Tuesday, June 19, 2012

The Arrival of Caleb James, Pt. 2

(Continuation from The Arrival of Caleb James, Pt. 1)

Agatha told me to practice bearing down until they were ready for me to start really pushing.  I had no idea how to bear down without pushing, so I just pushed!  Each time a contraction started, I lifted my shoulders, tucked my chin into my chest, pulled in my left leg - Jonathan had to move my right leg for me, I still couldn't feel it - and pushed as hard as I could for ten seconds at a time.  After entering some data into the computer, Agatha came over to see how we were doing.  She commented that my pushing was very effective.  I interpreted that to mean our son was on his way down and out, and we would be done with this soon.  We continued our routine, getting in 2-3 pushes per contraction.  She encouraged me not to do more than that so as not to exhaust myself too quickly.  Periodically she came over to check my progress, then went back to the computer.  Each time I asked if he was getting any closer, and she would encourage me to keep going, that he would be here soon.  During this time Dr. Partida was getting some rest herself; she had several of us in labor that night, and in between jumping from patient to patient she tried to recover some of her energy.  She was wonderful, though, in that she never once made us feel like we were inconveniencing her or disrupting her time.

Speaking of time, it continued to move on as I pushed, breathed, pushed, rested; pushed, breathed, pushed, rested; etc.  I still asked Agatha how well I was pushing, if I was making progress, every time she came to the bed.  An hour went by, then another half an hour, then another.  Jonathan later told me that it was painful to see me exerting so much effort and energy as Caleb's head would start to descend a little bit, but as soon as the pushing was over, he went right back up.  There was no two steps forward and one step back, as birthing usually goes.  It was two steps forward and two steps all the way back each time.  Neither of them told me this at the time, though, and I appreciate that.  I'm sure it would have been quite discouraging in the moment.

After about 1.5 hours of pushing, Dr. Partida came in to check on me and watch me push through a contraction.  She agreed that I was effective and directing my pushes well, but he wasn't descending like he should be.  The hospital's policy is to allow women to push for 2-2.5hrs before moving to a c-section.  We had discussed this previously with her at a regular checkup, and she assured us that as long as mama and baby are handling labor well, she isn't one to enforce that policy.  At this point, though I had been pushing for a while, the baby and I were both quite stable so we continued with the pushing.

Poor Jonathan was so good to me throughout all of this time.  Of course no one gets more exhausted during this time than the mother, but it's exhausting to a degree for the support person, too.  It was emotionally taxing on him to watch me struggle to get this baby out to no avail, not to mention he had to keep his energy up to encourage me and count with me and stay positive with each contraction.  After a contraction was over I would lower my left leg, but he had to keep holding my right leg since it was just dead weight to me.  Even though it had no sensation, I felt like it had to be held at just the right height.  If he wasn't paying attention and lowered it even an inch I would scold him and ask him over and over to PLEASE keep it where it was!  After the fact I realized how ridiculous it was, but in my mind it just wasn't comfortable to be held anywhere other than where I wanted it.  He was a great sport and never gave me grief about harping on him about it.

After 2.5 hours I noticed that the feeling in my abdomen was changing with the contractions.  As mentioned, there was a spot in my lower left abdomen where I could feel the tightening of each contraction.  Now I felt that spot growing and some pain accompanying the tightening.  Over the next 30 minutes, as I continued pushing, the pain intensified.  I knew the epidural had nearly worn off and I was beginning to panic.  I was absolutely unprepared to birth this baby without pain medication.  Dr. Partida came back in to check my progress and I immediately informed her of my discomfort (to say the least).  I begged them to do something, as by this point I had been pushing for 3 hours and strongly doubted my ability to continue without pain relief.  My sweet doctor said they would have the anesthesiologist come back in, and to continue pushing in the meantime.

In between contractions I was extremely uncomfortable, but every time I pushed I felt immense relief from the pain and pressure.  It felt SO good to push into the pain.  Then I would stop pushing, take a deep breath, and all the pain and pressure came rushing back. Resume pushing, resume relief, pushing over, overwhelming discomfort returns.  This is how it went for some amount of time - I'm not sure how long - until the anesthesiologist returned.  He gave me a boost of the numbing agent in the epidural.  I soon felt the warm relief creep in, but to my dismay I was more numb than before and could no longer feel even the tiniest bit of contracting.  This meant I now needed someone to hold my left leg for me, and we had to rely on the monitor to tell us when I was contracting.  I was so disappointed to no longer use self-directed pushing, not to mention I had a harder time directing my pushing effectively.  I felt a little bit woozy and drugged, which I hadn't felt when I originally received the epidural.

