How Anisha entered this world ? (Labor story - Part I)

Ultrasounds done at 36 weeks, by three different doctors, using two different ultrasound machines, showed that Anisha might be 3.5 kgs already. This ofcourse sent a wave of panic in me. If she increases 200 grams per week, she will be more than 4 kgs by 40 weeks ! My sister, who is a gynecologist, was advising me from the beginning of the pregnancy that it is wise to consider a c-section at 37 weeks. She was worried about my advanced maternal age and wondered whether my pelvic bones will be flexible enough to let the baby out. She was also reluctant to allow the gestation past 37 weeks. But I wanted a vaginal delivery so badly. Not that I believed c-section will be difficult on my body or it is unnatural, I just wanted to experience vaginal birth. It was very hard for me to decide between c-section and vaginal delivery. My mind was telling me, 'Why do you want to take risk, opt for c-section; it can be planned before; there won't be any last minute surprises and tension; the procedure will be straight forward and in minutes baby will be in your hand'. On the other hand, my heart was telling me, ' How nice it would be to experience a vaginal delivery; you can hold Anisha immediately; feed her; you will able to get up and take care of her without any assistance; if it is a c-section you will miss that initial precious bonding experience'. I asked Dr. E whether c-section will be better in my case. He just said that it was not necessary. My placenta was in proper place, Anisha was head down from 24 weeks, so, for Dr. E, there was no reason to suggest a c-section. I told him I was worried about Anisha's weight. He asked me, ' What was your birth weight?' I said I was 3.5 kgs. Then he asked how big Rajender was at birth. Rajender was born under a tamarind tree with assistance from an uneducated but experienced village midwive. That poor woman's husband died the exact moment Rajender was born. So she remembers him quite well even now :) I said I don't know.  I told him, 'Doctor can you please induce me at 37 weeks ? I feel very paranoid at times'. I also told him that Indian babies weigh 2.8 kgs on an average, and that I am worried whether Anisha will be a huge baby. He agreed for induction and said, ' We can induce you, but, not before 38 weeks !'

As I was nearing the 37 week mark I became very restless and paranoid. I was constantly looking for Anisha's movements. When I don't feel her even for short period of time I was so afraid. I became a very different person until I could feel Anisha move again. I didn't want to talk to anyone, all sorts of horrible thoughts crossed my mind at such times. I would mostly lie down on my left side, with my hand on my tummy and silently praying. Once I start to feel Anisha move I felt relieved. It was like being tossed between hell and heaven. I knew well it is not wise to allow my thoughts to run wild. But my previous experiences with twins has made me a coward and I felt very insecure. One fine day, in the morning, I was waiting for Anisha to move. I couldn't feel anything. Drinking cold water and lying down on my left side didn't help. I waited until afternoon. There were very little movements, not the usual brisk ones. I called Rajender in panic. We both went to our gynecologist. When I entered the clinic I saw a plate with Christmas delicacies. I ate a piece of sugar which is shaped lika a star and voila, Anisha started to move frequently. She started to hiccup too ( she hiccuped a lot in my womb and still does !).They hooked me to a fetal heart beat monitoring instrument called cardiotocogram (CTG). It monitors fetal heart beat in relation to fetal movements and records uterus contractions too, if any. The CTG measurement was perfect. Anisha was moving frequently and her heart beat showed periodic acceleration and deceleration with each of her movement. After that incident I decided that I must do something to feel safe. I told Dr. E that I want to be in hospital from 37 weeks and he agreed to it.

I was in hospital from 37+2 weeks. I was monitored twice a day with CTG which made us an expert in reading a cardiotocogram. Rajender would make sure that he was with me during CTG measurements. It was such a precious moment for us. We used to hear Anisha's heartbeat; I could sense her movement and watch whether her heart beat increases with every movement and falls back to the baseline. When she is not moving frequently it worried us. The nurse would come and see the cardiotocogram and say, 'The baby is sleeping, drink some water". I would have drunk buckets of water during those times !  Mostly, that helped to get Anisha move. Morning times, when my stomach was empty, it was very hard to make Anisha active. Once something goes into my stomach she became quite happy and moved frequently.

My cerclage was removed the day I got admitted in the clinic. Dr. E removed it. It took one hour to keep the cerclage in place, but removing took just two minutes. I was very afraid of the removal. My biggest fear is about the unpleasant feeling I get when the speculum will be inserted. On top of it, they were going to pull out something from the cervix, the cervix which I struggled to protect all the nine months. I thought, 'It is going to be hell'. There was one junior lady doctor along with Dr. E. She was the one who did the ultrasound on the ill- fated night when the amniotic sac of my daughter (one of our twins ! ) broke. She remembered me very well. She said she was so happy for me and offered to hold my hands when the cerclage will be removed. During removal it did hurt but not as much as I imagined. Dr.E showed me the thread which held my cervix closed or we thought it did ! It was a thick suture material a few inches length. There was some bleeding after cerclage removal and it stopped in a day. I was expecting to go into labor soon. Afterall, "isn't the thread that held my cervix from opening spontaneously removed now?" I was wrong; my cervix was closed tightly like a rock and wouldn't open even with multiple inductions !

They started to induce me from 37+5 weeks onwards. Induction drug that was initially used is cervidil. It is a prostaglandin (prostaglandin E2) which is in gel form and is tied to a piece of thread (imagine a tampon). It was placed close to my cervix. Cervidil slowly releases prostaglandin which helps the cervix to ripe ( to thin it ). At times it causes the uterus to contract and hence helps to open the cervix too. For some women it does one or the other which is mentioned above and for some it does nothing.

