Monday, April 12, 2010

A Long Story About A Quick Delivery

On this morning two years ago, at 4:35 A.M., Mad shot into the world like a rocket (after 36 hours of labor).  Since I've already written about the first part of my labor, this starts up once we arrived at the hospital.

Despite repeated warnings on the hospital tour about how it's better not to arrive during shift change, that's exactly what we did.  The downside is that we were stuck standing outside the maternity entrance for a minute while we waited for a response to the buzzing doorbell... and then again once we were two feet inside the maternity lobby and waiting to get into the maternity department.

The upside was that all the exam rooms were taken, so we went immediately into the room where our baby would be born.  Oliver Canyon or Madelyn Kenzie?  We didn't know.

The nurse who checked me out, Philomena ("or you can just call me Phil"), wasn't exactly pleasant, friendly or gentle.  I would have sworn she was wearing a 9 karat ring on her finger during the exam.  She declared I was dilated to about 3; I was so sure I was at least 4 by then, especially after all the walking I'd done over the past two days (not to mention, on the way to the hospital).  Lucky for us, Phil was going off duty and Maribel Cruz became our nurse.

Maribel was the kind of nurse I hope to have again next time.  Heck, I'd really prefer to have Maribel herself.

She had us on the monitor for an hour to see what the contractions were like.  When she re-examined me, I was dilated another centimeter and a half (or Phil's ring got in the way).  We were staying.  Corey was given a cell phone and a list of people to call.

We presented our birth plan, which was written mainly for us since we knew the hospital allowed most of the things we wanted.  It was pretty simple and straightforward.

*Soft music playing (Corey was the DJ)
*Friends and family allowed during labor
*Do not offer pain medication; I will ask for it if I need it
*Lots of walking and changing positions to stimulate labor
*Break my water if necessary instead of administering pitocin
*No antibiotic eye cream for the baby (as it just so happens, I don't have any STD's, so it was unnecessary)
*No vitamin K shot unless the baby has bruising or bleeding
*No Hep B shot (none of the people in our circle have hepatitis and we were counting on the baby not being sexually active for quite some time, so it was unnecessary... and it reduces appetite and increases lethargy, which are not good things for newborns)

Of course we had to sign declination forms for the shots and eye cream, but Maribel didn't make a big deal about it.  She did ask about our reasoning, but it seemed to be more out of curiosity than condescension.

One thing I did agree to was an IV fluids line.  Maintaining hydration isn't always easy for me under the best of circumstances.  When I was in labor with Corey, I'd taken several hot showers.  Getting an IV put an end to that.  I never even asked if showering would be possible this time.  Although the room was spacious, the bathroom was tiny; I didn't even want to try a shower. 

My mom and Nancy both arrived and stayed for the duration.  Tom was by my side almost every minute.  I used the restroom by myself... we're just not that kind of couple.  I'm not sure if Tom ever got to use the restroom.  I remember he tried to at one point, but couldn't get more than a foot from me before another contraction would start.  We walked the halls numerous times until around 11:00 or so.  I was usually in bed by 10:00, and my body wanted to catch some sleep like usual. 

Tom counted out my breaths for each contraction.  I know, I know... a lot of women would find that annoying, but I can not find a focus point on the wall or in a pair of booties.  I found it in Tom's voice.

Everybody in the room was quiet for most of the night. Once, my mom dared to whisper something to Nance while I was having a contraction. I shushed her. My own mother. As soon as the contraction went away I felt bad about it.

For quite a while things progressed pretty close to the one centimeter per hour like you hear.  But then I hung out at 8+ for over three hours.  That was not fun.  As we approached 3.5 hours of no progress, I started losing control of my pain (and, perhaps, my mind).  According to Nancy, the only thing I said the whole time (and only once) was a very quiet, "Oh my."

Can I be frank?  I have quite the sailor's vocabulary.  I could have said a lot of things, and I was definitely thinking them, but I had Corey in the room.  I wanted him to be part of the labor and see (to a point) what a woman goes through.  I did not want to traumatize him.  I also had my mom and Nance, two churchgoing women... who've heard my foul mouth on (the hopefully rare) occasion.  But it just hit me as unseemly at that moment (I don't know why then, when I really could have gotten away with it).  And lastly, I had Tom there.  I felt very protective over him and Corey.  I didn't want to scare either of them since they'd never been through this side of labor before.

At one point Corey, who is a night owl, decided he needed a snack.  We'd brought plenty for just such a moment.  He selected his A-1 steak sauce flavored beef jerky.  When the package was torn open, I could have sworn a skunk had been let loose in the room.  It smelled awful!  I explained, as rationally as I could, that even though it didn't make any sense he would have to get those things out of the room and not open them up again near me until after the baby was born.