After I was numbed back up, Dr. Partida returned to check on me.  It had now been 3 hours and 15 minutes of pushing and she could see I still was not making progress.  Throughout that time we'd been shifting me onto my right side, then onto my left, and back to the center, and nothing was making a difference.  She agreed to give me half an hour to keep pushing on my own, and after that if he hadn't crowned, we would have to either try the vacuum or go for a c-section.  We told her that a section was absolute last resort, and we'd be willing to try the vacuum first.  Well, I was not about to get cut open if I had anything to say about it, so I bore down harder than ever during those next 30 minutes, determined to get this baby boy out on my own.  But wouldn't you know, things just weren't lining up.  She promptly returned, watched me push again, and said, "Ok, let's get the vacuum ready."

While the room was basically prepared for a birth, there were still a few things left to do.  Another nurse brought in a warming station and blankets.  (Our families were still in the waiting lounge at the end of the hall during this time, and they knew by the warmer that we were close.)  Dr. Partida suited up in her delivery scrubs and someone prepared a small table with the vacuum suction, clamp, scissors, etc.  Dr. Partida suspected the cord was around the baby's neck and had paged a team from the NICU to come in, just in case.  (In hindsight, I believe she must have seen a series of heart decels on the baby's monitor.)  Finally she was seated and ready to go with the vacuum.  The moment of truth was here; would we be able to get him out vaginally, or would I be whisked away for a section?  I was NOT having that, so I brought my a-game and mustered everything I had.

I didn't want a mirror so I have no idea what was going on down there.  (And based on what Jonathan later told me about it, I'm glad for that.)  Dr. Partida and I worked together as a team, me pushing and her pulling with the suction.  The energy in the room intensified as we gradually got closer to getting his head out.  At one point she said, "Okay Jessica, I want you to push as hard as you can.  Keep pushing, don't stop!"  So I squeezed my eyes shut and used every fiber in me to focus on pushing.  After the usual 10 seconds, she said, "Keep going!  Keep going!" So I quickly drew a breath and continued with the push.  His head was so close, she didn't want us to lose all the progress we had made, so I continued with one huge push for about 30 seconds, taking gulps of breaths when I could.  I felt myself losing ground; I was pushing so hard I couldn't hold my breath in any more.  My throat and lungs didn't want to cooperate with all the pressure I was exerting.  Just when I thought I had nothing left, his head emerged.  Dr. Partida's instincts were right and the cord was wrapped around his neck.  She quickly looped it around to pull it off, suctioned his nose and mouth, and in another push or two his body slid  out.  At 3:27am, 4 hours from the time I started pushing, our Caleb James was born.  Our plan had been for Jonathan to cut the cord.  Caleb was quite pale and not crying when he came out.  Jonathan asked if he would be able to do that still, and she handed him the scissors and told him he could but had to do it quickly, so he did.

At this point my memory gets a little hazy.  I was utterly exhausted, still feeling druggy from the epidural boost and oblivious to much of what was happening around me.  I do remember a flurry of activity throughout the room.  We had written in our birth plan for Caleb to be immediately placed on my chest after the birth, but because he still hadn't cried out, he was rushed over to the warmer where the NICU team suctioned him some more, covered him in towels and rubbed him to stimulate crying which would help clear out his lungs.  Finally he let out a squawk and everyone breathed a deep sigh of relief.  As soon as he did that they brought him over and placed him right on my chest.  He was incredibly pale, almost pure white, and continued to be fairly quiet.  We rubbed him, stroked his arms, talked to him, encouraged him to make a little more noise in order to continue clearing out his lungs.  He responded with a few weak cries.  Nothing very loud, but enough that the medical professionals in the room felt comfortable with his state.  (At this point one of the nurses took the warmer back out of the room.  When our families saw her, they asked if that meant he was here.  She smiled and nodded and they erupted in cheers.  Agatha said she could hear them even with the door closed.  We love having such fun, supportive family.)

