Post Partem, Part I

Since a few people have complained that the last few posts weren't gross enough...let's talk about postpartum issues.

Everyone tosses around the phrase "postpartum depression", but you rarely get the joy of hearing about the other stuff.  Perhaps because it's considered impolite?  Pardon me while I go off in a corner and laugh.  You know what's impolite?  Not telling the truth about the facts of life to those who are yet to experience some of them.

People have babies around just at the time they are least capable of handling them.  Consider the following:  Women spend months on end in discomfort, gaining weight and feeling exhausted, losing sleep and then, when pregnancy comes to a halt, there's labor and delivery and/or a C-section.  It's a grueling, painful, scarring, traumatic, and gory event.  When all that work is done, suddenly there's a cranky, crying little weasel of a thing demanding food about every two hours around the clock--for months on end!  And what's more, if the child accidentally oversleeps that two hour period (as long as 4 hours between feedings), the doctors say to wake them and feed them!  This little weasel also wants to be kept free from its own excrement, yet it insists on continually soiling itself.

And through all that, somehow Mom and Dad have to figure out how to care for themselves.  Mom is expected to try and remember to continue to nourish herself and get sufficient rest, and Dad is expected not to go insane while Mom is greatly incapacitated--and has comparatively paltry recourse for calming the child due to a lack of mammaries.

And Mom is sore.  Maybe she tore.  Maybe she was cut.  Maybe she had a large surgical incision made through her abdominal wall and has a belly full of stitches.  Walking is painful.  Sitting is painful.  Perhaps just moving at all is painful.  But that is secondary to the child because even more painful is listening to the sound of a crying baby.

And what's more:  the blood just never seems to stop flowing.  During pregnancy, Mom's blood supply increases by nearly half again what she had.  Well, she doesn't get to keep it all.  Sure, some goes with the baby, and some leaves at the birth, and some more leaves with the placenta and cord.  But there's more.  Lots more.  And it wants to come out as soon as possible.

Some wonderful people along the way designed some very long, hygienic, disposable pads for postpartum bleeding.  They are too small.  In order to be useful, they need to be chained so that one goes in front and overlaps somewhat a second that goes further toward the back.  If you are a particularly large woman, it's conceivable that you might need three at a time.  I'm not kidding.  At 5'8" (1.73m), I'm hardly what you'd call petite, but I'm not fat either, and to cover the span of gore, I needed this doubling.  Later, after 4 days or so, I was able to start substituting Poise and Serenity incontinence pads, which hold more fluid than the traditional feminine hygiene options.

And then there's the groin pain.  The hospital offered me pain killers.  I was allowed a strong dose of naproxen sodium (Aleve), and while it helped, it was more of a numbing than anything.  Same with the canister of pain-relief foam and the tube of hydrocortisone cream they gave me.  I was continually aware of the pain.  Thankfully, the hospital staff were also innovative.

Part of the pain in the groin is from swelling.  Anyone who knows much about first aid knows that ice helps to reduce swelling.  But who wants to put ice on their feminine delicacies?  Well, I did, though obviously doing so was tricky with all the red tsunami issues in the region.  The nurses did something very smart:  they took a disposable newborn diaper (which is, of course, absorbent and somewhat designed to prevent leaks) and found one end of the crotch region which was open like a pocket.  Ice was crammed into said pocket, and the diaper was introduced to my nethers.  Relief!

Now, another consideration.  We civilized folk understand that having blood all around is something of a health hazard.  And we aren't keen on handwashing a bunch of the stuff out after all that other work.  What does one wear?

While still at the hospital for recovery, I wore the Hospital Gown of Impossible Modesty again.  But obviously that wasn't going to hold my pads to the area of interest, nor was a newborn diaper going to fit around my thighs and hips.  Some genius whom I could kiss a thousand times over created some totally awesome underwear.  This underwear is purely a mesh of gentle elastic material.  It's lightweight and net-like, and super stretchy.  It's just strong enough to hold things together but sympathetic enough not to remind a new mom of her injuries.  I took home as many pairs as I could acquire and even managed to send them through the wash a few times and reuse them before finally donating them to a mom planning a home birth.  Part of me was tempted never to wear any other kind of underwear again...until I stopped needing pads.  Turns out the comfort level was dramatically reduced when mesh meets tender flesh.

The hospital staff gave me certain requirements before I could leave.  Immediately after I was done with the octopus and pony show, I met my first requirement:  peeing.  Owing to the extra hydration from the saline drip, I more than made quota there.  They also kept asking me if I had any gas.  Apparently you can't leave the hospital until you are farting properly.  Let me tell you, it's very strange to be regularly asked by strangers if you are passing wind.

One benefit that I experienced (and I'm not sure how common this is) was that I didn't have to have a bowel movement until 4 days postpartum, and it was relatively easy since I had stayed well hydrated.  Andrew and I drank an entire 24 pack of bottled water during our vacation at the hotel--er, I mean, our stay at the hospital.

Showering was tough, but I was not allowed to take a bath, nor did I want one given that I absolutely did not want to try getting back to a standing position afterward.  For the postpartum mom, I suggest disrobing (and rerobing) while in the bathtub.  I did not realize how keen gravity was to help me make a mess and ended up smearing blood on the floor in a vain attempt to clean up my drippings before more exited my person.  At least it wasn't my floor, so it was somebody else's problem in the end.

The Aristocrats.

Okay, just kidding, but seriously, the whole experience was full of all sorts of nastification.  Still, there were bright spots.  I was up and walking around immediately after giving birth.  I was able to take pictures of Jackson napping on Andrew for the first time, just a couple hours afterward.

My mother-in-law (MIL) and then, shortly thereafter, my own mother traversed their separate drives (each in excess of 2 hours) and gladly snuggled with their new grandson.  My mom had already been made a grandmother twice over via my sister's reproductive habits.  My MIL had not, as Andrew was an only child, and she dubbed herself Nana.

Nana and I had not had a great deal of time to get to know one another in the less than a year's time we had known one another, but she soon got more than her fair share of time with her only daughter-in-law as she stayed the next 10 days to help us adjust to our own new roles as Mama and Dada.

Next up, a review of nursing and postpartum doulas, and (I promise) an end to the postpartum grotesquerie.  We'll start a new kind soon enough.

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!

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!