Sunday, March 16, 2003
This is Matt standing in for Stephanie, for reasons which will soon become obvious.
The week started with Stephanie getting strong, painful contractions late Sunday night. They were semi-regular: they’d go on at regular intervals of anywhere from three to seven minutes for clusters of an hour or more, then they’d die down until the next cluster an hour or less later. This and other signs suggested that we were getting close, but when we went in to the midwife on Monday, they indicated that there had been minimal progress since the last visit.
Still, the contractions continued. For days. Constantly. Stephanie was essentially unable to sleep for more than a half-hour at a time, at best. We went in to the midwife again on Thursday morning. When it developed that there had been no more progress, the decision was made to induce labor. Although we were still in a safe zone, the pregnancy, already a week and a half overdue, could become dangerous.
The plan was to start with cervadil, a relatively light-weight drug with a correspondingly lower chance of complications. We’d go in to the hospital that night (it required up to twelve hours of observation) and, if it didn’t work, wait through the weekend (the midwife was resolutely mute on the subject of doctors not wanting to start anything just before the weekend) and try again on Monday with pitocin, the heavy hitter of the labor-inducing drug world.
We got to Ft. Sanders hospital a little before six in the evening. We had to go to the hospital because the birthing center wasn’t allowed to administer those sorts of drugs. However, Susan, the midwife, came to administer it; the midwives have admitting privileges there. They set us up with a room that will surely cost my insurance company a healthy bundle of money, and Susan was soon by to set us up with the drug (although she’d leave thereafter, leaving the nurses to monitor us). The cervadil came in the form of a short cloth ribbon impregnated with a gel. It’s administered by inserting it next to the cervix, and if you want to stop the action of the drug, you simply remove the ribbon.
The cervadil was administered at about a quarter after six. Within a half-hour, Stephanie was experiencing extremely painful contractions at about three-minute intervals. A nurse checking her at around eight thirty said that she had dilated another centimeter (from about two to about three). The contractions stayed regular and became more intense, which was a problem. We had some comfort measures to try, but none were very effective: massage, changing positions, a warm shower, none of them made it any easier. For the first two hours or so, Stephanie was attached to a monitor with measured fetal heartbeat and contractions. The scale for that monitor ran from zero to one hundred; almost all of Stephanie’s were off the scale.
Then, about nine thirty, the cervadil fell out. The nurses were apparently not allowed to put it back in, so Susan was recalled to do so, and I called our doula, Kimberly, to consult on more comfort measures. As I was on the phone with Kimberly, Susan appeared and checked Stephanie’s progress before inserting a new cervadil ribbon. Stephanie was open to four centimeters. Labor was under way, and we could move to the birthing center.
A little after ten, we made the trip of a few short blocks from Ft. Sanders hospital to the birthing center. Stephanie and I got there first with Susan not far behind. Kimberly, who left home as we were packing up to leave the hospital, showed up a few minutes later, and Christine, the birthing center’s new midwife (who, as the new guy, was pretty much always on call), appeared as I was taking the last few things out of the car.
The difference between the hospital and birthing center was immediate and palpable. In the hospital, we were largely left alone with a long list of anxieties interrupted by brief visits by admittedly pleasant and friendly if entirely unfamiliar nurses. At the birthing center, there was a team of three people, all of whom we at least recognized, entirely focused on helping Stephanie. Kimberly earned what we paid her several times over here. She immediately took charge of helping Stephanie feel better, working with her to keep her breathing, and telling her the things she needed to hear at all the right moments. From our arrival to about midnight, Stephanie progressed quickly, going from four to about nine centimeters, although there was some concern that the baby didn’t seem to be descending any farther.
But around midnight, progress stopped. Stephanie didn’t dilate any farther and the baby stayed where he was. Moreover, her labor became more and more painful. Between midnight and about five in the morning, her contractions typically came about two minutes apart, hardly giving her time to recover from one before the next began. As if that weren’t bad enough, she was also going through some tremendously painful back labor; she had back pain comparable to what was going on elsewhere.
Despite our best efforts, we weren’t getting anywhere, and at about 5 AM, Susan decided that we had no choice but to go back to the hospital. This was, of course, the last thing that we wanted, but we didn’t have many options left. Unfortunately, this meant that Stephanie went from being a woman in charge of the birth to a patient being worked on by technicians. She got a shot of statol, a narcotic, shortly before we left, but it appeared not to help. Back we went to the hospital, where we were put in our original room, and she was strapped to a number of monitors. This time, instead of being left alone, we had a crowd: us, both midwives, our doula, one to four nurses at any given moment, a student nurse or two, and the student nurse supervisor, plus the occasional technician or specialist.
The first specialist through was an anesthesiologist, who set Stephanie up with an epidural. He had no personality to speak of, but he eventually got the drugs set up for her. She’s still opposed to their widespread use, but now she can see why people want them. After twelve hours of screaming agony, it didn’t feel so bad. More equipment was added, including a fetal monitor hooked directly to the baby and a monitor for uterine pressure. That last was particularly important. The question at hand was about how strong her contractions were. If they weren’t strong enough, we might be able to give her some pitocin to crank things up and deliver normally. If her contractions were strong enough and the baby still wasn’t coming, they’d have to do a c-section.