Sadly, I didn't bond with him immediately.  The weariness of what my body had just gone through along with the numbing effect of the drugs in my system prevented me from forming a close bond from the get-go.  Thankfully as I held him and looked at him I began to feel closer to him.  It didn't take much time before I was irrevocably attached to this beautiful boy that had grown within me.  However, his daddy was smitten with him from the moment he laid eyes on him.  He turned the video camera on shortly after Caleb came out and can be heard saying, "He's so cute!"  Jonathan experienced the rush of love and immense joy I had expected for myself, and I'm so glad for it.  Daddy deserved a reward too, especially after how much he gave to support his wife.

Though the baby was out, I continued to feel uncomfortable pressure down south.  I woozily asked Dr. Partida why that was, and she told me it was the placenta.  My body wasn't ready to expel it just yet, and during the process of actually delivering Caleb I had suffered 2nd and 3rd degree tears, so she worked on stitching me up for about 10 minutes.  Finally, in just a couple pushes, the placenta was out.  She held it up for Jonathan and I to see and I was struck by how big it looked.

Caleb was weighed at 8lb 10oz and measured at 20 inches.  As soon as I was completely stitched up and Caleb had been given a clean bill of health (his apgar scores were 6 and 8), the personnel gradually trickled out of the room until was just Agatha and our little family of three.  She helped me get Caleb latched on to nurse for the first time, which unfortunately didn't go very well.  I was still fully reclined and the angle was just awkward.  (However, we went on to have an incredible breastfeeding relationship that lasted 18 months.)  I snuggled Caleb while Jonathan ran down the hall to let the families know that mama and baby were fine and tell them Caleb's stats.  I held him a while longer then Daddy had a chance to hold him for the first time.  I took a picture of them and the love pouring out of his eyes as he gazed at his son is overwhelming.  Agatha gave Caleb a bath and showed Jonathan how to put a diaper on him.  (This really came in handy over the next few weeks when Jonathan changed almost all of Caleb's diapers.  My "area" had gone through so much trauma that I wasn't able to get around very well and spent most of the time sitting on the blowup donut the hospital kindly gave me.)  After about 3 hours from the time Caleb was born, once we got him comfortable and swaddled and me situated in bed, we decided it was time to introduce him to the rest of his family.  Agatha volunteered to go out and get them for us.  Jonathan held Caleb as they filed in and we shared his name for the first time.  They took turns holding him and he was so alert during all of it, gazing right back at each of them.  They stayed for a little while and then left to get some sleep (they had been up all night too).  Jonathan and I were beyond fatigued.  We turned off the lights in the room, Jonathan snuggled up on the window seat bed with Caleb, and we all finally got some much needed sleep.

16 hours of labor, 4 of that spent pushing, and finally the birth of our son.  This was one of - if not the - most profound, life changing experiences of my life.  I was permanently altered in a matter of seconds.  The only way I could think to describe what it felt like to give birth and become a mother is that my own heart began living outside my body; wherever that baby boy was, I felt a string attaching me to him.  I physically felt the draw toward him, and if he wasn't in the room with me I felt a sense of missing.  I became hyper aware of wherever he was, like a honing radar.  It's not as intense now as it was in the early weeks, but the draw is still there and I don't think that will ever change.

Not everything went exactly as we had hoped, but we achieved a vaginal birth and we all came through it just fine.  I've learned from our experience what I want to do differently next time.  However, I don't have regrets about Caleb's birth.  I am so grateful for the consistent support of my loving rock of a husband, my amazing nurses (my postpartum nurses were as wonderful as Agatha, who returned as our night nurse the following night), and my fantastic doctor.  She knows us well and truly cares for us.  We feel like we've gotten the best of both worlds: the training and licensing of an MD for Jonathan, the relationship and care of a midwife for me.

It's a true challenge to try and put into words a milestone like having a baby, but I've done my best.  There's so much more from the days and weeks following his birth that I don't want to forget, but the experience of birthing Caleb is most important.  I know this is lengthy; I intended this so I could have the most detailed record possible.  I know that as time passes it will become increasingly difficult to remember everything that happened that night, so these posts are my attempt to preserve the story of how our sweet boy came into the world.

