Birth day

It's Isaac's first birthday today! To lead up to it, for the last four Wednesdays I've written birth related posts, including last week, which was part one of the actual birth story. Here, at last, is part two.

Monday, September 5, 2005
8:30 p.m. (recap)

I had been having contractions for about 20 hours, and had been in labor that required intense concentration for about eight hours. We had just called the doctor, and based on my behavior on the phone (the next day she told me she had diagnosed me as 4 or 5 cm dilated) she had said it was okay to come to the hospital. But I had no inclination to leave my house. No one was timing my contractions (or at least they weren't telling me about it) so I was allowed to be in a labor outside of time, without boundaries, without pressure; I was simply bobbing along in this vast dark sea where there were occasional big waves to surmount. My mom was beginning to worry, she says now; she wanted to go to the hospital but didn't say anything. The doula only held it out as an option from time to time. I think I had forgotten sometimes that I was having a baby, so focused was I on the process at hand.

9:00 p.m.

Things got more intense. We were still in the bedroom -- me, Craig, the doula, my mom, and my sister. I sat on the birth ball and rocked side-to-side during contractions, pulling hard on a towel held by someone standing in front of me, and at the same time having my lower back rubbed by someone sitting on the bed behind me. Between contractions I leaned forward and rested my head on the person holding the towel. I took great advantage of those breaks, and I often nodded off. When there was no break between contractions -- this happened a few times during this period -- I whined about it, and the doula reminded me that there would be a space the next time. This went on for a few hours, long enough that everyone had a chance to rotate out and eat dinner. I remember objecting (briefly) when Craig left the room, but otherwise I didn't notice much; all my concentration was inward. I continued to keep my eyes closed. I didn't talk much -- nobody did, except to say encouraging things to me -- but I continued the low round moaning, which was still incredibly helpful.

During this, Craig finished packing our bag for the hospital. A lot of the items, like the iPod, massage oil, and breath mints, we never used. I didn't have the kind of labor where I would have noticed one of my support people having bad breath, but all the books do tell you to pack mints for that reason!

11:00 p.m.

Although she didn't voice these worries aloud, I think eventually the doula got worried about my lower back pain being an indicator of Izzy being in a posterior position. She was also worried that although I'd been in labor for a relatively long time, I wasn't yet asking to go to the hospital -- slow progress in labor is another possible indicator of a posterior baby. So she suggested I get on the bed on my hands and knees and she'd compress my pelvis by pushing on either side of my hips; I guess this makes room for a face-up baby to flip over.

But shortly after I got off the birth ball and onto the bed, things changed. I began to feel a certain downward pressure -- a little bit like I needed to go to the bathroom, with a strong desire to bear down. The doula said later that she could feel my tailbone flexing and could feel my reflexive pushing.

She realized then that I was all the way through transition (must have been the time on the birth ball), and I was ready to push the baby out. I had been deceptively calm and controlled, I guess, and she hadn't realized how far along I really was. Now we needed to get to the hospital immediately, or else we needed to decide that the baby was going to be delivered at home by paramedics. The doula really kept her cool, though; Craig said that one of her great strengths was not letting us see when she was freaking out.

11:15 p.m.

They took the time to shove a bathrobe on me before we left -- yes, it was cool outside and I was only wearing cut-off sweatpants and a t-shirt, but I wouldn't have noticed. After hours of being in my own separate world it was strange to leave the bedroom, strange to walk down the hall, strange to see my father and brother. I didn't want to take my car, since the baby's car seat was installed in the middle of the back seat, and I wanted someone to sit right next to me. So we decided to take my parents' brand new Prius! They had put down a few of those absorbent Chux pads on the seat in nervous preparation for me, but as I walked across the driveway I had a big contraction. I stopped and leaned forward on the car with my hands on the hood (as if I was being patted down by the cops after a traffic stop!), and with a huge gush my water broke. So they hurried to get even more pads, and towels, to throw into the back seat. (Luckily the seat remained unscathed at the end of all this.)

As I stood in the driveway, the doula quickly tugged down my shorts to examine the pad I was wearing, making up some story about checking for bloody show. Of course she was checking to see what color the amniotic fluid was, although she didn't tell me that explicitly. I luckily didn't realize what was going on, because there was what turned out to be a moderate amount of meconium, which got the medical personnel all fired up when we finally got to the hospital.

My dad drove, the doula sat in the front seat, and Craig sat in the back with me. I had my eyes closed almost all of the time, and apparently that was a good thing because my father drove really fast. Craig said it actually scared him. I just noticed the potholes; man, were they uncomfortable! As soon as we were driving, the windshield fogged up dramatically. The Prius was so new, my father wasn't sure where all the buttons were, so it took some time for him (and the doula) to find the defroster. That added to everyone's tension level!