In the course of all this, problems developed. On getting the epidural, Stephanie’s blood pressure dropped, which led to the baby’s heartbeat dropping. They put her on oxygen to compensate. The uterine pressure monitor indicated that the contractions were, in fact, not strong enough, but then the baby’s heartbeat started to drop alarmingly after each contraction and took some time to come back up. This implied problems with the umbilical cord, and if it didn’t clear up, it might be too dangerous to go the pitocin route.
This whole process went on until around eight thirty. The problem with the decelerations came and went a few times, but it looked like we might be able to try the pitocin. Then the amniotic fluid became tinted with merconium, essentially the baby’s first bowel movement. The doctor in charge suddenly appeared and abruptly announced that we’d have to have a c-section. The decelerations hadn’t cleared up and the merconium posed an infection risk, so the baby had to come out immediately.
Despite the enormous emotional upset, things progressed rapidly. In a few minutes, Stephanie was wheeled down the hallway to the nearby operating room to be prepped and I was issued a set of scrubs to change into. Although she didn’t have to, Susan also came in for the surgery. I was seated next to her head and there was a large drape across her at mid-chest level, so I couldn’t actually see much. The operation took under an hour, and most of that time was closing back up.
I peeked over the drape to see Alex before they had gotten him completely out. He was bloody, of course, and his head looked huge relative to the volume he had just taken up. They suctioned his mouth out and took him over to a heated table for cleaning and more work to make sure that the merconium hadn’t gotten into his lungs. Possibly because Stephanie had gotten drugged so soon before the operation, Alex was alert as soon as he came out. He was trying to open his eyes as they took him out of his mother, and by the time I got to hold him he was looking for something to eat. We’re told that he scored near the top of the APGAR test.
Stephanie was too anesthetized to hold or feed him, so after the surgery, they wheeled us back to the room and took Alex off to the nursery for some tests. After a few hours, they brought him back with the warning that his blood sugar and body temperature were a bit low. He had already been fed formula, and we weren’t sure we wouldn’t have to do the same.
But, to make a long story short, we didn’t. The nurse brought Alex back for an attempt at first feeding and, after a moment of manipulation, Stephanie started expressing little droplets of milk. Alex took to it immediately, latching on well and feeding contently until he fell asleep. After some cuddling and a feeding or two, the tests indicated that his body temperature was back up and his blood sugar was at a very good level.
(0) idle chatter
The week started with Stephanie getting strong, painful contractions late Sunday night. They were semi-regular: they’d go on at regular intervals of anywhere from three to seven minutes for clusters of an hour or more, then they’d die down until the next cluster an hour or less later. This and other signs suggested that we were getting close, but when we went in to the midwife on Monday, they indicated that there had been minimal progress since the last visit.
Still, the contractions continued. For days. Constantly. Stephanie was essentially unable to sleep for more than a half-hour at a time, at best. We went in to the midwife again on Thursday morning. When it developed that there had been no more progress, the decision was made to induce labor. Although we were still in a safe zone, the pregnancy, already a week and a half overdue, could become dangerous.
The plan was to start with cervadil, a relatively light-weight drug with a correspondingly lower chance of complications. We’d go in to the hospital that night (it required up to twelve hours of observation) and, if it didn’t work, wait through the weekend (the midwife was resolutely mute on the subject of doctors not wanting to start anything just before the weekend) and try again on Monday with pitocin, the heavy hitter of the labor-inducing drug world.
We got to Ft. Sanders hospital a little before six in the evening. We had to go to the hospital because the birthing center wasn’t allowed to administer those sorts of drugs. However, Susan, the midwife, came to administer it; the midwives have admitting privileges there. They set us up with a room that will surely cost my insurance company a healthy bundle of money, and Susan was soon by to set us up with the drug (although she’d leave thereafter, leaving the nurses to monitor us). The cervadil came in the form of a short cloth ribbon impregnated with a gel. It’s administered by inserting it next to the cervix, and if you want to stop the action of the drug, you simply remove the ribbon.
The cervadil was administered at about a quarter after six. Within a half-hour, Stephanie was experiencing extremely painful contractions at about three-minute intervals. A nurse checking her at around eight thirty said that she had dilated another centimeter (from about two to about three). The contractions stayed regular and became more intense, which was a problem. We had some comfort measures to try, but none were very effective: massage, changing positions, a warm shower, none of them made it any easier. For the first two hours or so, Stephanie was attached to a monitor with measured fetal heartbeat and contractions. The scale for that monitor ran from zero to one hundred; almost all of Stephanie’s were off the scale.
Then, about nine thirty, the cervadil fell out. The nurses were apparently not allowed to put it back in, so Susan was recalled to do so, and I called our doula, Kimberly, to consult on more comfort measures. As I was on the phone with Kimberly, Susan appeared and checked Stephanie’s progress before inserting a new cervadil ribbon. Stephanie was open to four centimeters. Labor was under way, and we could move to the birthing center.
