Sunday, October 14, 2007

Auletta: The early days

This is the whole birth story, plus first days at the hospital. It is very long.

I went to the hospital Tuesday morning to get the gel to ripen my cervix. The doctor told me that it was possible but unlikely this by itself would be enough to initiate contractions; otherwise I'd go in the next day, probably early, for the induction. While I was hooked up to the fetal monitor I had mild contractions, but nothing that looked like actual labor. I was dilated a centimeter, if that, and less effaced than I had been told I was on Friday (effacement is so subjective that I'm not really sure why they bother, but whatever).

On the way home I picked up Justin, who was tired and figured we might as well spend this last baby-less afternoon together. I started having contractions I could actually identify as contractions as the afternoon went on. By the evening they were regular and getting stronger. I started timing them more carefully around 9:00 and called the doctor twice; the second time he said we could head for the hospital. At that point they were at most three minutes apart and still not very painful, but I didn't want to wait that much longer because they were so close together.

We got to the hospital around 11:30 and went up to triage, where they have rooms for women in early labor. By that time the contractions were definitely painful, but manageable. A resident did an internal, the most freaking painful internal I'd ever had (no doubt because it was during a contraction, ouch). I was dilated two centimeters. The doctor who was doing deliveries that night came and told me to walk around the floor for two hours and then they'd check my progress and admit me to L&D if I had made enough progress. I wasn't sure I would make it two hours with the pain I was already having, but being on my feet instead of lying on my side attached to the fetal monitor was more comfortable, at least in the beginning. But after 45 minutes I asked Justin to see if I could get any sort of pain medication at all or have another internal. The nurses said I could have an internal, but if I hadn't dilated enough I might just be disappointed and still in pain. Fortunately, I had dilated to 3 or 4 centimeters and could be admitted to L&D, and the doctor asked if I was interested in an epidural. By that time any idea I had of even attempting natural childbirth had gone out the window, so the epidural was arranged.

We walked over to L&D. After this everything went haywire and I don't really remember exactly what happened. In some order, the following took place: I was attached to an IV. I was asked the same questions several times about whether I was allergic to any medications, etc. so I could get the epidural. The doctor broke my water. The number of people in the room increased exponentially. The fetal monitor made threatening beeping noises at wildly varying rates, which was the baby's heartbeat, and the doctor said, at what seemed like really soon after I had gotten into L&D, that they might have to do a c-section. I got an oxygen mask, which paradoxically made me feel less able to breathe, but nobody let me take it off.

I was in awful pain the whole time. Now I don't know if I am just a huge wimp or I didn't practice my breathing exercises or if this was an unusually horrible labor, but it was extremely unfun. The contractions were really intense, which I'm sure is normal, and there was often no time for me to relax between each one. Basically, I think it was like being in the transitional stage of labor (when you dilate from 7 to 10 cm, and which is supposed to be hideous but short) when I was just barely in active labor. As far as I know I never made it past 4 cm.

After some period of fetal distress and various medical personnel acting, in a controlled way, very worried, they decided to do the c-section. I remember the doctor telling me if I had another baby I could either have a VBAC or an elective cesarean, which it seemed weird for him to tell me at that point since either way I had to get this present baby out as quickly as possible, but the whole thing was weird so I didn't really notice it at the time. I signed the consent form at a rare moment between contractions and was wheeled rapidly to the operating room.

Justin, who had been incredibly wonderful and supportive the whole time, was left in L&D to await further instructions. At that point they didn't know if they could stabilize the baby enough to do a spinal block, in which case Justin could be in the OR with me, or if they had to knock me out as quickly as possible with general anesthesia, which would mean he couldn't be with me. I had heard them discussing the possibility of general anesthesia, which kind of scared me (as scary as this all was) because as I understand it, even with emergency cesareans general anesthesia is pretty rare.

Fortunately they were able to get the baby stabilized enough to do the spinal block. It probably helped that I was less frantic by this point, since I knew the baby would be coming out imminently. It took several more contractions for me to be asked the same questions about my nonexistent allergies to medications and to get the spinal block itself, which once it kicked in was the most beautiful physical sensation I have ever experienced in my life. The doctors and nurses set up a curtain between my chest and my abdomen, Justin came in wearing scrubs, and we had a nice conversation with the anesthesiologist about how Justin and I met and where we were from while the medical team delivered our daughter, who came into the world at 1:56 AM on Wednesday. We didn't even know she was out at first because they took her next door to get cleaned up and get her APGARs and all that, but they told us they had delivered her and after a couple of minutes we could hear her cry. And then they brought her out so Justin could hold her, and she stared at us and she was perfect and everything was good and worthwhile.