My mom and sister followed in my car, with the baby seat in the back seat, and with all the gear we'd packed. If anyone had asked me, I would have guessed that I no longer needed the birth ball, but my family dutifully shoved it in the back seat of the car anyway. My brother and his girlfriend stayed at home to watch the dog.

My contractions were further apart than they had been back at the house, but they were accompanied by a strong desire to push. I had begun to feel bit of this desire before we left, but it had really stepped up once my water broke. I just sat there and tried not to push, which was pretty difficult. Talk about an uncontrollable impulse. I don't remember if I kept moaning during contractions; it would have been loud in the enclosed space of the car, plus probably stressful for everyone besides me. I was feeling fine -- I wasn't freaked out by the pushing feeling. I guess I knew I still had plenty of time. The doula said to my dad, "She's not going to have the baby in the car," and I said, "How do you know?!" But I was making a joke.

11:30 p.m.

The drive to the hospital must have taken about 20 minutes, but it seemed to me like we got there much quicker. I think I might have been dozing off between contractions. There was a little argument about which way to go; the doula gave my dad one set of directions, and I objected loudly because I thought that way had too many potholes (Berkeley streets are terrible). I cried out, "No!" most pitifully when my dad began to take the exit off the freeway and really stressed him out. But it was too late, he was already on the offramp -- and although he seemed hesitant about what he should do then, the doula told him to just keep going.

We pulled up to the hospital and the doula jumped out and literally ran inside to get me a wheelchair. She was back in no time, but then I refused to get out of the car. I wouldn't move during a contraction, and between contractions I wanted to catch my breath. She ordered me into the chair and we all rushed into the hospital at a trot. The wheelchair didn't have any footrests, so I had to hold my legs straight out and keep my feet up off the ground. But I don't think I had a contraction between the car and the third-floor maternity ward. The doula said that when we got there, I should immediately tell them I was feeling the urge to push. I said dreamily, "I am feeling a little pushy."

We rushed right past the labor and delivery security check-in desk (the doula calling out that she'd be back to check in later) and over to the admitting desk. There I did have a contraction, and the doula whispered to me to go ahead and be loud, so they'd know we were serious and not waste time with a bunch of paperwork. They stuck the hospital admission form in front of me and I signed it with my eyes closed (I looked at it later, and my signature is simply a wavy line). Someone asked from a long way off, "Do you want an IV?" and I said, not really conscious of what I was saying but certain anyway, "No." The doula repeated this a few times: "She said no. Did you hear her? She said no." (I had been drinking Gatorade steadily throughout my labor and really didn't need to be hydrated.) They asked me about my Group B strep results, which were negative. Then they wheeled me into triage to evaluate how far along I was.

We were only in triage for a few minutes. The nurse suggested I get on the bed, but I said pathetically, "But it hurts more whenever I lie down..." So she got my clothes off me, the gown on me, and the monitors on me all while I was on my feet, leaning over the bed. What a nice nurse! She took the sanitary pad off of me and I got my first look at the green staining; this was the first time I realized there was meconium in the waters, which worried me a bit.

I was supposed to only have one support person with me in triage, and the nurse did point that out, but I again protested pathetically and she dropped it -- so the doula stayed in addition to Craig. I hated the monitors, two of them strapped around my middle; any pressure on my belly was painful and distracting. It would have been awful if I'd had to wear them the whole time. As soon as they'd gotten the monitors working, they hoisted me onto the bed, and the nurse did the world's quickest physical examination.

After one peek she promptly called out, "She's ten centimeters and plus three," meaning completely dilated and with the baby's head basically sticking out. There was a sudden swarm of people all around me. The wires were detached from the machines, the curtain was swept back, and the gurney was wheeled out into the hallway just like on TV. I remember smiling beatifically as they rushed me into a delivery room. I was feeling good, and I was so relieved that things were finally going to happen!

They took me to delivery room #1, the one closest to triage. (It was also a small and kind of crummy room, not nearly as nice as the one we'd seen on the hospital tour, but I didn't realize this until much later -- and it wasn't like I needed a Jacuzzi tub then anyway.) They parked the gurney next to the bed and told me to climb up in it. I said, "You have got to be kidding." (I knew I was making a joke, but I was also serious.) The doula said, "Right now you have got to do what I say." So I got in the bed.

11:45 p.m.

They thought birth was imminent, so they were busy getting ready. Things were so much different than they had been at home, where it had been quiet, peaceful, slow-paced, and private. Now there was a rush to mobilize equipment, including data entry -- I had come in so quickly that they hadn't entered me into the computer system yet. There were so many people in the delivery room, I could hardly comprehend it. Everyone kept introducing themselves to me, and I was insanely polite and happy to meet everyone. I was strangely peaceful and compliant, and I would have done anything they said. There was my labor nurse, and another woman to help her. There was a baby nurse, because of the meconium, who told me very seriously that she would have to take my baby away from me immediately after birth to make sure there were no breathing problems. At one point there were two baby nurses. In addition to them, there was at least one other hospital staffer, maybe two others, to help set stuff up.

