Isaac's Birth
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Early Labor

As many of you noted from the website, I was scheduled to be induced Sunday evening, November 13. As a last ditch effort to get me to go into labor, my ob stripped my membranes on Friday. This involves inserting a finger into the cervix and manually separating the amniotic sac from the wall of the uterus surrounding the cervix. I personally felt that this was a procedure designed to make you think your ob was "doing something" but was unlikely to actually induce labor. I still think the jury is out on this one...at the very least it didn't hurt at all.

With a set date for becoming parents, Craig and I went out to lunch on Friday and planned to go get pumpkin doughnuts at the Dexter bakery on Saturday. Friday evening was spent in the animal ER with Orion (for details, click here). I spent an uncomfortable night on Friday because the baby was pressed against my ribs and my hips were very sore. Saturday I finally woke up at 8 a.m. and noticed a stream of thick yellow mucus with blood in it. I figured this had to be my mucosal plug--and wow was there ever a lot of it!

I was very cranky from my poor night's sleep. Dexter bakery had no pumpkin doughnuts--this was my 5th attempt to get a pumpkin doughnut at 3 different bakeries. I think I will give-up. This didn't improve my mood, nor did the fact that they didn't take bank cards. Hell-oo, this IS the 21st century! My ever-present braxton hicks contractions were really starting to hurt. Since I knew I was going to be induced the next day, I wrote it off as indigestion and being partially in my head. I spent the afternoon resting while Craig and Ben set up our internet.

My contractions became increasingly more painful so that when the R.N. called Saturday night with instructions for my induction, I told her I thought I might be in labor. I still didn't actually believe it. Craig went to sleep, but I couldn't fall asleep at all. At 5 a.m. my contractions were quite uncomfortable and about 3 to 5 minutes apart. I decided to call triage at the birthing center. The triage gate-keeper told me I'd have to make the decision myself, but it was better to just stay at home. Hmm...not sure why we are supposed to call. Our theory is that the goal of triage is to get the numbers of home births up.

Craig timed my contractions again and determined they were 2.5 minutes apart and lasting about a minute. This sounded like active labor to us. Since sitting through the contractions made them worse, I decided I'd rather get the 20 minute drive to the hospital behind me now. So, we loaded my suitcase, pillows and Booboo into the car and drove to Ann Arbor. I had 8 contractions on the way and about ripped the "Oh shit bar" out of the roof of the car.

The oh shit bar in our Accord has never seen so much use! (Of course, I don't know how much use it got the day we loaned our car to our friend Pete Chang--one of the most frightening drivers I've ever ridden with. I'm sure I would have hung on as tightly had I been riding with him that day.)

They took me back to a triage room at 6:30 a.m. and hooked me up to a contraction and fetal monitor. Finally Dr. Barr, a resident, and a med student appeared with a portable ultrasound device. They determined that I was 4cm dilated--enough to merit admission--and that Isaac, though head down, was facing forward. This condition, annoyingly referred to as "sunny-side up" by all of the birthing center staff causes what is referred to as "back labor" by pregnant women. It also makes it much more difficult to deliver vaginally. This explained the growing agony in my back during each contraction.

Active Labor

Since I was intending to have a natural birth and wanted to labor in a tub, Danielle, the triage nurse, negotiated to get me one of the three available tub rooms. Nicole, another nurse who had given us our hospital tour, escorted us back to Room 19. Craig dropped Booboo on the way. He was found by a doctor and Nicole got him to us before he was even missed.

My first L&D nurse (each woman has her own private nurse) was Kim. I was still feeling pretty good, though a little tired after two nights without much sleep. Things started to go south while Kim was running my IV line. She couldn't hit a vein. After two attempts, we looked over and Craig was sitting in the "coach's chair" with his head between his knees. Kim and I sent him to get some juice. While he was gone, I suddenly thought "I'm going to throw up." I don't know how I knew because my stomach didn't feel at all upset. Kim got the needle out of my arm and I turned just in time to hit the trash can with all of the Hawaiian punch they gave me in triage. Contracting and vomiting simultaneously is really not fun! Not to mention, all of the muscle activity caused me to pee all over the floor. Wow, I hope those nurses get paid a lot!

