Tuesday, January 1, 2008

Finally! Claire's Pre-Birth Story (otherwise known as My Braxton Hicks School of Relaxation!)

What are “normal” Braxton Hicks (B.H) contractions? At what point in pregnancy are they supposed to be noticeable, what do they feel like, how long are they, and how many is one supposed to experience? These are some of the questions I would really like to have answered. Most of the women I’ve talked to either don’t know if they’ve experienced them or have had “a couple, the day before I went into labor” (perhaps because most of my friends/acquaintances have only had one or two babies so far and they aren't supposed to be "usual" until subsequent pregnancies). What I have read is not very helpful, either. Textbooks, I have come to believe, are far too constricting on the definition of a “normal” experience, and therefore have not been able to answer many of my questions. Surely, I am not the only one to experience what I do, but it seems as though nothing I’ve read or heard resembles what I experience. Please read on and let me know if any of this sounds similar to your experience or someone you know! (Is it truly that it’s not very common, or is it that the textbook definitions are just way off?)

When I started noticing Braxton Hicks contractions in my second pregnancy, (Claire—noticeable at 14 weeks, Jan. 2006) I realized my B. H. contractions must be very different from “normal,” because they feel like beginning/mid-labor contractions in their duration and intensity, as well as their frequency (especially during the last trimester). {Bonus note: At this writing, I am pregnant with my 3rd child and started noticing B.H. at 6 weeks that I could validate when I pushed on my rock-hard racquetball-sized uterus. By 9 weeks I had already experienced them every 10 minutes for several hours at a time; strong enough to keep me awake at night. Most days, at 18 weeks along now, at least 2 dozen contractions a day catch my attention, about 1/4 of which I would consider strong (i.e. I wait at least till after the peak of the contraction before comencing my activity).}

During my Braxton Hicks contractions, my entire uterus would get hard as a rock, feeling like it was about to burst, with an intense downward and forward pull and (especially toward the later weeks with Ruby & Claire, but already happening at 12 weeks w/the 3rd) much pelvic pain/pressure. Many of them were intense enough to have a nauseating effect, causing the back of my mouth to produce extra saliva and make me close to vomiting, which went along well with feeling "fluish" in the intestinal area. Pushing on my uterus during these contractions is painful, as it feels like it is bruised from overuse. Even having my belly touched is not preferable during most of my B.H. If sitting, I usually had to lean back (to give my belly room to move forward without any interference from my legs) as well as move or hold out my waistband on my pants to keep it from “digging in” during the contraction. In the last trimester, after experiencing frequent contractions for hours at a time, I often had to close my eyes, breathe deeply and relax all the muscles in my body in order to not worsen my discomfort and be driven crazy by these “go-nowhere” contractions. It was especially important to make a point of breathing abdominally to lessen the pain, because my initial reaction was to chest-breathe in order to keep the tummy part of me from expanding even more than it felt like it already was.

After months of long, strong, close together contractions (in the last few weeks for an average of 5-6 hours at a time, and sometimes all day and into the night), true labor was difficult to discern. I thought it would be easier to know for sure with my second child, since I now know what labor feels like and how bad it gets, but it was actually more confusing than when I was pregnant with Ruby (my first). With her, I didn’t know that my B. H. were unusually strong because I hadn’t ever had a baby before, so I didn’t know enough to wonder if labor was starting because I was having frequent and strong contractions. (I just thought that’s how B. H. were, and that I must be a wimp to be so annoyed by them.) Something should have clued me in that my contractions were not usual when my childbirth teacher described Braxton Hicks this way: “They don’t hurt, and they’re only like, 10 seconds long.” So only after I had been through labor and was again experiencing B.H. did it finally dawn on me why Ruby’s labor had been so confusing to me.

I decided to count some of my contractions and keep record of their timing in my pregnancy w/Claire. One reason was because I wondered why it was so easy for women to say “My labor started ________.” Why couldn’t I put a time on the start of my labor with Ruby? Was I crazy? And when I would tell people a little about my labor with Ruby, and that I didn’t know for sure if I was in labor until I was dilated to a six, I’d get some pretty weird looks; some assumed my labor must’ve been very mild for me not to know “this is it.”

Now, I have heard stories of women who didn’t know they were in labor because they didn’t feel anything until crowning, etc., but this does not even remotely resemble my experience! The reason that I did not recognize labor was due to the fact that I feel too much going on—and it is hard to discern whatever differences there may be between labor and prelabor for me—not because I wasn’t feeling pain or discomfort: I had been feeling labor-like contractions for months. This is why the description “Frog-In-The-Pot-Of-Water” is perfect for my labor experiences so far (and hence, why the blog has its name).

For the first few hours of my labor w/Ruby (my first), I wondered to myself, “Why am I timing Braxton Hicks just because I’ve had a bloody show?” My labor with her followed a shorter—but much more intense—prodromal pattern than Claire’s; putzing along from Sunday morning to evening, kicking into high gear all night long, then petering out to pretty normal (for me) B.H. on Monday, intensifying again the next night and continuing very hard until I had her Tuesday morning. But I wasn’t “allowed” to have started labor on Sunday—“women are in labor for hours, not days,” the triage nurse told me—so my chart reports that 1st stage was only 8 hours, 20 minutes. How nice.

