Labor & Delivery, Part IV

While I was not thrilled about being confined to the bed for the final portion of my labor, I realized that it was completely unfeasible to deliver in the Jacuzzi bathtub.  What I didn't realize was that the ingrained Westernized medicine practices were going to cause the nursing staff to depersonalize the process more than I felt was necessary.  Despite that I opted for no pain medication and had a doula present as well as a midwife delivering, it seems the general idea of natural childbirth was somewhat lost on this crowd.

Early in my visit to the hospital, I was outfitted with an intravenous (IV) catheter for attaching whatever fluids might be necessary later in labor.  Once I was in the bed to stay, this was then connected to a bag of saline.  Later I was able to feel justified in believing this to be a wholly unnecessary procedure as I overflowed the urine collecting "hat" in the toilet after labor.  Too much info?  Maybe so, but perhaps if another woman out there feels it is an extraneous addition to the process, she may, having read this, feel emboldened to say so (or at least try!) when the time comes.

Still, the saline was doable, despite that it was somewhat more confining and a distraction.  After all, I now had a cord attached to my wrist--which was covered in blood as the IV catheter was poorly inserted and had leaked a small but annoyingly dispersed bit of my 40-50% bonus life juice, aka blood.  More annoying was that noone seemed to notice or care that I was dribbling bodily fluids from my hand, and this was not corrected until several hours after L&D was through and we had been switched to a recovery room.

Chronology got a little hazy for me by this point.  I know what things occurred, but I would be hard-pressed to sort out the order.  One thing I do know is that there was a man, a stranger to me, that came into the room with a complicated bit of machinery.  I was acutely aware of his presence, and it took a small amount more willpower to remain uncaring as I was still naked on the bed and writhing with near-constant contractions, with only a thin sheet covering my groin region.  He seemed familiar with the idea that his presence might not be welcomed and took care to avoid eye contact or even to look much in my general direction.

I had to retain the fetal heart rate monitor elastic band and the contraction monitor (which still amazes me that it even does anything, considering it's a wholly external device) throughout the remainder of labor.

With my doula Sabrina holding my left leg and my darling husband Andrew holding my right, I focused on my musical bear and eye contact with Shana when she instructed me.  There were at least 3 other nurses in the room:  one watching my monitors and two serving as the first cheerleaders I ever appreciated.

As the contractions were building up steam, I began to "push".  This was probably one of the more awkward elements of the ordeal, as I was expected to keep my knees near my chest and make internal gestures VERY much akin to those of excreting a bowel movement.  It was at this point that I found myself immensely grateful for having expelled much of my intestinal contents after that Cajun lunch, prior to beginning hard labor.  Shana seemed surprised when I would begin pushing each time because I could feel the contractions beginning before the monitor ever registered them.  Later I was told that she and the nursing staff had also been amazed at how well I was handling what looked on the monitor to be very rapid and very strong contractions.  Not having any idea what the standard was, of course, I simply and (blissfully?) ignorantly kept chugging along.

Pushing seemed very slow going.  Jackson's fetal heart rate monitor kept indicating that his heart rate was dropping during each push.  Some genius decided that I therefore needed to wear one of those things that shoves plugs in your nose to push in oxygen.  This I did not like.  It was bad enough that I had a cable in my veins pumping water into me.  It was bad enough that two people I trusted were pulling me into a very uncomfortable position, against which I was forced to push--all the while feeling certain I was going to poop on the table.  And then they complicated things further by impairing my airways, despite best intentions to actually increase my blood oxygen (and therefore Jackson's, as well).  I felt I could not breathe and repeatedly removed the offending plugs until they finally agreed not to keep cramming them into my nostrils.

As of this point, my "bag of waters" had not yet broken.  My midwife, Shana, examined me and early in the pushing process asked me if I would like her to "rupture my membranes."  Now, given that I was a little mentally challenged at the time, I was unable to comprehend her meaning.  Erring on the side of caution, I said no, considering that any membranes I had, I would like them kept intact, thank you very much!  I also declined an episiotomy, despite that I had been less than diligent about my Kegel exercises--a mistake which I hope not to make again, though it was hardly the end of the world when I tore, given that it was precisely where Shana would have cut me had she done it herself.

