractions again until much later that night.  Seeing no immediate need for her to be there, I told her to go home and get some rest.  Thankfully, my parents and I live close to each other and enjoyed completely flexible schedules over this time period (e.g. neither of my parents work or have other regular obligations that are difficult to cancel on short notice.)  If this is not the case, it might be useful to create a Plan C for your Plan B. 

I Can't Believe I Ever Balked At the Cost of a Doula

Although I interviewed with my doulas back in February, when I was only three months pregnant, I did not retain their services until I was Thirty-Six Weeks pregnant.  Why did I wait so long?  Well, partially because I was feeling good physically and not very focused on labor and delivery yet.  In addition, I had to spend some time justifying the cost of the service, which was not insignificant ($1,200.00).  I had already been through labor and delivery once, and had been left with the impression that Fate was largely in charge of that event, with the Doctor and Medical Staff coming in second and third.  I had relegated myself almost to the role of bystander, having had my birth plan completely annihilated the first time around. 

That all changed when I arrived at the doctor's office one day to find that they had scheduled me for an elective C-section.  I believe they did it just to ensure that they could secure a surgical suite if I decided to go that route, but it was totally contrary to my deep seated desire to have a VBAC.  Frankly, I was shook and panicked a bit.  Then, we entertained questions about how long I was willing to allow the pregnancy to progress if I did not naturally go into labor by my due date.  This was complicated by the fact that having received a prior C-section, I was not eligible for inducement of labor (this increased my risk of uterine rupture, something that did not sound like very much fun at all).  Without the possibility for inducement, blowing past my due date left me with only two options: (1) wait; and (2) elective C-section.  When I realized that my son's first day of Kindergarten was only one week after my due date, I finally caved in and reached out to the doulas.  I knew that if I had a C-section, there was no way that I would be in good enough shape to truly participate in his first day of school.  To the contrary, if it was anything like my first C-section experience, I would be lucky to get out of bed without assistance. 

In retrospect, the services provided by my doulas were worth a hundred times what they charged.  During the forty-eight hour period during which I was actively laboring at home, I was in constant contact with them via group chat.  I sent them screen shots of my contraction patterns.  I begged for advice about managing the pain at home.  I followed their guidance about exercises to ensure that Baby Girl was well positioned for delivery. 

In the delivery room, I was blown away by the level of support they offered.  Since I was in the hospital for an extended period, two doulas took a "shift."  The first blew me away with her composure and advocacy.  I had a painful cervical check performed by a resident (by "painful" I should emphasize that I was in tears and she did not honor my repeated requests to stop the exam.)  My doula, Kristen, calmly, politely and firmly took her to task for it, emphasizing that this was not just a "well, sure, this hurts every pregnant woman and you should be prepared for the discomfort" scenario.  She emphasized that I had a history of multiple cervical surgeries and that this "simple exam" was not just physically painful, but also emotionally wrought and extremely invasive for someone who had that medical history.  It was a level of advocacy that neither my partner nor I would have ever provided in that moment, and I'm eternally grateful for it. 

Aside from that, I can state with certainty that their participation helped me to get through labor with much less medical intervention.  For example, a nauseous spell was dissipated with peppermint essential oils, as opposed to anti-nausea medication.  Various positions and use of a rebozo moved things along in meaningful ways.  Perhaps most importantly...

I had no freakin' idea how to actually push

I had read articles and attended birth classes.  I spent an entire lifetime in and out of yoga studios, learning to breathe properly.  I had even pushed for two hours with my son's delivery five years prior.  Still, I can honestly say, I didn't "get it" until my doula literally coached me through the process. 

​Basically, the secret sauce was this:  Take a deep, deep inhalation.  HOLD IT for a count of TEN.  During the hold, push.  Sometimes, your body will help you out.  I had a couple of amazing pushes where I could feel the smooth muscle in my body involuntarily moving Baby Girl along.  However, this was definitely not the case with 90% of the pushing stage.  90% of the pushing stage for me involved sucking down ice chips, struggling to take a deep inhalation despite feeling raw and dehydrated, wondering why I couldn't hold my breath past a count of "six" and getting gently reprimanded every time I would cry out ("Make each breath work for you!  Don't cry out or yell - that's wasting it!") 

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