When my doctor examined me, I was four centimeters dilated. (You have to get to ten to be ready to push.) For the next three hours my contractions came frequently. But I failed to dilate beyond six centimeters, where I remained "stuck" for those three hours. The contraction pattern on the monitor was "dysfunctional." Though the contractions hurt a lot, and I never got much of a break between them, they simply were not getting the job done. I had what is known as hypertonic uterine inertia, which means that the contractions, though present, are not efficient—they are erratic, originating all over the uterus at the same time, like the heart when it goes into atrial fibrillation. (The high heart—in the chest—does the same sort of thing as the low heart—the uterus in the pelvis—sometimes.) Instead of beginning at the top and moving in a wave to the bottom of the uterus, the contractions originated in many places at the same time. Labor didn't progress well. It was like trying to get toothpaste out of a tube by squeezing it in fifteen places at the same time with a little bit of pressure, instead of squeezing firmly only at the back end of the tube so that the paste comes out uniformly.
When my doctor told me that I had made no progress in three hours, I knew what was next. (Remember, my intellect thought it was in control of my labor.) "Okay," I said, "start the IV, plug in the fetal electrode, and hang the Pit." Pitocin (oxytocin) is a drug that artificially contracts the uterus. After the Pitocin was started, the contractions became almost unbearable, going to full intensity almost as soon as they started.