Monday, January 24, 2011

The Birth Story (Again)

Well, it's been quite a two weeks for Allison and me. Two weeks ago today, we were packing the car for our trip down to St. Michael's Hospital so I could be induced. It was 38 weeks + 3 days and the doctors and midwives wanted to induce because The Bean possibly had IUGR. They thought it was better to induce labor early in case the placenta was crapping out (not official medical terminology). If the placenta wasn't doing it's job they worried that The Bean wouldn't hold up well during labor, so it was better to get him out early when they knew he would be strong.

It turns out Monday the 10th was a crazy day for the labor and delivery staff at St. Mike's. A few unplanned c-sections, someone having twins, and a full house left us sitting first in the waiting room until close to noon and then in triage until close to 3:00 pm. Fortunately, the triage nurse gave us a wink and a smile at one point and suggested we take a walk down to the cafeteria for lunch. My mom and dad had arrived the night before and were down there enjoying lunch themselves, so we got to see them for a few minutes before heading back up to triage.

While we were waiting in triage, Allison tried some contraction inducing pressure points and based on the monitor results, they worked. After a couple of medical staff took health history and asked questions about the pregnancy the resident came in and examined me. The first step was to check and see if my cervix was ripened - what they call it when it thins out and gets ready for baby to push through. Not surprisingly, my cervix wasn't ready for picking yet so they inserted a medicine called cervidil.

I'd like to take just a moment to explain how medical staff determine how ripe your cervix is. I'm no stranger to a speculum, and undergoing fertility treatments I got very accustomed to medical professionals inserting random medical instruments into my va-jay-jay, and was expecting something similar to happen with the cervical check. Oh, boy was I wrong. Evidently, the way they check your cervix is by touch - meaning they shove their hand waaaaaaaay up inside you and do a poke test with their fingers. My biggest takeaway from that experience (one that I had multiple times during the birth process) is to look for someone with really long fingers to administer this part of your care - unfortunately that feature wasn't common among most of the hospital staff I encountered.

So, back to the cervidil. It comes on what looks like a shoelace with a small tag attached to one end. My doctor folded it all up and got it waaay up in there and said that they'd check in 12 hours to see how much I was dilated.

At this point, they sent us to a room in the ante-natal unit for the night. They also prescribed non-stress tests (they strap you up with two monitors 1 for the baby's heartbeat and one for your contractions) every four hours and would check on us at 3:00 am to see how dilated I was. Fortunately, Allison scored a recliner and was able to sleep beside me in the room. About 1:00 I started feeling some small but regular contractions and called the nurse in. She did a non-stress test and everything was cool so we were still to hold tight for the resident to check my cervix at 3:00.

At 3:00 a very tired looking resident shoved her hand all up in me and said I was only dilated 1 cm and that we had to wait and check again at 3:00 the next day - Tuesday.

When we woke up later Tuesday morning we both got showered and cleaned up. I was still having regular contractions and Allison and I decided to do some laps around the floor. Our nurse, Virginia, noticed us doing the laps and asked about the contractions. She decided it was time to get us back down to labor and delivery. She went down and spoke to them and a couple of hours later we made the trip down to a labor suite. And, let me tell you, the labor suites are to hospital rooms what a penthouse is to a hotel. They were large, with a couple of chairs, a recliner, a private bathroom, a flat-screen TV (you do have to pay extra for cable), and one on one care from a nurse.

My time-line of the next little bit is fuzzy, but it involved the staff doctor doing a check of my cervix, the cervidil being taken out, and around 3:00 a resident breaking my water. That was weird - there was a lot more of it than I expected and I wish someone had given me the heads up to remove my socks first. The water was nice and clear though - no signs of the baby in distress.

They had me walk the floor some more and we only made one lap around because those contractions that weren't so bad before were a real b**ch now. Allison said my knuckles were turning white when I was holding onto the wall railing during the contractions. I also started sweating and feeling kind of weak - like I wanted to lean on something for fear I might topple over.

After these real contractions started, I decided to get an epidural (up until then I was trying to keep my options open to try without meds or with depending on the situation) because we were expecting it to still be some time until I was ready to push and I didn't think I would have the stamina to deal with the contractions for that long of a time period and still have enough left in me to push.

Fortunately, the anesthesiologist was outside our door at this point and came right in to do the procedure. I was still having those nasty contractions and they were good about working during them but waiting to do any ouchy stuff until in-between.

Somewhere around this time, they also put in an IV for saline-type fluids + the pitocin drip that would ramp up the contractions. After this I was strapped to the monitors and in bed for keeps. Oh, but they gave me this thing I called the Happy Button which topped up the epidural if I was feeling pain. I tried not to let the Happy Button stray too far from my grasp.