I spent a large portion of my active labor in the tub. Initially, I was able to lay back and actually doze off between contractions. Then I started vomiting again. I was too exhausted to actually reach the trash can, so I just lay my face down on a towel on the edge of the tub and vomited onto it. Craig tried to exchange it for a clean towel, but my back hurt too much to move. I really didn't care that I was laying with my face in a pool of vomit. By then it was about noon. Not knowing what else to do, Craig brought his cross-stitch into the bathroom and sat next to me.

Eventually the doctor wanted to check my dilation, so Kim helped me back to the bed. I vomited again while the doctor was examining me. She decided to give me something for the nausea which helped a lot. I was still getting through the contractions with breathing and visualization, but the vomiting was more than I could take. I was dilated to 7cm. Dr. Barr wanted to break my water--in fact she was really gung-ho about this. I knew from what I had read that this makes the contractions much more painful. The effectiveness of the procedure has also recently been called into question. I decided to wait until the medication had kicked in and I wasn't throwing up anymore.

Transition

Dr. Barr and the med student came back a while later to break my water. By now I was in transition. I knew from our class that this is the most painful but shortest phase of labor. I figured it would be over soon, so even if breaking my water made the contractions worse, I'd get through. The med student tried first (I was later told I must have been a model patient for them to allow the med student to break my water). Understandably, he was a little nervous to jab around inside someone with a crochet hook, so Dr. Barr had to take over. Water gushed and gushed out of me. It felt like a river. I didn't really notice any increase in pain after my water was broken.

Time seemed to take on a new dimension. On the one hand, I made it through from one contraction to the next, but on the other hand, hours passed without my realizing it. My back pain became so intense that I couldn't move out of the bed anymore (see me in the photo above). Craig rubbed my back so long that his hands went numb--I really didn't show much sympathy when he complained. He watched the contraction monitor and told me when they were peaking. That helped keep me sane. Unfortunately, my contractions were double-peaked and lasting sometimes 2.5 minutes with only a few seconds of reprieve in between (see the contraction chart below). The pain in my back continued even between contractions. Kim said considering the contractions, I was holding together pretty well.

Top graph is Isaac's heart rate, bottom graph are my contractions. Dark red lines indicate minutes.

By four in the afternoon, I was starting to wear out. The back pain was intensifying. I asked that my doctor come to see if I was fully dilated yet or not. The maternity ward was so full, that a doctor was called over from family medicine. I was in too much pain to roll over onto my back and she had to check me from the side. I was still only 7cm dilated, and they started talking about giving me pitocin to make the contractions more effective. Yikes!

Kim's shift ended and Lorie arrived. For the first few hours she was there, I sat in the bathtub where Kim had insisted on moving me and refused to talk or move. Finally, I flopped over to the edge of the tub and asked for an epidural. What great timing. After coping relatively well all day, I chose the moment when the one anesthesiologist was in an emergency C-section (with my normal ob, I might add) to ask for an epidural. And when I make up my mind about something, I want it yesterday.

Lorie and Craig eventually managed to get me out of the tub and back to bed where I finally talked someone--I don't know whom since I wouldn't even open my eyes--into letting me have some morphine until the anesthesiologist could arrive. I sat on the bed and held Lorie's hands for about 40 minutes until someone announced the epidural team had arrived. I scrawled my name on the bottom of some form that was thrust at me and submitted to having my back turned into a pin-cushion. I'd been so worried about the complications of an epidural. Ha. Ha. I ended up having to be numbed in two separate places and had needles poked into my spine at about six different locations before the epidural catheter was successfully placed. Craig said later he was having a fit that something would go wrong. All I remember is his asking me over and over, "Are you sure you really want this?" And my thinking, "Is he crazy?!"

My parents arrived just after the epidural took effect. I was lying in bed with Booboo laughing and talking with Craig and Lorie. My ob Dr. Stalburg--finally out of surgery--came in and shooed everyone out so I could rest.

Pushing and Delivery

After all my concern that an epidural would slow down labor, I had the most progress while I was lying in bed. I couldn't feel my contractions at all, but I could still feel Isaac moving around a lot. At about 8:45 p.m., I was finally 10cm dilated and Isaac was at +3. I got the go ahead to start pushing. No one knew still what direction he was facing, but no one seemed to care except me.