As I continued grunting along and demanding my musical bear be played, word came to me that the baby was visible, at long last.  There was an awkward sensation all throughout my pelvic structure, as though unusual pressure (which of course it was) was being put upon places that were unused to such sensations.  Then progress seemed to stall.

Shana looked concerned and kept having me contort to various tilts to keep Jackson's fetal heart rate up to acceptable levels.  Now I was laboring and pushing at a 30 degree angle in addition to all else.  Finally Shana all but begged me, with a plaintive look on her face, to be allowed to break my water.  Apparently when I pushed, the amniotic sac appeared to her as though a giant water balloon were being squeezed--with the business end aimed at Shana's face!  I acquiesced to what I then understood her to mean by the rupturing of my membranes.

The soothed midwife then carefully inserted an amniohook, and the fountain began to flow.  Pushing became "easier", or at least, more productive.  Around this point, I felt something warm and liquidy dribble down my nether-regions.  I was certain I had just defecated on the bed, but I forced myself to ignore that "fact" and focus on the task at hand.  In fact I had not pooped--that was when my second-degree tearing occurred in my perineum.  The liquid I had felt was blood.

Shana then instructed me that, once the head arrived, I should not push again until she gave the word.  Andrew had begun to get very excited at the sight of Jackson crowning.  All around me people were cheering, encouraging me to hold tight and keep pushing through just that little bit longer.  Perhaps if I had it to do over again, I would ignore them more and trust my own instincts (and possibly thereby avoid tearing), but at the time their constant exuberance was very motivating.

Suddenly, there was a baby head hanging out of me, and Shana alerted me that it was time to pause my efforts.  Andrew looked on curiously as Shana swiftly slid a finger inside and gently pulled a loop of umbilical cord out and around Jackson's neck.  And again a second time.  It had been wrapped around his little neck twice and might have caused problems had I kept pushing.  (Oddly enough, one might have expected this part to be some of the worst pain, but those who had informed me in advance were right--the constant pain and efforts numb the opening to the vagina before the kid's head has a chance to escape, so this event was largely inconsequential to me, sensationally speaking.)

If memory serves me correctly, it was at this point that Shana also cleaned out Jackson's mouth.  Babies generally do not begin to breathe air until the umbilical cord is cut, so it would have been easiest to clear any debris from his airways at this point.  What I had believed all along was confirmed now:  I was having back labor (significantly more painful/uncomfortable than traditional labor), as Jackson had been oriented facing my front instead of my back, so his hard skull was pressed against my spine during the entire evacuation process.

I got cleared to continue, and a couple pushes later, something that felt like and looked like a slimy purple octopus slid out of me.  Shortly thereafter, it was crying and as they asked me if I wanted to hold my baby, I felt like there could be nothing in the world I would want more.  Ever since becoming impregnated, I had felt more complete than ever before, and I was afraid that now that Jackson was a distinct entity from me that that feeling would leave.  (In truth, the feeling of completeness remained until he was fully weaned from nursing, and only then did I begin having "withdrawal" symptoms.)

I know he felt the shock of it more poignantly than I did (though I confess I often forgot that at the end of the ride a new person would be around!), but already it seemed strange and sad to be disconnected from him.  So, gross as he was with birth matter all over, and naked as I was, I hugged onto my slithery little baby.  Well--at least he was littler than me!  He looked like he was a month or two old!  His arms were nice and chubby, his cheeks were good and fleshy, and soon after birth he was already spending much time with his eyes open and lifting his own head.

My baby was born!  I was a mom!

Jackson Edward Adams was born at North Florida Regional Medical Center on December 31, 2007 at 8:19am, with no drugs and after 12.5 hours of labor.  He weighed 9lbs, 15oz and was 22in long (roughly 4508g and nearly 56cm long, for those of you on the metric system), which is about the size of the average 1 month old.  The above image was taken by Sabrina the Magic Doula just as Jackson was making his way into the outside world--which is why you see my right leg in the picture, taken from my point of view, as Shana the Awesome Midwife deftly catches my little bundle of joy.

The fun was not over yet, though:  I still had another organ to deliver.  Stay tuned next week for the placenta and immediate post partum discussion!