Unfortunately, at one point the nurse didn't like how the baby's heart rate would dip after a contraction and came in to check on me. We switched my position around and somewhere in there his heart rate dropped for a good few minutes. The medical staff jumped right on it and within minutes there were two doctors and at least three nurses in the room checking on me. They turned back the pitocin and we all had a conversation about the possibility of a c-section if The Bean's heart rate was continuing to drop with the contractions.

At this point I was pretty freaked out, but was reassured when the doctor's watched the monitors after they stopped the oxytocin and said that he was doing okay. The staff doctor recommended that we take a break from the drugs to let him recover and then start them up again but more slowly this time. I have to say, for all of the talk about OB's being interventionist, she was excellent at trying to make sure I could still have a vaginal delivery. When his heart rate dropped, if they had said the only safe way to deliver was by c-section I wouldn't have hesitated to roll on down to the OR. I'm appreciative of Dr. Meffe's efforts to keep the birth vaginal.

So, they cranked back the pitocin and waited for a bit. At one point the nurse came in and said it was probably time to start it back up again, but both doctor's on the floor were in deliveries at the time, so she was going to wait until they were out and start it up then. And that's what they did.

Allison and I had just settled in for the long haul - expecting to deliver sometime in the late night or early morning when a new nurse came in to check on me. My regular nurse was on her break and this woman was her break relief. A former mid-wife, this nurse (who I later just called coach) checked my dilation and to our great surprise said I was 10 cm. She flicked on the lights and started doing stuff to the bed saying it was time to push. Whoa - It was only around 10 pm.

Allison asked the medical intern to find our midwife who was at the hospital with another client. Luckily, she had just finished delivering the baby for the client and in just a few minutes she was in the room with her student helping to do labor support.

Again, there were a ton of people in the room during most of the pushing. At one somewhat comical moment, it was only Allison, me, the medical intern, and the midwifery student. They coached me through the pushing. Around the 45 minute mark (I think!) Allison looked down and said she could see see his head and it was covered with blonde hair! I kept pushing and about 1 hour into it, the staff doctor said that she was getting concerned about letting the pushing go on for much longer because of the IUGR possibility. She also said that part of the reason it was taking this long was because I had very strong muscles that really weren't letting him through. Sooo, they busted out the vacuum and also gave me an episiotomy because of the above mentioned Ms. Olympia-worthy pelvic muscles.

Something I appreciated about the resident using the vacuum (which Allison says looks more like a suction cup than a vacuum) is that she told me that I still had to do the work of pushing, she was just using the vacuum to guide him out. Saying that let me know that I couldn't slack off on my job, and also helped me realize the vacuum wasn't as scary as some people make it out to be. Afterwords The Bean only had minor bruising on his noggin.

So, on the next set of contractions I pushed and Dr. Gen (AKA blonde doctor) guided. At one point, someone told me to look down and I could see The Bean from the torso up as someone was pulling him out of me. It was awesome.

They didn't put him on me right away because of the IUGR concerns. They wanted someone from pediatrics to examine him immediately. So, over to the warming station he went. Allison went over with him while I stayed to deliver the placenta and get stitched up.

Over at the table, the pediatrics doctor and some of the midwives cleaned him up and did his apgar score - a resounding 9! (The highest you can get is 10, but no one ever gets it.) They administered the vitamin K shot and put erythromycin in his eyes to prevent infection.

The pediatrician came over after a few minutes and told me that he was a healthy little boy. He clocked in at 5 lbs, 10 oz and 19 inches long.

At this point, care was transferred back over to the midwife team. They brought him over and gave him to me to hold then one of the midwives helped him latch onto my breast for the first time. Allison went down the hall to the waiting room and got my parents. They had stayed later then intended when my mom came to say goodbye and noticed that all of the lights in the room were on and it was filled with medical staff.

Mom and dad didn't get to hold him that night, but they were both super happy to see him. We hadn't told anyone his name before this point, so we announced it to them. His middle name is my dad's first name and he appeared to be touched.

Kristen, our midwife, discussed discharging me and asked if we preferred to stay overnight or go home. I wanted to go home so I could try to get a better night's sleep, but my dad piped up and informed her that we live in a 3rd floor walk up. Given our apartment location, my stitches, that the weather was pretty bad, and that we'd been through a lot the past couple of days, Kristen thought it was better that we stay the night.

So, off to the ante-natal rooms again we went. I got to be chauffeured down in a wheel-chair, though to tell the truth I got one kickin' hemorrhoid from pushing and may have preferred to shuffle down on my own.

This time Allison didn't have a recliner, so we both slept in my hospital bed (we fit much better that night than we would have had my belly still had a baby in it) with The Bean. It was amazing to doze and wake up with him snuggled between the two of us.

Overall, the experience felt very long but the hospital staff was unbelievable and I'm ecstatic to be home with my wonderful wife and our beautiful and healthy new son.

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