Sometime around 3:30 in the morning I started enquiring about pain medications.  Even though I could recite which drugs do what to Mom and Baby, and Tom and I shared a common view on each of them, I really didn't care what they gave me.  I just wanted the pain to end. 

Tom knew how much I wanted to deliver naturally, and Maribel also understood me (she was pregnant, too... Fynnie will be born when her son is about 2).  When Tom called to ask her about pain meds, she came to talk with us. 

We talked after Mad was born and Maribel said, "I knew how much you wanted to go natural, but you'd been stalled out for so long.  What if it took several more hours?"

Tom asked if it was still possible to get an epidural.  She said it was, had me change positions (we'd forgotten that step somewhere along the way) and then left us alone to talk about it.  Of course, with the position change, the pain of the contractions increased.  I was as close to wanting an epidural as I'd ever been in my life.

Tom called Maribel back and they talked some more about my getting the epidural.  She had me change positions again (ugh!) and told me the anesthesiologist was just down the hall.  He was about to do someone else first who had been waiting a long time, but if it was really bad, she would have him come to me first.  I don't recall an actual response, but in my mind there was no way I could step in front of someone else. 

Another exam and I was at 9.  Progress!  Maribel left the room again.  I'm not sure if a decision had been made at that point.  It seems to me she or Tom said something about talking it over and getting back to her.

Are you onto them yet?  They tag-teamed me and stalled me.  Whatever.

At some point, though, I did specifically ask for the epidural.

I've heard that "you know a woman's about to have a baby when she doesn't care who sees her naked." Not so much on my end, thanks.  With the position changes that Maribel suggested, somewhere in the fog of my brain I recalled that getting on all fours could be useful.  I didn't mind doing that in front of my peeps, but I didn't want the back side of my gown opening and revealing... me... to them.

Of course I handled it all with tact and aplomb.  I believe my frantically whispered words to Tom were, "Get those people out of here!"

"What?  Who?"

"Them!  Those people!  Get them out!"

Tom ushered them out pretty quickly.  We changed positions a couple more times.  Eventually I had him call because I thought maybe I had to push.

Nope, 9+.  Maribel worked some obstetrical magic on my body.  A few minutes later when she checked me... just as the anesthesiologist walked in... I was finally at 10.

The pain doc apologized for taking so long.  I said, "No, it's good.  Really."  I was so relieved to have made it, even if it wasn't entirely of my own free will or internal strength.  My man and my nurse helped me get where I wanted to go, even if they had to carry me a little way.

Maribel left one last time to call the doctor.  In no time at all I understood the difference between, "I think maybe I have to push" and "I can't not push!"  It's pretty amazing what you can feel when you aren't medicated.  I remember being able to visualize the baby's head moving down the birth canal.  It might sound painful, but it wasn't.  It was a tangible sign of progress.

The whole time I pushed I made some sort of a low, guttural humming sound.  I remember hearing myself and wondering why I was doing it, but I didn't stop.

One thing I didn't want was to have someone counting out how long I should push.  I was concerned more about feeling like I couldn't breathe when I wanted.  Turned out that I didn't care about breathing, all I could do was push.

I'd been working on my right side and was pretty comfortable that way.  So when Maribel came in and had me move to my back, I was not thrilled.  Just then my water broke and there was some meconium in it.  She called in all the people who would need to check the baby out after he or she was born. 

On the last night of class Pamela had done an activity that showed how many people would be in the room if there were any complications.  Tom was the "mom in labor," I was his partner and the rest of the other members of the class ended up surrounding us as Pamela told us what each person's job would be in such a case.  We weren't panicked.  I felt pretty calm because I'd seen so many "Baby Story" shows where meconium was present.  Everything was smooth sailing and I figured the same would be true for us.

I pushed for 10-15 minutes.  The bed was not broken down and the doctor did not arrive until after the baby was halfway out.  Tom was the person who saw first and said, "I think it's a girl."

Someone, maybe Maribel, said, "Let's look."

Tom said, "No, it's a girl!"

I sat up to look at her and immediately noticed she had Tom's mouth and chin.  She had the same pucker he makes while sleeping.  Her left hand made the sign for the letter T.

Tom cut the cord after some instructions from Maribel.  I was surprised that he did because he gets pretty queasy around blood, but he had no problems.  He seemed rather proud of himself.  I know I was.

We didn't get to hear that first cry for a long time as they worked to clear out her lungs.  It was a loud, strong cry.  So loud that the family was able to hear her even though they'd been shuttled to the lobby and were on the other side of a glass door (ours was the room second from the lobby door).

Tom went to be with our little girl as the doctors and nurses tried to stabilize her breathing.  She had been upset, but when she heard Daddy's voice, she stopped crying and looked at him.  That was beautiful.

It was a good thing he was there, too, because the doc stepped in then to deliver the placenta.  Someone pressed on my abdomen and blood and guts shot out of me and hit Doc with a large splat.  I had been laying back, but sat up to see what had happened.  I looked at her scrubs and said, "Well that's a mess."  Doc laughed and said she needed more patients like me.