On the morning of 37+5 weeks pregnancy, at around 7 AM midwife checked my cervix. It was tightly closed and not effaced (thin) too. It was very scary when she was trying to reach my cervix, painful too. My cervix was still high above and hard to reach. After some prodding she said she could feel it. She inserted the cervidil inside. I was monitored using CTG every hour afterthat to make sure Anisha was not in distress.

A couple of hours after cervidil insertion I started to have menstrual cramp like pains. I was very happy. It was exciting to see the initial contractions in the monitor which CTG machines picked up. Although they were not stronger, there was something going on. My uterus is responding to the prostaglandin. Anisha was doing fine too. I slept that night with cervidil in and with moderate, bearable pain. I was advised to come in for CTG monitoring if pain becomes unbearable. I had no idea about what to expect. I was wondering what will happen if my cervix opens in sleep and the baby starts coming out. My concern was dismissed by the midwives with a smile. They said, "If your LO is ready to come out you will know."

The following morning I woke with the same amount of pain. Surprisingly I managed to sleep through that discomfort. I was called in for CTG monitoring. There were still weak contractions every 10 minutes apart. I watched with glee those contractions. My pain was pleasurable ! They removed the cervidil and sent me to my room. I was asked to return for CTG monitoring when I get strong pains. I waited for the pains to get stronger. But alas, within an hour the pain died down and I was back to normal again ! It was ofcourse frustrating. The first try on induction failed.

That day was a free day. No more induction that day. I was allowed to rest. The next day (38 weeks) morning my cervix was checked again. Nothing happened to it. That was very, very disappointing. I was again given another dose of cervidil and was monitored frequently with CTG again. After an hour of cervidil insertion the pains started to come. By evening the contractions were coming on stronger and more closer. They were 6-8 minutes apart. Rajender and I looked at each other happily; I thought that was it ! That day night, I was in much more pain than the previous time. I was expecting to go into full blown labor. Next day morning I woke up with same kind of pain. Again the same procedure was repeated.  They removed cervidil. Midwive checked my cervix. She took a lot of time. I was eagerly waiting for her words. She said, "your cervix is 2 cm open. I could feel your baby's head and she has lots of hair". I was so happy. I went around and told everyone about this. I saw Dr. E from a distance, almost ran to him and delivered the news. He smiled and said, "your baby will be here soon".

I called my mom, my mother-in-law and said that Anisha has lots of hair :) Then I called Anju, my sister, who is a gynecologist. With a childish excitement I told her the same too. There was silence at the other end and she slowly asked, " Was your amniotic sac intact?". She continued, "With an intact amniotic sac how could the midwife feel the hair?" All my excitement vanished and fear gripped me.I started to think. I haven't felt any unnatural wetness down there. The sac must be intact. What if I failed to notice the amniotic fluid leakage ! I went to a junior doctor there and asker her whether it is possible to feel baby's hair via cervical opening when the amniotic sac was intact. She said it was not possible. I told her my concern and asked for an ultrasound. Anisha was fine, the sac was intact and there was enough fluid for that stage of pregnancy !

After the cervidil removal I was very hopeful that the pains would get stronger. I thought the contractions will come in full force. Again the old story repeated. The pain went away in a couple of hours. I was slowly losing patience and hope, so is Rajender. Will this ever work was the question running in our mind. I was wondering whether my cervix is really incompetent or was it a twin pregnancy problem !

The following day there was no induction again, I had to rest. I was informed the next day (38+2 weeks) that they were going to give me a different drug. It is called misoprostol and the active ingredient is an analogue of prostaglandin E1. Misoprostol is not FDA approved for labor induction. It is originally used to induce abortions. The online search for 'misoprostol for labor induction' gave me scary stories. But the doctors assured that they routinely use it and haven't had any adverse effects in patients. And moreover, the dosage used is very, very less and they assured me that they will monitor me and Anisha closely. So, I was given the first dose of misoprostol (2 mg). That was such a minute dose. Before giving me misoprostol vaginally, a midwife checked my cervix again. I was expecting to hear that my cervix is 2 cm open. But, she said that it was just a fingertip open and she was not sure about it too. I was disappointed.

The first dose of misoprostol did nothing, I had no reaction to it. Not even the period like pain I had with cervidil. After 6h they gave me the next dose, again nothing happened. I thought, "This is not going to work". I was slowly getting ready to accept the fact that c-section is the way to go. It was saddenin,g but more than my desire for vaginal birth, Anisha's safety is of prime importance. I decided to do what doctors ask me to do to bring Anisha safe into this world.

My mom and Rajender came to visit me in the evening. By that time I was getting some pain on my lower back and not in the front. We walked inside the clinic, chatted for sometime, I was trying to cheer up Rajender. He was feeling cheated too because of failed inductions. We went for CTG monitoring; although I had lower back pain, there were no contractions visible in CTG monitor. I asked my mom and Rajender to leave. I thought that I must talk with doctors the next day and fix a date for c-section. As time passed by, the lower back pain was increasing in intensity. I tried to sleep but couldn't. I didn't feel good. I messaged Rajender to come to the clinic, I told him that the pain was increasing in intensity. It was around 11 PM. I decided to go in for another CTG monitoring.

I went to the room where the CTG machines are kept. I told the midwive that my lower back pain was increasing in intensity. She hooked me to the monitors and left the room. I was alone. I was looking at the monitor as usual, there were no contractions, Anisha's heartbeat was in the range of 140 beats per minute, and was showing acceleration and deceleration as she moved. I got a sudden crushing pain in my lower back - the same kind of back pain which was repeating itself periodically. I was looking whether there was any contraction. All of a sudden Anisha's heartbeat started to drop from 140s to 110s to 80s and then to 60s-40. My heart missed a beat. Without knowing what to do I froze with fear !