Natalie's birth from daddy's point of view
Don't Go Home, Go Straight to the Hospital
My wife's due date was July 29, 2005, but her perinatologist and her obstetrician decided to induce on Tuesday July 5 because Doris was showing signs of pre-eclampsia.Pre-eclampsia (or toxemia) is one of the nastier complications of pregnancy. One of the symptoms is extremely high blood-pressure, which, if left untreated, can lead to brain damage in the mother and severe problems for the child.
With the foetus considered full term (having just reached week 37) and the only treatment of pre-eclampsia being the removal of the placenta, there was only one way to go.
At the doctor's office, we were directed to go straight to Los Robles hospital, which conveniently for both doctor and patient is right across the street.
After the usual 40 minute wait in admissions, we went to labour and delivery room 4 at around 3:50pm.
In Los Robles, the entire process of labour and delivery takes place in one room, unless an emergency cesarean section is required. The room held a pretty standard hospital bed, a chair, a recliner, a dresser, a small and uncomfortable bed for daddy, a pregnancy monitoring system, a baby warmer (essentially a small bed with a regulated heater on top of it), a scale, and a locked cabinet holding various medicines and the drug dispensing computer. Despite all the furniture and equipment, our room seemed huge. We would discover the reason for its size later.
By way of coincidence, we had been in the exact same room four days earlier for evaluating Doris' high blood pressure. At that time I noticed that some hornets were nesting in a hollow space in the window frame. As you can imagine, I didn't notice the hornets the second time around. I don't think I ever looked out the window.
Choices
To make things more interesting, we'd been given the choice of induction or cesarean section. Of course Doris was torn between the simplicity of the c-section (and its longer recovery period and higher risks for the mother) and the much more arduous induced labor (with the possibility of the induction not working and a c-section being required anyway). Since Doris had been on bed rest for 3.5 months prior to this, the choice wasn't easy.Hookup
But first Doris got hooked up to the pregnancy monitoring system. We'd been quite familiar with this nifty device as this was our fifth visit to the hospital and the first thing the nurses do when you arrive is hook the mother up. Fully configured, the system will monitor baby's heart rate, mother's heart rate, her blood pressure, her oxygen saturation and her pulse. As expected, Doris' blood pressure was very high but the good news was that baby was doing just fine as evidenced by baby's heart rate jumping around quite a bit. The professionals call that 'acceleration'.Shortly after, the nurse hooked up an IV with magnesium sulfate. Magnesium sulfate is what they call a 'smooth muscle relaxant'. It will relax all smooth muscle in the body, including the uterus and the blood vessels. Doris was quite familiar with magnesium sulfate as she'd had the 'pleasure' of getting it earlier in the year.
MgS also has some annoying side-effects. In Doris' case this included being very hot and getting a headache. Unfortunately, MgS needs to be run at a concentration very close to toxicity levels to be effective. If overdosed, MgS will lead to respiratory difficulty and possibly failure. Fortunately, we didn't run into that. But I digress.
Go
We had some time to make up our mind because the doctor was going to drop by at around 6pm to discuss the next steps. Doris ended up choosing to try induction.Having made that big decision, the first step was administration of Cervidil. Cervidil is a prostaglandin that softens the cervix. This is necessary when inducing pre-term because the cervix is usually not quite ready for birth. Interestingly, Cervidil can sometimes induce labor alone without the use of Pitocin (Oxytocin).
The Cervidil was given at around 6pm. We were told that the plan was to wait for twelve hours and then re-evaluate the cervix.
Normally, pregnant women get nothing to eat or drink after being admitted except for ice chips. Fortunately, our doctor was humane enough to allow Doris to have a final meal.
First Stage of Labour
Sometime around 7pm Doris started having mild contractions that were stronger and different from the Braxton-Hicks contractions she'd been having for the past three months. This was an expected and welcome development although the the frequency didn't give rise to the hope that anything major would be happening before morning.Since we had an uneventful nine hours ahead of us, we first had dinner and chatted a bit. At around 9pm, I went home to take care of the cat and get some things. When I came back at 10, the situation had changed dramatically...