 Caleb James Gilroy
8lb 10oz   20"

The Arrival of Caleb James - Pt. 1

NOTE: This is a series of two very, very long and detailed posts. I've omitted the more gruesome parts (pretty sure I'll never forget THOSE details) but included everything else as best I can remember. I've written this out to share, but it's primarily for me to remember everything about this experience.

March 27th found me less and less comfortable, tired from long nights awake with false labor, increasingly impatient and 1 week past my due date. Throughout my 40th week of pregnancy I had contractions that graduated from Braxton Hicks to very real and sometimes painful contractions. Two or three times they got as close as 5 minutes apart but never lasted long enough to become real labor. Jonathan and I walked, and walked, and walked. I still enjoyed being pregnant but my belly felt like the turkey in National Lampoon's Christmas Vacation - swollen, overcooked and ready to explode should something sharp make even the faintest contact.

I had progressed on my own to 2cm dilated and 90% effaced. For not being in labor and a first time mom, that was a good sign. However, I was paranoid that I wouldn't go into spontaneous labor on my own and would have to be induced at 42 weeks. We were blessed with a very supportive OB-GYN who was understanding of our decisions and didn't put pressure on us to induce prematurely; in fact, she encouraged us to wait if we felt comfortable doing that. We went in for a checkup sometime during my 40th week. An NST (non-stress test) and BPP (biophysical profile, an ultrasound to check amniotic fluid, placental condition and baby's growth) showed that our little boy was doing just fine and my body was supporting him well. Even so, I couldn't shake the fear that an induction was in my future. Based on my progress and gestation, we decided to try a Foley bulb to help me progress to 3cm and, if my body was ready, encourage labor to begin. (The Foley is basically a catheter in the cervix, the end ballooned with water so that it sits and puts pressure on the cervix, encouraging dilation.)

We arrived at the Family Maternity Center (FMC) at 10:30am for the Foley to be placed. After signing in, they took us back to triage. I changed into a gown and got hooked up for another NST before the procedure. The NST took about half an hour. I was grateful that my doctor, Dr. Partida, was on call that weekend, so she could be the one to put the Foley in. They got me set up in a small room with only a little counter, exam bed and one chair for the doctor. Jonathan stood next to me and held my hand. At 11:50am, I wasn't paying much attention to what my doctor and the triage nurse were saying, but suddenly my brain kicked in and I realize that the word "water" was spoken. "Did you just say my water broke??" Dr. Partida confirmed that indeed it did, that in all the times she'd done the procedure, that was a first. I was very confused as I hadn't felt a thing, then I could sense the warmth. All that worry for nothing; my water spontaneously broke before the Foley was in. I looked up at Jonathan with a mix of shock and excitement. It was clear that for him it was 100% shock when he asked the nurse if there was somewhere he could sit down. Neither of us were expecting my water to break at that moment but it definitely hit him harder than it did me. After stepping out to sit and regain his strength, he came back in apologizing over and over for leaving me, but I promised him that I was fine and needed him to be ok too. And he was; he was an awesome coach throughout the rest of our experience.

Finally the water stopped flowing. Dr. Partida said, "If anyone ever asks how much water you had, tell them this," and she lifted the bedsheet and wrang out all the water. She wasn't kidding, there was a ton. She felt around my belly and guessed that our baby would be about 7.5lbs. That number sure sounded good to me! At 36 weeks I tested positive for Group B Strep (GBS). To reduce the chances of our baby contracting it during his delivery, I would have to receive antibiotics throughout the labor. This also meant that I was on a time clock from the moment my water broke. (It is hospital policy that if the baby isn't out by 24 hours after water breaking, a c-section becomes necessary.) For this reason, she went ahead and put the Foley in, hoping that the pressure from it in addition to my water breaking would protect me from the possibility of a section. It was no big deal - until I stood up.

I was immediately hit HARD by major cramping and contractions - or rather, one long contraction that never seemed to let up. Labor is known to speed up and get more intense when the mother's water is broken. Add to that the pressure of the Foley, and the pressure of the baby's head ON the Foley without the cushion of the water sac, and I was in intense pain. I could hardly walk back to my triage bed, and even then, laying down did nothing to relieve the pain. Dr. Partida suggested I order some lunch but the pain took away my appetite. They admitted us and showed us to our room, which I had to walk to. It was a very long, slow, agonizing walk. After they got me settled, Jonathan went out to call our families and I tried my best to breathe through the pain. I got up to use the restroom and the Foley fell out. Oh.My.GOSH. Instant relief! I couldn't believe how much better I felt. The pain stopped right then and there. That also meant I had dilated to 3cm.

