December 8, 2004

Jenn's Labor

4am Dec 7

Jenn's labor began quietly enough... Tuesday morning at around 4 am I heard her moaning in her sleep every couple of minutes. The thought "Oh she's in labor" crossed my mind, and I fell back asleep, a weird reaction considering all the anticipation building up to the labor. We had just passed the 41 week mark and people were starting to worry. The OB was ordering lots of new tests and exams, I was worried about Jenn's discomfort. Our families were antsy. But perhaps I knew I had to get my rest too, so I slept.

5:57 Jenn woke up thinking she was having cramps. The day before she had been examined and a midwife in our OB practice. The midwife did something called "stripping the membrane: in which she used her finger to slough off some of the outer membranes of the placenta by reaching through the cervix. Painful? God, I can only imagine. This is supposed to stimulate labor and perhaps it did, but Jenn didn't recognize it as labor. She was upset because she was in a kind of pain that she hadn't experienced the entire pregnancy and was cramping. In retrospect those cramps might have been the uterus getting warmed up.

So Jenn woke up and headed to the bathroom with a bout of intense nausea. My wife can dislocate her shoulder without a wimper, but she doesn't do well with nausea. She began shaking like a leaf. I felt a pang of panic, but we were fairly well prepared. I already called our doula, made sure the bags were in order, made sure I had cash, phone, phone numbers, etc. The contractions were coming about every 5 minutes and were a minute long... in other words everything seemed normal. But within a few minutes the intensity increased and Jenn wasn't getting the sensation of release in-between. The release is what is supposed to make labor bearable, but it wasn't happening. This scared both of us.

The doula, Terry Richmond, arrived promptly and went right into trying a number of positions to ease the pain. Some were working, but the nausea and the shaking were getting worse. Also the contractions were speeding up. We tried the tub for a while which helped, but again there was no sense of release. By 9:15 we were headed to the hospital.

I had been dreading the drive to the hospital thinking that I would be so stressed that I wouldn't be able to focus, but I felt oddly relaxed and in control. Rush hour traffic was not that bad and more importantly the ride seemed to settle my wife a bit. The pain felt bearable she said.

9:45
Arriving at the hospital we found it easier to walk upstairs than to use a wheelchair. We were brought into a triage/examination area outside labor & delivery. The place was busy. 6 babies had already been born that day and it was early still. Jenn was put behind a curtain with an external monitor. A few minutes later our doctor came in did an internal exam and everyone was surprised to learn that Jenn was still at 4cm. This was the same dilation she had in the days before labor. Babies are generally delivered at 9 or 10 cms so this was disheartening. Also a second bit of bad news. The baby was very high, it hadn't even begun to descend. Our doctor, Dr Paka, a good natured MD from Hyderabad with a habit of calling my wife by the wrong name, shook her head and clucked, "I think this baby is very big." Then she went away to attend to other deliveries. An IV drip was inserted into Jenn's wrist and a saline drip was started. She was dehydrated and quickly absorbed 2 full bags of saline.

Privately a resident told me he had expected Jenn to be at 8cm based on the strength of her contractions and her general demeanor. This resident kept filling out forms with lots of repetitive questions. I thought it odd that he kept asking Jenn the questions as opposed to me, but I know they have procedure to follow. At this point we had a choice, get an epidural to ease the shaking and the pain, or go down to the birth center to try to deliver totally naturally.

Our plan had been to use the birth center. It's rooms are bigger, quieter, just in general nicer (relatively speaking). The birth center at St. Lukes Roosevelt has the feel of a two star hotel while the hospital rooms are, well, hospital rooms. The birth center has very different set of procedures than in Labor & Delivery. There is much less monitoring, fewer contraptions, no epidurals, and etc. It's an approach that trusts the woman's body to do the right thing. The idea is to put couples comfortable room with a whirlpool where the woman can get into any position that works for her without too much medical intervention. By most accounts with normal deliveries, and with women who are prepared for birth without an epidural, the birth center is one of the best bets in New York City for a satisfying birth experience with the safety net of being near a hospital. Also after the birth, the couple and child are pretty much guaranteed a private room. In Labor and Delivery you must ask for a private room and they are doled out as available. Husbands aren't allowed to spend the night in shared rooms. So the decision was upon us, birth center or labor and delivery (and epidural)? The decision was easy: labor wasn't progressing normally, and we all felt Jenn's shaking and nausea were side effects of the pain. She was laboring with high pitched non-productive squeaks as opposed to the productive deep moans we were looking for, and she was throwing up. So we decided on the epidural in the hopes it would relax her and allow labor to progress. My concern as that she would feel upset, because she had invested so much in the idea of a totally natural childbirth, but at this point she was just looking for relief. But even after we put in the request we had to wait... All the anesthesiologists were tied up.