Again, I was just glad Tom was over with Madelyn, because I had virtually promised him that there wouldn't be much blood involved in delivering our baby.  There wasn't any when Corey was born.

Doc said I had a small tear.  She gave me enough anesthetic to numb a miniscule tear.  I could feel the last several stitches.  Even though I told her, she did not do anything but continue sewing.  Jeez!

After about 20 minutes I was finally able to hold Madelyn (Tom handed her to me), but only for a couple minutes because she was still having a hard time breathing.  She was grunting and rather gray and on her way to the nursery.  Everyone got to see her while I held her, but that was it.  Once Mad was on her way, Nancy kissed me goodbye and went to take her husband on what would end up being his last trip sailing.  Mom took Corey to her house and I'm sure they slept the day away.  I began calling anybody who was out of state and likely to be up.

An hour or so later Tom came in to report that Madelyn was going to the neonatal intensive care unit.  She had a collapsed lung and the air had gone into her chest, not out her mouth or nose.  Because of the meconium, she was at risk of a potentially fatal infection.  And the course of treatment required at least three days.

The first time I got to see her looking pink was in a photo a nurse brought to me.  My sweet daughter was covered in tubes and wires.  It was surreal.

The neonatologist came to see us and told  us the plan.  He said I could go into the nursery and hold her for a few minutes before they moved her to the NICU.  After that we wouldn't be able to do more than touch her foot for a while (and that only every couple of visits, it turned out).  We were there as soon as we were allowed and held her as long as they let us.  Seeing my baby with a pacifier made me kind of sad (like there wasn't enough other stuff, right?), and I remember being surprised at how little she seemed.  At 8 pounds 3 ounces, small isn't usually what one thinks about a newborn.

I didn't make any more calls that morning, but I may have sent out a text.  In any case, friends came to visit, which made things better.  My dad and Margaret brought my sister and niece.  All the adults took turns going in to see Mad with Tom while I stayed in the lobby with the rest.

Speaking of which, I do understand keeping the regular nursery separate from the NICU, but is it really necessary to put it on the other side of the maternity ward... and on the other side of the lobby?  The family of about 20 people who were waiting for their own long delivery knew our entire story after Tom had passed through there about a dozen times.

Mom brought Corey back later that afternoon.  Corey didn't want to see the baby like that.  Mom stayed with me while Corey and Tom walked home to feed the iguana and get our car.

I remember feeling like I was ready to leave the hospital almost immediately after giving birth.  The only thing that kept me there was Madelyn.  The nurses and my family all encouraged me to stay just because it was easier to visit with her from my room instead of a few blocks away.  So I postponed walking out of there and into our home without her. 

The air pocket (which was now surrounding her lung and heart) did not resolve itself as can happen, so it was removed with a needle.  The doctor said that Madelyn didn't cry.  Except for the risk of infection, she could have gone home the next day.  Her respiratory distress resolved pretty quickly.

Instead of starting off with breastfeeding, Mad went without food for about 24 hours.  Then she was given IV nutrition and then a bottle.  Meanwhile I was pumping everything I could.  It was hardly anything.  Even though I wasn't outwardly expressing how upset I was, the lack of physical contact with my daughter was killing me.  After the 12th time I pumped, I finally managed to get a few drops of colostrum.  We got to nurse when she was three days old.  Making it happen involved me, Mad, Tom, a lactation consultant and the neonatologist (who had to tell the lone idiot nurse we had that Madelyn could nurse).

It seemed like every time Mad would reach a feeding milestone set by the medical staff, they would increase the goal.  When a mild case of jaundice occurred, they talked about keeping her for up to an additional week (that was another gem from the lone idiot nurse... the rest were spectacular).  I might have raised a small amount of holy hell because the jaundice numbers were low; if we were home we'd have to keep her near a window for the indirect sunlight.

She kept getting stronger and was able to regulate her body temperature and breathing.  The morning after the course of antibiotics was completed, she came home.

One thing we decided after bringing her home was that it was nice to do all of her first diapers and feedings and baths under the caring supervision of the NICU nurses.  Tom became an expert at everything and my skills were refreshed, so we weren't as nervous as we might otherwise have been.  Most importantly, we got to bring her home.  I never doubted we would, but it was easy to wonder if it would ever really happen.


Bossy Betty said...

SO glad you wrote this all down! What memories! Glad that little girl is happy, healthy and ruling your world today!

Rebecca said...

Wow. What a story. I can't imagine how difficult that NICU stay must have been for her and you.

Anti-Supermom said...

What an amazing story, just reminds me that even if it might not all be 'perfect' the outcome of having your baby, in your arms is the best feeling in the world.

Happiest Belated Birthday (or so it looks!)

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