So I kept a decent record with Claire’s pregnancy for several reasons: to make sense to myself why I was always wondering “will this turn out to be labor?” when it wouldn’t; to keep me from second guessing my memory when given the questioning looks (“But are they real contractions? How can you not know if you’re in labor? How lucky for it to be that easy for you! Mine was so hard/painful. I’d love to be able to say I didn’t know.”); to challenge people, like the triage nurse—who don’t believe me because my experience doesn’t fit into their box of what is possible in labor—that some women do not have a textbook experience, but the fact that you have never read, heard of or seen it doesn’t negate its validity, and finally to encourage other women who have or will experience something similar that they are not insane or wimps, and that they, too, can make the experience work for them, not against them. (As if the contractions don’t drive you crazy enough—you don’t need doubts that you’re imagining it all to top it off!)

{Just to make sure that we’re on the same page re: contractions, I’ll define what I mean. Duration/length: the time from start to finish of a contraction. Frequency/spacing: the time from the start of one contraction to the start of another (i.e. if a contraction started at 5 p.m. and was 1 min, 30 seconds in duration and at 5:05 p.m. I had another one, the time that I felt no contractions was 3 min, 30 seconds, yet I would say that the contractions are 5 min. apart). This is the standard way of timing contractions, but some women count the spacing from the end of one contraction to the beginning of the next as the frequency. This can make quite a difference when charting frequency if the contractions are of sizable duration, so it is important to define what I have in my mind when using the terms frequency/spacing and the like.}

In my pregnancies so far, my Braxton Hicks build in duration and intensity over the last trimester, becoming extremely strong and uncomfortable the last month. They never get totally regular—one month before Claire’s due date they were 5 to 18 minutes apart and everywhere in between (averaging 10 min. apart) but as regular as they can get (2 to 10 minutes apart—w/an average of 6 min.), they can really throw me off. Contrary to what many books say, a woman can be in active labor and not have a “regular” pattern. Even on Claire’s birthday (“real” labor!), my contractions were from 2 to 11 or more minutes apart within the same few hours.

Contractions also have a pretty long duration in the last few weeks of my pregnancies: I didn’t usually count any that didn’t last more then 30 seconds, and most of the time dismissed any that lasted less than a minute (so when, at 36 weeks, I wrote on my calendar on June 22 that I had counted more than 65 contractions in just short of 18 hours, or, almost 4 an hour—not that it was ever that neat—that’s not counting any short ones). Toward the last 3 weeks before Claire was born, I timed many that were in excess of 2 minutes long, and on several occasions, longer: a 6+ and 9+ minute contraction (around 8:45 p.m. and 2:30 a.m., respectively, July 3); one on my list lasted 3 min. 30 seconds and double peaked (10:07 a.m., July 5); I had 4 contractions on my chart July 9 that were between 3 min and 3 min, 15 sec. long, and a 5+ min. contraction (2:20 a.m.); I had a 4 min, 30 sec. contraction (10:15 p.m., July 10); and on the 13th—day before Claire was born—a 7 min, 40 sec. double peaking one at 7:41 a.m. (Too much detail, you say? But I did go to the trouble of keeping a careful record. I had to make it worth my while and put it in here somewhere!)

For the last month of my pregnancy w/Claire, I mostly counted my contractions on days when they seemed to be more frequent or regular. When they were also accompanied by pain associated w/labor and/or prelabor symptoms, I would also time them. The first day I did this was June 25th (36 weeks prego). I had extreme and constant pain in my lower back, as well as round ligament pain shooting into my legs, both of which did not let up between contractions (the pain, not my legs!). I was in agony, but the contractions themselves were uncomfortably strong and annoying, not what I would consider very painful. Nevertheless, I was in such pain overall, I thought this could be the day. (How many women start their labors with extremely painful contractions anyway? In most labors, it takes time to get to the “Wow, these are too painful!” stage, right?)

I started timing them in late morning, after seeing off my out-of-town company. I timed 47 contractions from 11:16 a.m. to 11:25 p.m., (averaging out to about 4 an hour, but I didn’t count or time all day—took a nap, took a break from timing for a few hours, etc.). Contractions came every 5 to 18 minutes (though most fell into a 5-12 minute window), were strong in intensity, and were anywhere from 30 seconds to 2 minutes, 10 seconds long. (When I timed—not counted—them, I did include the shorter ones in order to chart the frequency. But the average duration of contractions that day was 1 min, 15 seconds, which is funny, since some textbook “real” labors don’t ever get contractions longer than that, and if they do, that duration is not an average for the whole labor, but maybe an exception—say, during transition.) But, no baby came of all that contracting. I just quit timing and went to bed.