Water Breaks
The first sign of things to come was the nurse zipping into the room at an elevated pace. Normally nurses amble about at a very sedate and calming speed. To my question what was going on, the nurse replied that Doris' amniotic sac had probably ruptured and that she had gone into labor. The contractions were much stronger and closer together. The nurse checked the fluids with a pH strip and concluded that the water had indeed broken.This is the point where it got a bit messy, because water continues to leak after the amniotic sac breaks. Technically, the water is urine of the child but amniotic fluid is a story for another day. Fortunately, the nurse knew how to deal with that efficiently and professionally.
The contractions continued to roll in about every five to six minutes for the next few hours. Doris was getting more and more uncomfortable, especially since the nurse started a Pitocin IV at around 3am because the contractions had started to slow down a bit. Pitocin is the brand name of the naturally occurring Oxytocin, which is a hormone produced by the brain to cause the uterus to contract.
Even before the Pitocin was used, we observed an interesting pattern in the contractions. There would be one big one, folled by a slightly smaller one within a minute or so and then a space of five to seven minutes when the pattern would repeat.
Epidural
Doris and I had discussed the option of using an epidural anesthesia for labor a while back and had concluded that it would be a good idea to get one. According to the nurse aboud 98% of patients choose the epidural, so we were in good company.Epidurals are an interesting and somewhat scary procedure: A hollow needle is pushed into what is called the 'epidural space' in the lower back. This is a small area next to the spinal chord. What looks like a metal braced catheter is fed through the needle into the epidural space, the needle is removed and the catheter is taped in place on the back of the patient. Medicine is fed through the catheter first from a syringe and then from a small pump. Marcaine mixed with Fentanyl was the drug of choice in this case. [Research Fentanyl if you have time, it is amazing stuff.]
Doris was fed up with the pain at around 3:30am and the nurse woke the anesthetist. Dr. Quong turned out to be a short asian lady exuding an aura of competence. She had Doris sit up on the bed and lean forward towards me. Dr. Quong first examined Doris' spine to find a good place to insert the needle. She then wiped the area three times with an antiseptic. After numbing the site with a local anesthetic, she inserted the hollow needle and placed the catheter. This took about 30 seconds. She then gave Doris a small dose of anesthetic through the catheter to check Doris' reaction. Everything was fine, so Dr. Quong injected a larger dose to get Doris more comfortable. Doris was then taped up with the catheter hanging off of her shoulder. Because of the reinforcement of the catheter, the patient can assume any position wihtout obstructing the flow of anesthetic.
The nurse then checked the cervix, which turned out to be dilated to 4cm which came as a nice surprise. It meant the labor was already progressing quickly and Doris wouldn't have to suffer too much longer or worse, have a c-section anyway.
The dosage in epidural anesthesia is kept low in order to only suppress pain, but allow the mother to still feel pressure as well as feel and move her legs. The disadvantage - as we soon found out - is that as labor progresses the pain will be more intense than the epidural is able to block. The good news is that the anesthetists are more than happy to top off the anesthesia which usually takes care of the pain within three contractions.
At this stage, Doris actually fell asleep between contractions as she was very tired and quite exhausted. She'd doze off immediately after one contraction passed and wake up when the next one rolled in. I was able to get some sleep between 5am and 7am too.
Shift Change
The nurses have their shift change at 7am and we were very happy to find that Jolene was going to be our nurse from now on. Jolene has five children of her own, is very friendly and a pleasure to have around.Jolene checked the cervix at this point which had dilated to 6cm already.
I noticed an additional locked door in the room from which loud clunking noises emanated once in a while. I didn't give much thought what lay beyond that door of wonders at this point - I was too busy supporting Doris in her efforts.