A little after ten, we made the trip of a few short blocks from Ft. Sanders hospital to the birthing center. Stephanie and I got there first with Susan not far behind. Kimberly, who left home as we were packing up to leave the hospital, showed up a few minutes later, and Christine, the birthing center’s new midwife (who, as the new guy, was pretty much always on call), appeared as I was taking the last few things out of the car.
The difference between the hospital and birthing center was immediate and palpable. In the hospital, we were largely left alone with a long list of anxieties interrupted by brief visits by admittedly pleasant and friendly if entirely unfamiliar nurses. At the birthing center, there was a team of three people, all of whom we at least recognized, entirely focused on helping Stephanie. Kimberly earned what we paid her several times over here. She immediately took charge of helping Stephanie feel better, working with her to keep her breathing, and telling her the things she needed to hear at all the right moments. From our arrival to about midnight, Stephanie progressed quickly, going from four to about nine centimeters, although there was some concern that the baby didn’t seem to be descending any farther.
But around midnight, progress stopped. Stephanie didn’t dilate any farther and the baby stayed where he was. Moreover, her labor became more and more painful. Between midnight and about five in the morning, her contractions typically came about two minutes apart, hardly giving her time to recover from one before the next began. As if that weren’t bad enough, she was also going through some tremendously painful back labor; she had back pain comparable to what was going on elsewhere.
Despite our best efforts, we weren’t getting anywhere, and at about 5 AM, Susan decided that we had no choice but to go back to the hospital. This was, of course, the last thing that we wanted, but we didn’t have many options left. Unfortunately, this meant that Stephanie went from being a woman in charge of the birth to a patient being worked on by technicians. She got a shot of statol, a narcotic, shortly before we left, but it appeared not to help. Back we went to the hospital, where we were put in our original room, and she was strapped to a number of monitors. This time, instead of being left alone, we had a crowd: us, both midwives, our doula, one to four nurses at any given moment, a student nurse or two, and the student nurse supervisor, plus the occasional technician or specialist.
The first specialist through was an anesthesiologist, who set Stephanie up with an epidural. He had no personality to speak of, but he eventually got the drugs set up for her. She’s still opposed to their widespread use, but now she can see why people want them. After twelve hours of screaming agony, it didn’t feel so bad. More equipment was added, including a fetal monitor hooked directly to the baby and a monitor for uterine pressure. That last was particularly important. The question at hand was about how strong her contractions were. If they weren’t strong enough, we might be able to give her some pitocin to crank things up and deliver normally. If her contractions were strong enough and the baby still wasn’t coming, they’d have to do a c-section.
In the course of all this, problems developed. On getting the epidural, Stephanie’s blood pressure dropped, which led to the baby’s heartbeat dropping. They put her on oxygen to compensate. The uterine pressure monitor indicated that the contractions were, in fact, not strong enough, but then the baby’s heartbeat started to drop alarmingly after each contraction and took some time to come back up. This implied problems with the umbilical cord, and if it didn’t clear up, it might be too dangerous to go the pitocin route.
This whole process went on until around eight thirty. The problem with the decelerations came and went a few times, but it looked like we might be able to try the pitocin. Then the amniotic fluid became tinted with merconium, essentially the baby’s first bowel movement. The doctor in charge suddenly appeared and abruptly announced that we’d have to have a c-section. The decelerations hadn’t cleared up and the merconium posed an infection risk, so the baby had to come out immediately.
Despite the enormous emotional upset, things progressed rapidly. In a few minutes, Stephanie was wheeled down the hallway to the nearby operating room to be prepped and I was issued a set of scrubs to change into. Although she didn’t have to, Susan also came in for the surgery. I was seated next to her head and there was a large drape across her at mid-chest level, so I couldn’t actually see much. The operation took under an hour, and most of that time was closing back up.
I peeked over the drape to see Alex before they had gotten him completely out. He was bloody, of course, and his head looked huge relative to the volume he had just taken up. They suctioned his mouth out and took him over to a heated table for cleaning and more work to make sure that the merconium hadn’t gotten into his lungs. Possibly because Stephanie had gotten drugged so soon before the operation, Alex was alert as soon as he came out. He was trying to open his eyes as they took him out of his mother, and by the time I got to hold him he was looking for something to eat. We’re told that he scored near the top of the APGAR test.
Stephanie was too anesthetized to hold or feed him, so after the surgery, they wheeled us back to the room and took Alex off to the nursery for some tests. After a few hours, they brought him back with the warning that his blood sugar and body temperature were a bit low. He had already been fed formula, and we weren’t sure we wouldn’t have to do the same.
But, to make a long story short, we didn’t. The nurse brought Alex back for an attempt at first feeding and, after a moment of manipulation, Stephanie started expressing little droplets of milk. Alex took to it immediately, latching on well and feeding contently until he fell asleep. After some cuddling and a feeding or two, the tests indicated that his body temperature was back up and his blood sugar was at a very good level.
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