Jonathan came back in. We chatted with the nurse as she put in my IV and strapped on the monitor. She started me on fluids and the first dose of penicillin for GBS. After a bit I felt a tingling sensation in my hand that morphed into burning, slowly creeping up my arm. Alarmed, I asked the nurse if that was normal. She said it was a normal reaction to the penicillin. The veins in my whole left arm, from fingertips to shoulder, tingled and felt ice cold and white hot at the same time. After 15 minutes it subsided and my arm was back to normal.

My monitor was portable so I put on my robe and fluffy slippers and we went for a walk through the halls. After several laps we went back to the room for something to drink. We walked in to find a tray of food which Dr. Partida had ordered for me even though at the time I didn't want it. I was grateful she did. I lifted the lid from the plate and... a tuna sandwich. Really? The kitchen sent tuna for a pregnant woman? (For those who don't know, tuna is one of the "no-no" foods for pregnancy because of the high levels of mercury.) I ate the other items on the tray and gave the sandwich to Jonathan. The nurse checked me and I hadn't progressed at all so they suggested starting Pitocin. My goal was to get to 7 or 8cm without an epidural, which I was afraid would stall my labor if put in too soon. I hoped to avoid Pitocin because I knew it would intensify contractions and increase my likelihood of requesting an epidural before my goal but time was ticking by and labor needed to move along, so we agreed to start the lowest dose. We walked around for a while and stopped at the FMC's kitchen for some jello. I looooved red jello during my labor. I can't even remember how many cups of it I ate.

At 3pm, they upped my pitocin from 2 to 4. Still very low, but when we hit the halls to walk some more, BAM! Hard contraction. I had to stop walking but I could still talk through it. The contraction subsided so we continued. A few minutes later, BAM! Another one, this time even stronger and I could no longer speak. We only made it another 15 minutes in the hall when I wanted to get back to the room. The contractions were very quickly becoming very painful and I didn't want to be on my feet anymore. On the way back I had to stop several times to lean against Jonathan, close my eyes, breathe and be silent. We got to our room and the first thing I asked for was the birthing ball. I found my rhythm as I sat and swayed my hips back and forth. During each contraction I leaned over to lay my head and arms on the bed, swaying as Jonathan sat behind me and applied counterpressure, massaging my lower back and shoulders and softly exhorting my efforts. Each contraction seemed worse than the one before and many were tandem - swelling, peaking, starting to come back down and then a second swell before the first was done. I felt relief in between the contractions, but the pain during was exhausting. Our day nurse was very sweet but she talked a lot and at one point she asked me a question mid contraction.  I could hardly hear her and speaking was out of the question. Jonathan knew this and answered for me. He became my voice while I labored silently.

The pain was a combination of aching, cramping, burning and pressure and the intensity continued to increase. I instinctively went inward each time I felt the swell begin. I moaned and mumbled something then leaned over onto my pillow, closed my eyes, swayed on the ball and focused on relaxing through the pain. Swell, swell, swell - peak - and slowly back down. I couldn't hear anything around me, completely unaware of the room. All I could think was, 'I can't bear another one of these,' but then the pain would subside and in my relief I'd decide that I could make it through one more. My coping methods eventually shifted. What once had been helpful became distracting. I remember in the middle of one contraction thinking that Jonathan's massaging was no longer helping me but I didn't have a voice to tell him, so I had to wait until the contraction was over. I stood up and tried leaning over the counter while Jonathan squeezed my hips together but that was MUCH worse. We tried a few more positions but the birthing ball was my friend so I stuck with it. Jonathan sat on the other side of the bed and during each contraction, I closed my eyes, rested my head, reached across the bed and held his hands. He gently suggested that I get in the bathtub but I was so uncomfortable that all the trouble of getting undressed and into the tub, then having to get out, dry off and dress again sounded like far too much work. (In hindsight, yeah, it really would have helped but in the moment I couldn't focus on anything but getting through each contraction and resting in between. I would have had to get in much earlier.)