One other thing I noticed about my B.H. contractions that seem different from what I’ve read and what other women describe is that mine don’t seem to care much what I’m doing (including the textbook solution to lots of B.H.—drink water and empty your bladder often). Some of my friends have said that theirs will subside if they drink some water or change their activity level. I charted myself eating, drinking, bathing, walking, resting, etc. and they didn’t stop or even change much. Sometimes things like taking a bath or shower would even make them closer together—usually a sign that it is “real” labor. Another way they’re not like the textbook definition is that they are more—not less—noticeable during exercise; again, a sign of real labor.

Something that did help me through the last month (because I hide when I’m in pain if I don’t know someone extremely well) was spending time with people. Casey encouraged me to do this to keep my mind off the contractions and preserve my sanity. I met friends for lunch, took my Gram to her Dr. appointments, had company for dinner, etc. It was refreshing to think of something else besides, “Why is this happening . . . and why is it not happening at the same time?!” I was able to keep my mind otherwise engaged, all the while noticing most of the contractions I was having. They were strong enough to not be able to ignore, but I was agreeably occupied enough not to be frustrated by their presence.

Before switching to a home-birth midwife with Claire (another story for another time), I mentioned to my OB early on in the pregnancy that I had strong, frequent B.H. He said to tell him if they ever got to 4 an hour or more, because there would be a concern of pre-term labor. I just smiled. Later, I decided that I wouldn’t tell him, because this is exactly what happened w/Ruby, too, and I went full-term w/her (3 days early). I figured it would just cause unnecessary stress to me and the baby for them to do tests or “watch” me, or put me on drugs. I wonder how often that happens that something is falsely labeled as preterm labor, when time would show that it is just a cantankerous uterus? (It is probably too much of a risk—good thing I didn’t know better with Ruby. :) On April 24, 2006—when I was 28 weeks along—about the time I switched to a home birth midwife—I had 25+ contractions in about 2 hours (an average of less than 5 minutes apart). And yet they petered out and there was no delivery of a pre-term baby.

Perhaps I should take comfort in the fact that my B.H. contractions oftentimes fit the textbook description of active labor contractions. I suppose it should encourage me that it’s not all in my head. But if it’s not “labor” and it’s not “not” labor, then what is it?

On several occasions during the lovely month of “non-labor” with Claire, I would get back on the internet, type in “false labor” again and read what different medical/pregnancy/baby websites would say about it (had I missed something crucial?). It was so frustrating to run down the list of “if it’s really labor . . . ,” and say, “yes, they are strong, yes, they are regular (again, as regular as mine get—even in “real” labor), yes, they are close together, no, they don’t stop or change with differing behavior, yes, they are building in intensity” (though that is a subjective question—never knew quite how to answer that one—maybe I was just getting annoyed with them after so many hours.) “Yes, yes, yes.” Until I got to the cervical dilation part, which I didn’t know because I hadn’t been checked (and didn’t want to be checked: why bother with something that is either going to give me false hope that I’m going to have this baby any minute or disappoint me that I’m going through all this pain for nothing? So what if I am 70% effaced, dilated to a 4 and baby’s at zero station? I could go like that for weeks, as women have before me. And what if I’m an absolute zero and the baby hasn’t dropped? I could have the baby tomorrow, as women have before me. Numbers don’t necessarily mean labor is or is not happening!) And the last on the “real labor” list that would seal the deal: “It ends in a baby being born.” So I’d get off the computer, dejectedly figuring that the only way I’d know if it really was labor is when I actually had Claire and, in retrospect, could say, “So it was labor that time!” And what do you know? It happened almost exactly as I predicted (although I did realize it was the real thing almost 2 hours before she was born, so I got to have the excitement phase at least!).

On one of my last visits to my midwife before Claire was born, I told Barb I didn’t know at what point I should call her. She told me to call when contractions were 5 min. apart, lasting one minute for an hour. I said that I would have already called at least 5 times by now by that standard. She said, “Oh, you’re one of THOSE.” It was so different and very reassuring that she recognized that it was possible to experience what was happening to me. And she didn’t tell me, “You’ll know,” like most other people did when I expressed concern in the possibility of not recognizing the real thing (I didn’t “know” with Ruby and I felt more unsure the second time around, since I knew what real labor felt like and what I was experiencing felt like real labor). So she told me if there was blood I should definitely call. (In retrospect, that would have been a few moments before Claire was born!)

Well, all this worked to our advantage in the end. In many ways, I’m very thankful for the way that my body gets ready for labor. With Claire, it really did make most of my “real” labor seem like a walk in the park. I feel so prepared to take on anything by the time it actually kicks in, and relaxation is second nature by then. But it does take hindsight to appreciate all the pain and frustration! My “easy” and “fast” labor with Claire was not without its price tag. That last month was pretty expensive. :) Had I not experienced all those weeks of strong, long, frequent contractions, I would have immediately recognized the start of Claire’s labor, and may have even been disappointed that for a second birth, it was a whole 12 hours long. As it turned out, I was ecstatic that it was during the day and only one day long. It's helpful to see the positive side: that God is good to have given me experiences that are beyond what I can handle and that stretch me beyond my perceived limits, driving me to Him.