And of course there was Craig, and my mom, and the doula. To let you know how crowded it was, I didn't even realize my sister wasn't there until after Isaac was born. We had planned on her being there, but in the rush from triage to the delivery room she got left behind with my dad, and she didn't have the nerve to knock on the door. The doula had asked me somewhat vaguely if I was okay with the people who were present (she tries not to ask leading questions of women in labor), but since I had my eyes closed most of the time and I thought everyone was there, I said mellowly, "It's all good." I was really high on endorphins or something. I don't know why Craig or my mom didn't say anything.

Now you would expect action, but instead the wait began. First of all, my contractions stayed slowed down; some were five or seven minutes apart! Second, my doctor was right in the middle of delivering another baby. Put those two things together, and what do you get? You get told by the nurse to lie back, relax, and don't push. Like I said, I was compliant, so I tried not to. The doula whispered to me that I should listen to my body and do what I felt, but I couldn't process mixed messages right then. I really wanted to push, and had wanted to for at least 30 or 40 minutes already, but I kept holding off. I think that's what slowed my contractions way down! That and lying down, which didn't feel good, and all the activity in the room.

We waited for the doctor. It seemed like no time at all to me, especially since I was so out-of-it between contractions, but I'm told it was at least 30 minutes. It was hot in the room, due to the incubator which they had fired up in anticipation of a baby. They brought me cool towels for my face and neck, which I really appreciated once I finally got to push.

Tuesday, September 6, 2005
12:15 a.m.

Then the doctor arrived. She got right down to business and explained some pushing method she wanted me to use. I had a terrible time understanding what she meant, and kept asking anew each contraction, "What am I supposed to do again?" It didn't come naturally. Even before I felt the urge to push, I was to take a deep breath and hold it like I was going underwater, then bear down. I was to do this to a count of ten, or something, and repeat it three times per contraction. I had read about other methods I had planned to try, but the doctor was running the show. (She was like a drill sergeant, the doula said later.) I hadn't planned to push on my back, either, but at the time all I could do was to go along with whatever anyone told me; strange. The doctor had me sitting up at a steep angle, grasping my thighs, with Craig and the doula each holding up a leg, and my mom mopping my brow. My muscles ached the next day!

The long pauses between contractions continued. Now that the pushing had begun, the tension in the room had lessened (for everyone else!) and they began to chat while waiting for my next contraction. This irritated and distracted me. I also hated hearing the fetal heart monitor. Of course the heart rate dropped during contractions, which freaked me out each time, and I would ask each time, "Is the baby okay?" Basically, I hated pushing. It hurt, it was tiring, and the method felt imposed and artificial. Dealing with contractions had felt natural.

Even when the first little bit of Isaac's head appeared I wasn't thrilled like everyone else. Someone suggested I reach down and feel it, and I grumbled, "I can feel it." I now wish I had been able to join in the magic, instead of being goal-oriented, fixed on getting the damn pushing over with. It only lasted about 30 minutes, maybe five or seven contractions total. I guess despite my complaints about it feeling "unnatural," it worked, and it worked fast! (When I saw the doctor the next day, she said something about my being as good at pushing as anyone ever was.)

Isaac also helped push himself out! On one of the last contractions he got his feet up under my ribs and gave a hearty shove. Everyone could see it, and it caused quite a murmur in the room. Someone asked if I'd seen it (I didn't, having my eyes closed as usual) but I pointed out that I'd felt it. When it became clear that Isaac's head would soon be emerging, the doctor told me how to stop pushing once it did. They wanted to suction his airway before his lungs started working. But I didn't hear her, or didn't remember what she said, and at any rate I couldn't stop the train that the doctor had started. She started me pushing hard, I finished up pushing hard. Out he shot, with a second-degree tear for me.

12:45 a.m.

And there he was, although my immediate thought was simply relief that the pushing was over. They quickly determined his airway was clear, thank goodness, so they didn't have to take him away from me at all, and set him immediately on my chest. He was big and red and healthy and alert and loud, although he quieted down right away as he went nuzzling up to nurse.

Isaac was born after 24 hours of contractions, and after 12 hours of serious labor. He weighed 8 pounds, 8 ounces, and was 21 1/2 inches long. About an hour after his birth, the labor nurse and I got around to filling out the consent form for a vaginal birth, and funniest of all, the anesthetic consent form -- considering the only drug I got was a Motrin or two the next day!