Labor & Delivery, Part V

***Potentially gross photo alert below.  If you aren't digestively stable, don't scroll down!***

Hurray, I had given birth to my little baby Jackson!  But the fun doesn't stop there.  You know the old saying about a woman's work never being done?  While there are arguable feminist issues to be made with that statement, it seems true when it comes to Labor and Delivery...and even more so in the time following when there is suddenly a child who needs constant care and attention.

So, after I got to hold my crying little purple octopus, Jackson was conveyed to a special table with purple lights and had all sorts of poking, prodding, measuring, and cleaning perpetrated on him by the staff.  As far as he was concerned, he had been abducted by perverted aliens (or was being recruited by the military).

Andrew and Sabrina got to go over to the table then and ogle the cute little thing I had made while I was stuck on the Transformer bed still.  This gave the staff time to inject something into my IV without asking me or any of that informed consent "nonsense" that hospitals are supposed to employ.  I noticed and asked as coherently as I could what was being put into my bloodstream and was informed that I had just been dosed with pitocin.

Apparently the staff was impatient?  I don't know why they didn't ask me or at least tell me (or my husband, or my doula, or...) beforehand that this was something they might do.  Since pitocin helps stimulate uterine contractions (which, I'm fairly certain, were still doing just fine at that point), I can only assume they were doing it to expedite delivery of the placenta.

Before this whole experience, I had wondered how aggravating it would be to be stuck waiting for the placenta to come out, and now...I have no idea what the standard duration post-baby-delivery would be.  (Is it sufficiently obvious that I'm irritated by being drugged with pitocin?  Okay, good.)  Suffice it to say that I did not have to wait very long, and I barely felt anything when the placenta and cord were born.

I say "born" because I was surprised to find myself somewhat emotionally attached to these inanimate organs.  As part of my attempts to assuage my

 desire not to waste anything, we had already

 planned to donate the cord blood, which was done by a needle being inserted into the umbilical cord and draining the awesome, stem-cell-rich blood into containers.

Because the placenta was so large, we had well more than the standard quantity available for donation and were later thanked in person by a representative from the cord blood bank.  In fact, the placenta was so big that the nursing staff all crowded around to gaze at it.  Though with a nearly 10lb child, it was hardly surprising that his source of nourishment should scale up so much above the norm as well.

The size of it was something of a blessing for me, too, as it meant that much more of my 50lbs (about 22.6kg) gained during pregnancy was already gone!  But...emotionally, however, I felt a strong sense of guilt about the placenta itself going to waste.  For a long time afterward, and occasionally even now, 16 months after the fact, I felt as though I had had another life in that placenta that had just been treated like so much garbage, just another piece of "hazardous waste" for the hospital to handle.  My guess would be that if I were from a very primitive culture and had just endured labor and delivery on my own, I probably would have been pleased to find a nice big hunk of nourishing food made available until I was recuperated.

But in this day and age, and living in the United States, I'd feel like some kind of pervert for making a meal out of my own placenta though if I look for a reason, a valid and incontrovertible reason, I cannot see what problems there would be other than: how do I cook this? and How does one season a placenta?

Alas, however, the placental delivery was not the end of the journey.  I needed stitches.  Andrew had returned to my side for the final part of my additional organ ejection and was now enjoying his new son some more.  (Note my leg in the background as Andrew held his son for the first time--also the first time he ever held a baby!)

Shana was calm and focused, carefully sewing my perineal tear before I got too much more sensation back in the area.  I cannot remember if she used any anesthetic, though I know it hurt somewhat.  Andrew was curious but I forbade him to watch her sewing my flesh because the expressions on his face were making me feel uneasy.  More than ever, I was vowing to be better at doing my Kegel exercises if ever I should find myself impregnated again.

As for Jackson, life wasn't a great deal better.  He was naked.  His cord had been cut and clamped.  His limbs were no longer cozily squished into a very small container and (if I had a guess), he probably had some serious "pins and needles" going on in them.  Because his color at birth was something akin to what you would expect to see on a choking victim, he failed one of the points on the APGAR test, but otherwise he passed with flying colors.

Our pediatrician, Dr. Judy Banks, had come into the room.  (Why not?  It was a party, right?  Never mind the naked woman spread-eagle with the needle and thread hanging out her privates.)  She gave a very thorough examination of Jackson's abilities to make sure there was nothing of concern.  I was somewhat busy at the time, so most of what I have to go on are the photos that Sabrina the Fabulous Doula had taken.

And Labor and Delivery was done.  The postpartum period was beginning, and I was very shortly given the opportunity to nurse my very own child for the first time ever.  Stay tuned next week for some postpartum fun!

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!