The triage area was extremely noisy with other laboring women and people coming and going, there were 2 people ahead of us for a delivery room... so we waited. This probably was the most agonizing part of the entire day. We spent almost 90 minutes in the holding area but it seemed like an eternity. I kept re-assuring Jenn that a room was coming, but kept getting word that the room wasn't ready. Annoyed by the noise and clatter, I said, "It will be quiet, you'll get some relief and you can rest". Jenn, much to the amusement of the doula, the resident and myself, said, "oh it's nice and quiet in here..." She was going internal.

12:00
We were wheeled to a room in labor and delivery. The room was small a phalanx of machines. Despite 2 broken chairs, and a large wall clock stuck at 12:05 the room was comfortable. Outside we had a fairly decent view of the city. An anesthesiologist, the head resident arrived at 12:50. He had a firm calming manner (and he was wearing the cleanest chucks I've ever seen) and went to work. The epidural procedure which involves a needle in the spine was performed with merciful speed.

Within 20 minutes Jenn started becoming her normal self again, even cracking a few jokes. Now we just had to wait. The plan was for her to try to get some sleep and see if contractions would start again, if not Pitocin, an artificial form of Oxytocin to stimulate contractions would be delivered. Despite the reprieve from the pain, Jenn was upset. This was exactly what we had been trying to avoid, she said she felt like she had failed. I did my best to let her know how proud I was of her and how I thought this was the right decision given the slow progression of labor, but she was having none of it. Pitocin was delivered via IV and the contractions, which had been calmed by the the anesthesia started again on charts. Finally she simply slept.

I took a break for lunch.

1:20
Dr. Paka examined Jennifer. No progress, so she decided to break the bag of water. I wasn't in the room for this, but apparently the procedure was painless.

On the way back from lunch, I ran into the doctor. She had told me she thought the baby was big and might need a c-section. I tried to make her promise that as long as there was progress she would hold off. While she wouldn't promise, I think she heard me...

In the meantime Jenn's sister Becky arrived. In typical Becky fashion she bopped into the room in good spirits, took a flash picture of Jenn and then held the camera out and took a picture of herself. "So will the baby be here soon?" she asked. She was unaware of the drama of the morning.

Dr. Paka returned. "Let's see how Judy is doing."
"Jennifer," I said.
"Let's see how Jennifer is doing."

The results of the exam were disheartening. 5cm. But it was progress. The doula and I kept emphasizing the point. Dr. Paka looked worried and said she would be back soon. Also a fever had started. Fevers after epidurals are common, so antibiotics were added to the saline drip.

Hours passed without much progress. Outside, the scene was a chaotic with babies being delivered every hour. Q nervous Pakistani man, a tough looking man with a scar from the Bronx, and an Orthodox man and assorted soon-to-be grandparents paced the hall.. The respective wives were making incredibly varied noises from sing-songy sounds, wolf howls, to something that sounded like a yodeler being strangled. None of this was particularly calming. The noise bothered Jenn and I had to keep closing the door. I admit I also kept closing the doors to the other room. By 6pm, twelve babies were born. The clock on the wall still stuck at noon was beginning to really bug me. Luckily Jenn couldn't see it.

And inside our room, Jenn's epidural started wearing off. She began to feel everything again. The shakes returned and the nausea.

5:40
The epidural was "topped off" and Jenn instantly began to feel better again.And the second epidural had kicked up the fever. At 6:00 it was 101.9. More antibiotics were ordered as well as two internal monitors. One for the baby, one for the mom. The baby monitor involves inserting a long thin tube with a tiny wire inside. This wire is actually screwed into the baby's head. At this point Jenn had these monitors, a catheter in her elbow for saline/pitocin/antibiotics, the epidural in her back, another tube connected to the sphygmomanometer on her arm... All this was scary for me, but for Jenn it was disheartening. Again we had invested so much in doing all this naturally that she kept saying that she felt like she had failed. I'll admit hearing her say this got me choked up because I was so darned proud of her. She had been working so hard, and had been so calm. At one point we kicked everyone out of the room and just talked it out. I don't know if I said anything helpful, but afterwards she was more focused and calm.

8:30
The epidural was wearing off again. Again Jenn was feeling everything.An anesthesiologist was called in. She performed a series of simple tests. "Do you feel something sharp on this leg? How about this leg? What about here?" Her conclusion was the epidural was in properly but that for whatever reason the nerves to the pelvis were not being saturated and that the only possible solution was to remove the current epidural and insert a new one. She left the room to call in another doctor. A second doctor confirmed the analysis of the first. A new epidural would be required.

A new labor nurse was on call, Jaye. Jaye is super cool, with lots of arm ink. She told us not to worry.