At 5:30pm - 4 hours after starting Pitocin - I considered asking for the epidural. My contractions were literally off the charts and at least half of them were tandem. (The nurse was kind enough to give us a section of the printout as a souvenier; proof of my endurance.) I hesitated out of fear that I hadn't progressed enough. She offered to check me and call the anesthesiologist, who would take some time to get there. He would at least be on his way and if I changed my mind we could call it off. At this point they turned the Pitocin back down but it didn't make any difference. I got on the bed and laid down for the exam. Let me tell you, when women say that flat on your back is the worst position during labor, THEY AREN'T JOKING. The pain was unbelievable. I had to vocalize a little bit through a contraction and then nicely told the nurse to check me FAST before the next one hit. She did, and I was almost at 6cm. Not as far as I had hoped to be, but far enough that an epi was less likely to stall my labor. Getting onto the bed while laboring was an ordeal and the anesthesiologist was on his way so I stayed there while we waited. He came in and Jonathan continued to be my voice for me while the procedure was set up and executed. I had to sit on the edge of the bed and hunch over so he could see my spine. He kept telling me to lean over further. Hard to do when you have a giant basketball in your way. This also made breathing through contractions considerably harder. Jonathan stood in front of me so I could lean over and hold onto his shoulders through the contractions. At 6:45pm, the moment a contraction ended, the doctor put in the epi. I never felt a pinch or sting, only some pressure and then he was done. The whole procedure took 5 minutes.

It took about 15 minutes for the epi to kick in. I was restricted to the bed now and I laid with my left side slightly elevated by pillows to keep the epi line open. I first felt a little warmth in my right foot. It spread up my leg and torso and then stopped right at the top of my belly. Then I felt it in my left leg. Ahhhh.... such relief. My eyes came back into focus and I could see the room, think, talk, even smile and laugh. It was nice to see Jonathan's face and talk to him again. I did feel guilty for not thanking the anesthesiologist and realized I didn't even know what he looked like. (Apparently when I'm in pain my eyes are fused shut.) My right leg was completely dead weight but I had control over my left leg. I still felt a nagging pain in my lower left abdomen, kind of like a sideache, where the epi didn't take. I didn't mind it though. It wasn't terribly painful, just a little annoying, and I liked knowing when I was having a contraction without having to look at the monitor or feel my stomach.

The nurses had their shift change, so the night nurse came in and introduced herself. Her name was Agatha (pronounced a-GAW-tha, with the emphasis on the second syllable). She is from the Congo, has a wonderful accent and was God's gift to us that night. She was EXACTLY what I wanted in my delivery nurse, and I later found out she is also a Christian. The next day my mom told me that in conversation, Agatha told her that she hadn't worked in the FMC for a while and before her shift she prayed for God to put her with just the right family. He answered both our prayers that night. At Evergreen, laboring women have their very own nurses at night so Agatha belonged exclusively to us. She didn't have any other patients to check on and stayed in our room the entire time. I can't say it enough - we loved her.

My family had arrived a couple hours earlier and we knew they wanted to come say hello, so at 7:30pm I sent Jonathan out to bring them in for a bit. We chatted and told them about our day. They stayed about half an hour then left to get dinner and let me sleep. I was exhausted and at the same time exhilerated from the absence of pain. I closed my eyes and drifted off, resting and regaining my strength before the hard work began again. Jonathan tried to sleep but couldn't, so eventually he went out to the waiting lounge and spent some time with his parents who had recently arrived. By 11pm I was awake again. Jonathan brought his parents to the room to say hello. We visited for a bit then they left when Dr. Partida came in to check me. We were beyond thrilled when she said, "You're complete!" meaning I had reached 10cm and was ready to start pushing. They broke down the bed and covered everything in plastic. (Are you familiar with the Pemco Insurance ad about about the "Blue Tarp Camper"? That was kind of what our room was like when they were done.) Dr. Partida went over pushing positions but because of the epi I really just had one option with a few variations. The stirrups came up, I scooted down, and a tingle started at the back of my jaw. Someone brought me a little kidney-shaped bowl and I threw up, just once. I don't know if it was transition or nerves, but I didn't feel nauseous before or after. As soon as I was done, I was ready to get this show on the road. At 11:30pm, the birthing part of our labor began.

(The story continues with part 2)