A Long Road to a Happy Ending: ICSI and Induction

 

From the moment I found out that I was pregnant, I knew I would be induced at 39 weeks. My path to becoming a mother included a long journey of IVF and I was pregnant after a successful transfer of an embryo which was created through ICSI (Intracytoplasmic Sperm Injection).

For those not in the know, ICSI is one of the most invasive forms of fertility treatment, and means that the sperm is injected directly into the egg, unlike "traditional" IVF where the egg and sperm are mixed together in a petri dish and left to naturally inseminate. Due to an embryo beginning its life like this, there are lots of questions around how the placenta forms and multiple academic papers reference induction at 39 weeks being of benefit so that the placenta does not live past its shelf life for lack of a better way to put it.

I made the decision to birth at a public hospital, so was generally seen by a midwife. During one of my first appointments, I stated that I wanted to be induced and the midwife arranged for me to speak to the lead OB at the hospital. When I spoke to him, he was completely in support of my decision and signed me off to be induced.

During my last antenatal appointment at 36 weeks, my induction was scheduled. I was booked in for 16:30 on the Sunday, where I would be 38+7. I was advised that I would be examined and that the Foley bulb would be placed overnight. Then, all being well, my waters would be broke on the Monday morning and I would be placed on the pitocin drip. During this appointment, the midwife answered all of my questions and provided me with lots of information about what to expect from my induction.

When the day arrived, I excitedly attended the hospital with my husband at my scheduled time. I was settled into a private room and then the midwife came to examine me.

Upon examination, it was discovered that I was already 3cm dilated. As such, I was sent home for the night and told to come back at 7am to have my waters broken.

On the Monday morning, at exactly 39 weeks, we arrived back at the hospital. Another examination showed that I remained at 3cm dilated so the decision was made to break my waters then wait a little while before starting me on the pitocin drip. At 7:30, a midwife broke my waters and at around 8:30 I started on the pitocin drip.

I really didn't have a birth plan, my plan was very much to go with the flow. As I was induced, I was birthing in the High Care part of the labour ward so I knew that I could have an epidural if I wanted one. The pictocin drip was turned up every half an hour and, until around 10:30, I managed well with this. Around that time, my contractions were still tolerable but getting much more intense. I started on the Gas and Air, spent sometime bouncing on a ball and walking round the room to try and help with the pain.

At 12:00, I requested an epidural. My contractions were very intense and I felt like there was no reprieve in between them where I could catch my breath and re-centre myself.

The anaesthetist arrived shortly after she was paged and placed the epidural. I immediately knew there was an issue with it as only my right side was numb, however I was happy to wait and see how it progressed.

By 14:00, it was very clear that I needed the epidural replaced and the anaesthetist was recalled. By this stage, I could feel every contraction and I remember asking my midwife if I could just have a c-section instead because I had had enough. When she unsurprisingly said no, I told my husband we were leaving. Obviously we did not, and hindsight tells me that I was likely in transition at that point!

When the anaesthetist arrived it was discovered that the epidural was no longer in my back and that, every time I pressed the button to receive the medication, it was squirting onto my nightie rather than giving me the relief I was needing. The epidural was replaced and it was immediate relief. I was able to rest and sent time half sleeping/half watching Bridget Jones' Diary on Netflix. Due to the epidural, my baby's heart rate dropped a little and I needed to be repositioned every so often to help with that.

At 17:00, I was examined again and was finally at 10cm. My baby wasn't quite in position yet though so my midwife told me that she was going to give me until 18:00 and then I would start pushing.

When 18:00 rolled round, my midwife told me that I would have around 2 hours to get baby out or I would need a c-section.

Due to the epidural, I was unable to feel where the pressure was and which part I needed to push into so my midwife guided me through the pushing by showing me exactly where to focus my pushing.

The pushing all became a bit of a blur but I do remember the room filling with several people. Due to this being my first baby, I didn't really take much notice and assumed that that was normal. It was only when a doctor took over from my midwife and told me that I needed to push as hard as I could and that she might need to provide baby some assistance to arrive did it briefly enter my mind that something might not be right.

Despite pushing as hard as I could, I was unable to deliver my baby, so the decision was made to use the ventouse to assist with the delivery. I was advised by the doctor that she would be placing the cup on my baby's head and that she would help to get the baby out. Everything was so calm, I was not panicked or made to feel any anxiety regarding the situation. It was very much a "this is totally normal and no problem" kind of vibe.

At 18:55, my baby was delivered with the assistance of the ventouse. My husband got to look at our long awaited baby and tell me that it was a boy before he was placed on my chest. Once he was safely on my chest, the doctor advised me that the cord had been wrapped around his neck and that every time I stopped pushing, he was being pulled back up the birth canal undoing any progress I was making. I was advised that I had required an episiotomy to enable the use of the ventouse and that I had a small tear too.

I was stitched back up whilst I held my beautiful baby boy (with his very attractive cone head thanks to the ventouse), fortunately my epidural was still active so I did not have any discomfort.

I was in the shower for 21:00 and it was the best shower of my life, followed by the best cheese sandwich of my life! I remember sitting on the bed, eating my sandwich and saying to my Mum "that wasn't that bad, I'd definitely do that again!".