And at this point a small miracle: as pain increased, Jenn began letting out low sonorous sounds with the contractions... she started laboring productively, ie the baby started moving. We could see it on the chart. With every group of contractions, an inverse blip on the baby's chart, let that let us know the kid was on the move. It was obvious to everyone that the pain was shattering but Jenn was working with it. Later she would say the feeling of the baby moving meant everything in the world. She was dealing... all the while letting out long operatic moans that seemed to come from the base of her soul. The anesthesiologist showed up to redo the epidural. Amazingly she turned him down saying simply, "don't worry, I can deal." All the while, the encouraging blips showing were showing the baby moving. We each one we let her know what was going on. At one point Jenn actually smiled between contractions. During all of this, our doctor had been called away to attend an emergency delivery which gave us about an hour... Jenn told the labor nurse she was feeling the urge to push and the delivery nurse paged in a doctor for an evaluation. As Dr. Paka was busy, another OB came in and did a quick exam. She was at 8cm, almost through transition to the pushing stage. This was an intense time. Jenn's mom was in the room praying. I was letting Jenn know what was going on with the contractions based on the charts, and Terry was providing comfort by cooling Jenn's head, giving us all water and generally keeping things on track.

required.

10:30
Dr. Paka was paged. She seemed shocked find Jenn fully dilated, as she had been preparing for a c-section and had already ordered a us a room. The news kicked everyone into action. Dr. Paka was still worried about the babies size. As a precaution she brought in a full team of residents and nurses. There were 8 or 9 people in the room in addition to the doula and myself. The bed was broken so the doctor could have better access. I was given the job of holding one of Jenn's feet. The pushing part of labor is athletic and extremely focused. Jenn did not need any help here. She was pushing beautifully. The thought I kept having was that if anyone ever doubted the power of women they needed to witness a this. When the head appeared Jenn was told to push as hard as she could. With one great concentrated effort an arm appeared. One of the nurses shouted that he was coming out hands up. I did not know it at the time, but this was a small gracenote because with one arm up the shoulders are narrower and the baby can move through the birth canal easier. With large babies the danger is that they get stuck and the doctors are forced to break their shoulders to remove them. The doctor would later call our situation her worst nightmare. Hence the large team, hence all the worry. So with the hand, the entire room visibly relaxed.

11:17
A second or two later the rest of the body slipped right out. Dr. Paka stood their holding the baby for a moment clipping the umbilical cord. The baby lay there eyes blinking, covered in blood hands up in the air. "This is a very big child," she said softly and quickly handed the child to a pediatrician so that meconium could be suctioned from the babies mouth. I think it was a delivery nurse who said, "It's a boy." Dr. Paka I don't think had noticed as she was so focused on just getting the baby out and on dealing with the umbilical cord. I think everyone in the room repeated "A boy?" to themselves at least once. I ran over to the warmer as the boy was cleaned and checked. He let out sharp cries as he was poked and prodded but was otherwise quiet and alert.

I was literally speechless. Jenn was calm, a bit stunned, but looking surprisingly relaxed given that she was still in the middle of delivering placenta. "A boy?" she kept repeating. Then the weight was announced. 10 pounds 10 ounces. Even the doctor seemed flabbergasted. Later Jenn would say she was also shocked by the number of people in the room. She hadn't been aware of anyone other than myself, the doctor, the nurse, and the doula.

I stood by the warmer holding the boy's hand with my finger and snapping pictures. I was checking to make sure everything was in the right place. 10 toes. 10 fingers etc. It was all there.

Soon Raul Andres' eyes were open and calm. I was anxious to get him to his mother. After a few mintues which stretched like an eternity he was on Jenn's breast for a first feeding. Jenn's mom came in. She had been peeking into the birth and was, I'm afraid a bit traumatized. The baby calmed her. I called my parents and Becky. All were at bedside within thirty minutes.

The family stayed around for about an hour. The whole time, the Raul Andres was calm and alert. Jenn was feeling as well as could be expected. Everyone was happy, a bit dazed, full of emotion,but quiet. Surprisingly no tears were shed. We also exhausted. Soon was time for everyone to go. Jenn was wheeled to her recovery room. The baby was wheeled over to the nursery for some tests.

No private rooms were available so we had to share with a girl who kept the TV on seemingly all day long. After about an hour the baby was returned to us (everything normal) and Jenn and baby finally went to sleep. I was kicked out at around 3:30am. As I walked out of the hospital onto the quiet rainy streets of New York City I certainly didn't feel like a dad yet, but the tug on my heart was strong, and it took everything I had not to try to go up and sneak back into the room with my wife and child. The streets were empty. I didn't have an umbrella but I didn't care. I walked all the way over to my parents place on 5th and 60th full of wordless emotion.

posted at 01:53 AM by raul

Filed under: on kids

TAGS: labor (6) pregnancy (12)