Labor & Delivery, Part III

We've all seen movies where the woman is laboring in the hospital bed, looking pathetic or screaming in pain.  When I was brought to the L&D room, I was pleased to find it exactly as I remembered from the walk-through our birth education class had done:  a well-designed bed with all sorts of configurable, Transformer-like parts to facilitate labor and delivery, a rocking chair, a comfy couch, a private bathroom with a Jacuzzi bathtub, and other little touches here and there that really made it seem more like a hotel with easily cleaned floors.  The lights were kept appreciably dimmed, particularly given that by now it was after 11pm.

My contractions (which almost completely ignored the standard durations and frequencies they lie about in prenatal education) relented slightly so that I felt brave enough to try a little food and drink.  I knew I had a ways to go to get to 10cm dilated before my beast of burden would be experiencing the New World, and I wanted to be sure I was sufficiently hydrated and calorically stable.  I downed a bottle of water and some small snack foods.

Now, they say that women don't remember the pain of labor or that they forget the experience afterward.  I felt that I had a very clear memory of the flow of events, though my ability to estimate duration was admittedly impaired due to more pressing matters occupying my everything.  When I initially set to writing down the story of my labor and delivery a matter of weeks after the fact, I had somehow forgotten entirely (until reminded) about this next development as my segue into the Jacuzzi bathtub.

For the first time in nearly 5 months, I vomited.  It was not expected.  It was not pretty.  It was ALL OVER my Hospital Gown of Impossible Modesty and the Transformer bed's sheets.  Well, I didn't like the gown anyway, and I wasn't keen on laboring in the bed either, so off came the hospital gown and, naked as the day I was born, I climbed into the tub to rinse off and continued to labor there a while.

By this point, I no longer cared who saw me naked, so long as they weren't taking pictures.  I was ginormously pregnant and in pain and trying to maintain focus on the task at hand.  Sabrina, the Fabulous Doula, had brought a small kit of battery-operated tea light candles, and we turned the lights down low in the bathroom.  She and my husband Andrew traded turns providing counter pressure on (i.e. pushing a fist hard against) my lower back while I writhed about in the water.  Sabrina occasionally had to escape to relieve her stomach of its contents (morning sickness knows no time/place boundaries), and Andrew often had to trade out because his knees dislike him and kneeling on the tile floor by the tub was not helping them to like him more.

They also tried as best as possible to obey my commands and to take them seriously--despite that I was undoubtedly difficult to interpret.  Sabrina was able to discern my gestures (mostly a lot of grunting, vague hand motions, and attempts to speak through gritted teeth) with considerably better accuracy than Andrew, who is most definitely not a multi-tasker, despite how appreciably calm he seemed to remain throughout the process.  Besides being made to kneel beside the tub and essentially maintain a fist pressed against my low back, my labor assistants were also tasked with two other annoying efforts.

One, the Jacuzzi tub had problems.  The tub had 2 jets on either side, which were both weak and irrationally placed, but still they were better on than off.  An unfortunate side effect of the jets was a perplexing inability for the tub to retain water.  Many various measures were attempted to keep as much as possible from draining; however, despite all valiant efforts, frequent refills were still required, which were made all the more obviously necessary by the horrendous cacophony of the jet intake when the level dropped too low.  This helped me, in a way, as a distractionary technique, despite being a somewhat aggravating development.  

The other major task I imposed on Sabrina and Andrew was to continually restart a musical pullstring teddy bear.  The entire time I was laboring at the hospital, this bear needed to be played for me to listen to the soothing sounds of Rock a Bye Baby.

Occasionally, I was forced to leave the tub and get checked for my "progress" on the bed.  Still I managed to get most of my monitoring done in the tub.  For those not in the know, during labor the hospital staff put these elastic bands around your belly with measuring instruments attached to them.  One is for measuring the baby's heart rate, and the other is for (mysteriously) tracking the mother's contractions.  During this eternal and hazy period of labor, I was grateful for the lack of a clock in sight.  All I could do to track time was to tolerate the occasional 15 minute bouts during which the staff insisted I don the elastic bands--and with only moderate petitioning, they let me use the waterproof ones (boxed region) so I could stay in the tub!

So, looking like some horrible science experiment, I writhed naked in the bubbling, cacophonous tub while wireless electronics were strapped to my insanely swollen midsection and teeth-grindingly painful contractions wracked my body.  Good times.  I once hinted at the idea that I might need painkillers after all, but Andrew quickly reminded me that I did not want them and sternly indicated that I should not ask again.  I didn't.  And I thank him for it, though I know if I were more insistent, he would have relented.

At 7cm I had still been lucid but my communication skills were rapidly diminishing again.  By 9 cm I could scarcely say "bear" to indicate that my focus needed restarting.  My nurse had a shift change, and a new crew came on.  These women flowed into my room and took up positions all around me.  Shana (remember my midwife?) had been hanging by the sidelines most of the time, often whispering inaudibly with the nursing staff (which I later learned was to show amazement at how I was laboring).  Now she informed me that I could no longer leave the bed.