As labor progressed, Doris got a lot more uncomfortable with strong back pain with every contraction. Unfortunately, the anesthesist, now Dr. Scholz, was busy with a c-section at the time, so it took quite a bit of time for him to drop by. When he did, he happily topped off the epidural again which helped a lot. He also said that the labor must be progressing rather quickly as this strong a pain is indicative of approaching final stage.
Predictions
At 10am, our obstetrician, Dr. Gorelick, dropped by. He checked the cervix also and was glad to report 8cm. At this point, he predicted Doris would be delivered before lunch, which made him very happy. :-)Dr. Gorelick was in and out of the room from now on, checking on Doris regularly. At around 11:30am he concluded that it was time to start pushing!
Second Stage of Labour
Another nurse joined the team now: Kim. We've known Kim for a while, we first met her in April. She's also a pleasure to work with and we were very happy that two of our favorite nurses would attend the birth. A huge lamp was lowered from the ceiling at this point, and - surprise - the door of wonders opened and a set of tables with medical instruments and other supplies was rolled out. The doctor was helped into full surgical gear by the other nurse. Doris was draped a little bit on the legs and stomach.All the while, Jolene coached Doris through the first pushes. Fortunately, the epidural was dosed correctly, so that Doris was able to push, but without much pain (at least at first).
Jolene did all of the coaching which made me wonder why I spent countless hours in childbirth classes. I suppose so Doris would know what to expect.
The doc gave us a progress report after every push, showing us how much progress had been made and how much more was needed.
Sometime halfway through both nurses and the doctor had to leave for a few minutes. They told us to keep doing what we were doing. They didn't go far or for a long time, but it was a bit odd to be completely alone with my wife in this situation. We did get through one push successfully, without the three of them.
It took about ten contractions for the head to crown. The contractions were still five to seven minutes apart, which is a bit unusual. However, the doctor assured us that the contractions were very effective and that the spacing wouldn't have any negative effects.
When the head crowned, the doctor told Doris to stop pushing. It took him another minute or so to pull out head, shoulders and the rest of the poor little bundle.
Birth!
Natalie Marie was born 12:28pm with 2712 grams.The doctor then proceeded to clean out baby's airways which she acknowledged with squirming and an increasingly deepened frown which eventually ended up in her first breath and scream.
The nurse then cleaned the baby and put her on mom's stomach. Interestingly, babies are wide awake in the first two hours after birth so we got to see her grayish eyes quite a bit.
My initial reaction to Natalie being placed on mom was "where did that baby come from? What is that baby doing on Doris? I need to take care of my wife, she's not happy!" Fortunately, this quickly changed into the unconditional love and caring I expected.
The doc clamped the umbilical cord above baby's navel and offered me scissors to cut the cord. You have to apply a surprising amount of pressure to cut through.
Third Stage of Labour
While we were paying attention to Natalie, the doc (literally) pulled out the placenta. Due to too much bleeding, Doris was given an injection by the nurse to force the uterus to contract. The bleeding became less and the doc was satisfied.He then examined the placenta to see if there were any pieces missing. Placental tissue remaining in the uterus have two nasty side-effects: They cause bleeding and they cause infection. In this case, all was well so Dr. Gorelick proceeded to stitch poor Doris up.
Sugar
Meanwhile, blood was drawn from Natalie's foot to check her blood sugar. Unfortunately, her blood sugar was very low (20), so she was whisked away to the nursery to receive a bottle of sugar solution. I went with the nursery nurse to see what they would do with Natalie. She received antibiotic paste on the eyelids (to prevent eye infection) and a vitamin K shot to prevent vitamin K deficiency bleeding which can cause brain damage.Post Scriptum
I wrote this a few days after Natalie was born to make sure I'd be able to remember all the details. We were kicked out of the hospital two days after birth, which is pretty standard these days.Natalie is now almost four weeks old and rapidly gaining weight. We're still struggling a bit with sleep deprivation, but the most important thing is that both Doris and Natalie are happy and healthy!