Scott, a med student, and Lorie held my legs while I pushed. It was a weird sensation to work so hard at pushing but not feel like anything was happening. I'd asked for a mirror, so I finally got to see when the first sliver of baby's head appeared. At least then I felt like the pushing was doing something. Finally, someone decided I was close enough to call in the delivery team. My nice quiet birthing room was transformed into a delivery room as medical students, residents, nurses and Dr. Stalburg rushed in and gowned up. Two other women were delivering simultaneously, so things were pretty hectic. Everyone's pager went off at least once. Dr. Barr had to check her pager with her toes.

I was so focused on pushing, I didn't even realize until we got home from the hospital that Craig had been able to take some great photos of the final moment. My mirror had gotten lost in the shuffle of medical staff, something I'd been pretty disappointed about.

Isaac's head begins to crown. Notice the huge purple bruise where his head had been pressed against my cervix. Craig says Dr. Stalburg was really pulling at my labia skin to keep it from tearing--I couldn't feel much of anything still at that point.

Isaac's head is finally out.

Dr. Stalburg told me to pull. I was surprised by this and made her repeat it. I was also surprised by how hard I had to pull. She ended up doing most of the work.

I got baby Isaac up on my tummy. Everyone said, "What is it?" I thought, "A baby, duh." But then realized they meant gender. I turned him over, saying, "A boy, I hope." I was still stunned that there actually had been this little person inside my belly and I was looking at him.

Suddenly, Dr. Stalburg said, "Get peds down here. Is it okay if I cut the cord for you?" Simultaneously, I noticed Isaac's blue arm flop limply down on my chest. After handling the pregnancy and labor like a champ, Isaac wasn't figuring out that he was supposed to breath. I was really scared--for the first time in the entire pregnancy and birth. The cord was cut and Isaac was whisked away. My last glimpse of him was a little sneeze bringing up gobs of mucous. I hadn't seen the myconium (first stool) that he had pooped out during the delivery, or I would have been even more panicked.

 

Isaac's cord gets cut in a hurry--and not by Wendy as was planned.

Isaac Getting Revived

 


Isaac was pretty blue and breathing very weakly. A glucose test showed abnormally low levels. You can really see the cone head and bruise at the top of his head in the picture. While all this was going on, I was across the room having my placenta delivered and being assured by Dr. Stalburg that nothing was really wrong, they were just taking precautions.

The nurses had to smack him and wave his arms around a bit to get him breathing.

 



After some considerable roughing up by the nurses, Isaac began to breath normally and started to cry weakly. So much for the wails of the newborn we all hear in movies!

Isaac gets his vitamin K injection--his first shot ever. He also had to have 3 more glucose tests over the next several hours--all of which were normal.

After Birth

It has always frustrated me that the 3rd stage of labor never really gets discussed, being overshadowed as it is by the birth of the baby. So, I will include some details here.

Dr. Stalburg quizzed Scott the med student on the 3rd stage of labor as she tried yanking my placenta out by the cord.

Eventually, they decided it was going to need some assistance, so they asked me to push. Here is the placenta in all its glory. The whitish film is the amniotic sac (I believe). You can see the umbilical cord in the upper left corner. The placenta resembled a bag of chunks of liver all fused together. I insisted that the doctor let me see it. I decided not to keep it, however, not having a good idea as to what to do with it.

My belly got really flat almost immediately. It is super flabby, though, and my belly button looks like a volcano crater.

 

To answer some questions I've gotten, I didn't have an episiotomy (an incision of the skin between the vagina and the rectum to enlarge the vaginal opening). I had a second degree tear inside my vagina which required a few stitches and a "skid mark" on my left labia. Although this would have healed without stitches, as Dr. Stalburg explained to Scott, it would burn during urination without them. The tearing was significantly smaller than an episiotomy incision would have been.

I had done reading during my pregnancy which indicated that complications from an episiotomy are often higher than from natural tearing. The procedure, developed in the 18th century in France has been so ubiquitous, however, that it is still frequently used. Craig has met a lot of med students up here and for some reason loves to ask about their feelings on episiotomy. They are so universally in-favor of the procedure that I was sure my doctor would be too (she helps set curriculum at U of M med school). I discussed my concerns of episiotmies with her and learned that she rarely performs them anymore. The students, however, watch a video from the 70s and the lecture is given by a (crusty old male) physician who remains pro-episiotomy.