Lying naked in a roomful of strangers would ordinarily be unnerving, but I had some scant coverings on my lower half, and anyway, I reasoned, these people see this sort of thing all the time.  I made up my mind that I did not care:  there were more important things imminent.

The time to start pushing had nearly arrived.

Doula Selection

After reading about doulas in our prenatal books, Andrew and I decided that a labor doula would be very helpful to have.  Our reasoning was that:

1. We could afford one (in the end, we paid about $575)
2. Outside of ourselves and hospital staff, we had no local network of support during labor
3. With my hip malfunctions (from that cruel hormone relaxin) and my cervical disc herniation (from a pre-conception car accident), we wanted someone who could help me be as comfortable as possible
4. Andrew's general level of sympathy is not very, shall we say, "developed" and he was honest about that upfront -- he wanted me to have the best possible experience.  (n.b. Andrew entered this one; it does not mean he was wanting to shirk his responsibilities as a father at the birth--just wanted help!)
5. Given the stress of labor and delivery, it made sense to want someone a bit emotionally removed who could remain clearheaded and help to enforce our preferences and rights as parents-to-be

So, I queried my midwife for suggestions for a doula.  At first she was reluctant to offer any, stating that whichever midwife from the practice was on call would stay with me during my labor.  (Ironically, she turned out to be the midwife on duty, and perhaps it was because I had a doula and perhaps not, but she was NOT around much at all until close to pushing time!)  Eventually she surrendered the name of a local midwife named Daniela.

I called Daniela and scheduled an informal interview with her at our home.  Andrew researched online for appropriate questions to ask her, and we added a few of our own:  just what exactly is it that a doula does?  After we had a chance to interrogate our prospective doula (who turned out to be a midwife as well, specializing in home births) about any manner of things, including the name and number of her hairdresser (her hair was fabulous!), my husband and I conferred.

While Daniela was perfectly agreeable, she was also somewhat mousy.  She seemed affronted by our unusual questions (which were likely the result of a certain amount of anxiety on our part) but tried to hide it while remaining reasonably cheerful.  Then we struck gold:  she had a back-up doula!

As Daniela was both doula and midwife, she seemed overly qualified to the point where it was practically insulting for us to hire her as "only" a doula.  Her back-up doula, however, was a doula AND a massage therapist, which was exactly what we had hoped to find.  We politely requested Sabrina's contact information so that we might interview her as well, and in the process I fear we may have offended Daniela--though I suspect she was secretly glad not to have further dealings with us, the "crazy" couple with the odd sense of humor!

Andrew and I were nervous about a second interview, but we were better prepared this time around.  Still, we felt little need to pretend to be people we were not since our true personalities were likely to resurface in the excitement of labor and delivery.

Sabrina was a godsend!  From the moment she arrived I felt very comfortable with her, almost as though she were my own sister.  She even bears a strong resemblance to my actual sister!  While at first she was rather uncertain of how to interpret our strangeness, Sabrina quickly warmed to us and seemed to even enjoy our often unexpected injections of humor into the whole process.

One thing that was very impressive to us was her apparent level of organization.  She had paperwork for us to complete with basic information about ourselves and what restrictions and allowances we wanted to have in place at Jackson's evacuation from my uterus.  Her payment plan was very straightforward and reasonable--and it included a free prenatal massage!  For control freaks such as ourselves, Sabrina was the ideal candidate.

As we only met her a month before my due date, she returned on only 2 or 3 other occasions before the birth itself for training sessions.  Sabrina had recently learned some new techniques for helping laboring moms to cope with the pain.  Andrew and I accepted our tutorials, which included an emphasis on changing focus.

One lesson in particular involved us holding a piece of ice inside a closed fist for a given duration.  We had to look around at various objects and focus on basic concepts about them:  green couch, wood chair, the feel of carpet on bare feet, etc. while trying to maintain steady breathing and minimal awareness of the ice.

Any laboring mother can tell you that ice is no substitute for the real deal, but for learning a basic trick to use in labor, ice sufficed quite well.  [Please, if you try this yourself, exercise caution as prolonged exposure to ice can severely damage your skin!]

Everyone has their own individual preferences and comfort levels.  When it came down to it, Sabrina was chosen by us because not only did she exude confidence, but she also helped us to feel relaxed and comfortable.  Giving birth is stressful enough an experience that anything that can be done to mitigate that stress rather than exacerbate it is much appreciated by all those involved.  Andrew and I knew that we could rely on Sabrina to help serve as an ambassador to hospital staff, someone who would state and reaffirm and enforce our individual preferences in dealing with both medical professionals--and ourselves!