After they sewed me up (this took a while; Justin heard the doctor say something like "Who has her bladder?" which was a little disconcerting, but I did get it back), they took us to a recovery room. This was probably the weirdest part of the evening. I was extremely cold and shivering uncontrollably. My temperature got down to 94.2. I didn't know it was possible to be that cold and be, like, not dead, but apparently it is. So they put a warmed blanket over me, which was nice but kind of lame under the circumstances, and then put this weird sort of inflatable blanket hooked up to an air hose with hot air coming into it, which was less lame but still didn't heat me up as quickly as I would have liked, which was immediately, or at least soon. We were in the recovery room for probably an hour and a half; the baby had to be warmed up too, although Justin got to hold her a lot. The spinal block, which was a darned good spinal block, took several hours to wear off, so I was still flat on my back at this point. There was a nurse in and out of the room, but otherwise we were alone, which seemed kind of bizarre. Eventually they got the baby to a safe temperature and me up to 96-ish, which for being two degrees below normal body temperature was pretty great under the circumstances, so they brought us up to our room on the maternity floor. I got to hold the baby, kind of, in the crook of my arm. We got there around 4:00 AM. The baby had to go to the nursery to be weighed and measured. We sort of slept for a couple of hours.

* * *

So you remember how the baby's head never fully engaged? This probably had something to do with how she ended up coming out. My doctor thought at first her head was smooshing her umbilical cord, which would definitely have explained her distress, which turned out not to be the case. But her chin was tipped down toward her chest, instead of upward, which is how babies are supposed to be facing when they're born, and it was bent at kind of a weird angle. We also overheard the doctor saying something about my narrow pelvis during the surgery. Not that you could ever tell from the outside, but it seems perhaps I am not built to deliver babies, at least this big-headed one. I'm not sure it was a case of true cephalo-pelvic disproportion (which I believe is rare, for obvious evolutionary reasons), but I'm sure that didn't make things any easier. I'm hoping to get a better idea of what happened at my first postpartum appointment. I think the doctor kind of explained it afterwards, but I was not in much of a condition to remember if he did.

* * *

We had four days in the hospital to recover. We probably could have been discharged on Saturday, but we took advantage of the extra day's worth of food (which was room service and generally pretty good), baby help, and rest, sort of. The first day I only got out of bed twice, with the help of nurses, and was still hooked up to an IV and catheter. We got started breastfeeding. I had been worried that since I wasn't able to hold Auletta or even try nursing her for the first twelve hours or so of her life that it might make things more complicated, but we managed fine, it just took a little longer to get started. The baby was sleepy and mucusy her first day, so she wasn't really hungry, but I pumped a little bit to keep up my supply and kept encouraging her to feed. And whatever I might think about Yale-New Haven as far as the scheduling of my induction, they have wonderful breastfeeding support, so I got lots of help from all the nurses and lactation consultants. I especially adored one of our night nurses, Caren, who was a sweetheart and helped out with our first successful couple of feedings the first full night we were there. Once we got rolling things just went incredibly smoothly. I had very few expectations about my childbirth experience, which is good because none of them would have been met anyway, but I really wanted to breastfeed and had myself mentally prepared to stick it out through days or weeks of pain and frustration if it turned out to be difficult, but it wasn't. So I'm really happy about that.

Justin's mom spent all day at the hospital on Friday. (She'd tried to get there on Thursday, but it didn't work out. Another U.S. Air-is-evil story.) This is when I discovered for myself one of the advantages of breastfeeding, which is that every couple of hours people have to give you your baby back. His mom and dad both came on Saturday and spent the day fighting over the baby, which was very cute. She's their first grandchild, and the first girl in their branch of the Schwab clan since Justin's sister was born twenty years ago, so they're really happy to have her.

I think I'm recovering pretty quickly from the surgery. Actually I felt better in the hospital, but they kept loading me with Percoset and I didn't have to do as much there as I am doing at home (although my sister's visiting so I have lots of help). After the first day I was moving around slowly but without much pain.

We came home Sunday morning, which is when my sister's flight got in, so I'll have help until Friday, and then Justin has the next week off. We are probably doing Auletta's first road trip--a short one, for us--this weekend; more about that later.

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