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.

Labor & Delivery, Part II

****Warning:  This blog entry is somewhat graphic in its descriptions.  Do not read while eating lunch!  The author accepts no responsibility for food in your sinuses or sprayed on your friends, family, coworkers, or electronics.****

Labor contractions had begun at 7:45pm on December 30, 2007--which would have been my grandfather's centennial birthday had he not followed his own advice that "no one should ever live past 95."  The chart we had drafted in MS Excel was being used, and we learned that my internal twinges of pain were running 7 minutes apart.  Not so bad!  

[Well, they were bad.  Still, I have a high tolerance for pain, it seems, so I was doing well enough, given that I was in labor.  What did it feel like?  That was always my concern when considering the pain of labor.  I knew it would hurt, but I didn't know how it would hurt.  For those of you who wonder the same:  the pain is primarily in your cervix.  It's a frustrating sort of pain because you cannot touch it.  You cannot massage it or poke it or access it directly to alleviate the sensation.  Your cervix is surprisingly similar in appearance to the head of a penis (gross picture of extracted cervix available here).  When the male gives birth, it's just to a swarm of sperm, which are well suited to zoom on out of his penis.  But imagine giving birth to a several pound child through a similar hole?  Granted, the cervix is "designed" to expand a bit more than the male urethra.]

After a few steady contractions at 7 minutes from start to start, we contacted Sabrina the Magic Doula, who turned out to be at a small gathering a ways away.  Expecting several hours of labor, and not wanting to yank her from fun to work so early, I told her she could take her time coming over.  After we got off the phone, my contractions immediately changed to every 2 minutes.  Andrew called her back to say never mind, please come now!  She was already en route.

The next step was to inform my midwife.  Since the midwives in our practice worked on an on-call basis, I wasn't sure who I would get and was a little disappointed that Shana was the one to answer and not Jane, my preferred practitioner.  Andrew called the hotline and Shana asked to speak to me.  She asked me how my contractions felt, presumably to ascertain whether or not I was just experiencing Braxton-Hicks, and then proceeded to tell me not to bother coming to the hospital yet since I could still talk.

By this time we had assembled an arsenal of belongings to bring to the hospital, including what turned out to be an extremely useful case of bottled water.  Trusting Shana's judgment, we decided to stay home awhile so that I could spend more time in a comfortable environment.  Given that I was decidedly UNcomfortable, I put on some loose and modest clothing and sank myself into a nice bath, just as Sabrina arrived at the door.

My friendly stranger sat down calmly on the toilet and helped soothe me through my tubby time contractions.  Between the rapid fire agony, she shared some great news with me:  she was pregnant!  I tried to feel happy for her at the moment, but I have to admit, my mind was literally trying to be elsewhere.

Shortly thereafter, I had my "bloody show."  I had thought I'd already had it when something small and snotty and pinkish had ventured out of me a day or so prior.  People talk about the mucous plug and describe everything but the size.  It's BIG.  You will definitely notice when your mucous plug exits!

Leaving the tub and drying myself, I changed into a maternity tank top and some comfy bottoms--an outfit which I naively believed I would be wearing during my remaining hours of labor at the hospital.  We called Shana to say that we were on our way, and Sabrina followed us to North Florida Regional Medical Center in her own car.

As often as women give birth, I can honestly say that I have never seen a woman laboring in a car.  I was a little embarassed by the experience, not to mention worried about the upholstery in the van, so I tried as best as I could to hide my personal agony from those in neighboring vehicles.  Andrew later told me that it was of no use as people were still looking in the windows at me like I was some deranged lunatic.

Arriving at the drop off for the Women's Center at the hospital, Andrew left the van for Sabrina to park (at her offering) and came upstairs with me to check in.  I wasn't fond of the desk clerk, though I suppose it's not really her fault--she was just doing her job.  Still, I felt like she was so cold hearted when she looked at me skeptically and asked how close my contractions were.  At that point, they were so close together that I could barely gasp out an answer of "very" before the next one started and was clinging onto Andrew for support in standing.

Skeptical Nurse directed us down the hall to triage, where I was told I had to wear the Hospital Gown of Impossible Modesty.  Andrew waited with me, trying to be a comfort at a time in my life in which comfort was just a distant memory.

After an eternity of probably 15 minutes, the triage nurse arrived, and for what seemed the millionth time since becoming pregnant, a total stranger became intimately familiar with an area of my body not meant to be shared with such a variety of people.  She confirmed my contractions were true labor ("Good job there, Sherlock") and announced that I was 3cm dilated and that the baby's heart rate was fine.

It was time to get a room.

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!