36 Weeks: In which I GIVE BIRTH (!!!!!!!)

Allright, y'all ready for this?

Checklist:
*Baby fed, changed, sleeping: check!
*French vanilla coffee with cinnamon-hazelnut creamer available: check!
*Banana bread available: check! Already devoured. Time to eat another loaf.

Okay! Good MORNING, Nebiverse fans! By now most of you have heard this at various other places on the interwebs, or at least deduced it from the picture above, but, just to make it really clear:

I HAD A BABY!! Wow.

There's so much to tell you I don't even know where to begin, but maybe we should start with last Wednesday, huh?

*My Birth Story*

First, a disclaimer: the following narrative contains references to the real-life details of childbirth, like bodily fluids and things. If you are squeamish, or believe that such things shouldn't be mentioned on people's blogs, I would suggest that you skip reading this post. If you want to know why I can't just write a birth story that omits these details, I will give you two reasons: the first is that I think that hearing other women's birth stories- including all the details- was a very important part of my preparation for having a baby. I enjoy reading birth stories on blogs and bulletin boards and seeing the wide variation in people's experiences. The second reason is that, when all is said and done, I don't write this blog to communicate with all of you- I write it to communicate with myself. This is my chronicle of my life and I feel the importance of telling this story as it is, with the details of real life included. So for those of you who would like to read, I hope you enjoy it, and, thanks for listening!

So after I posted the last two posts (this was Wed., Aug. 8th) I did normal typical morning Neb things and around noon, I lay down for a brief nap. (Not at all unusual- I like napping, and especially liked it in the third trimester.) Around 1:00 I felt this weird little pop somewhere down low, and thought, What was that? I got up and checked but there was no liquid or other visible sign of anything interesting happening, so I decided it must have just been a weird kick and ignored it. About ten minutes later I got up to go to the bathroom, and just as I got there, there was a warm gush of fluid. At first I was like, "Oh my goodness! My water is breaking!" But after a few spoonfuls of liquid it stopped, so I thought, oh, maybe not. I was under the impression that water breaking would involve a whole pint or something and I also knew that having labor begin with water breaking is not too typical (around 15% of the time, I read somewhere). As far as I could tell I hadn't had any of the "early labor symptoms" that books and the internet had been telling me to look for. I checked with a couple of friends who've had babies, and my mom, and none of them were sure, but all agreed with my thought that I should call the OB to ask about it. So I called and got their answering machine (apparently lunch is 1-2 at their office) and left a message. Then I woke up Nate and said, "Something funny happened... I might have to go into the doctor to get checked..." and he was all groggy and said something like "Wake me up when something important happens." At that point I was thinking "I always assume things are much more dramatic and significant than they are... this is probably nothing..." so I wasn't too excited yet.

At some point during that hour though, I started having mildly painful contractions, and realized, "THIS is a little weird..." None of my contractions had been painful before. But I had read that labor contractions usually start in the back and move around front, and these were still like Braxton-Hicks (ie tightening in the front), but with pain like menstrual cramps. So I still wasn't sure. I got a little more excited when I called Sara and she said that her labor contractions were like that, but still didn't want to get my hopes up too much. For some reason I didn't feel nervous or afraid.

So by the time I finally got in touch with my OB around 2, I had had several painful contractions that seemed like they were increasing in intensity, and when I told them about the fluid and then the contractions, they were like, "Oh! You need to go to the hospital to get checked." That surprised me because I assumed they would tell me to come into the office first. So then I was more excited, and woke up Nate and told him we had to go. He was a little freaked out and hid under the blanket for awhile. The problem was that he really needed to go into school to meet with his advisor at 2:30 to finish up things for his dissertation, and was pretty stressed about getting that done, so I told him (still assuming that nothing interesting would be happening for several hours, even if this WAS really labor- all the books and websites point out that first-time labors are usually fairly long and start gradually) that I really didn't mind if he dropped me off at the hospital, went to Lehigh (5 min. from hospital) to do his things, and then came right back. He asked if I was SURE I was okay with this, and I reassured him I would be fine. I was still feeling a little excited and confident and not very nervous. I didn't have a bag packed for the hospital or anything yet (that was on my to-do list for the next few days...), so I was trying to figure out what to put in my tote bag to take with me, just in case I wouldn't be coming home again before giving birth, and finally settled on just my wallet, my address book, the big binder of information from the hospital, and "What to Expect When You're Expecting." I made a couple of phone calls (including my mom) and then we set off.

As planned, Nate dropped me off at the front door of the hospital and I went to the information desk and asked, "Which way to Labor and Delivery?" I set off down the hallway and eventually found the right elevator and the right floor. In the car I had had some increasingly intense contractions, and in the elevator I had a big one and I remember thinking "none of these people I'm with know I'm in labor!" It was weird. I found the front desk of L&D and there were a couple of ladies sitting there who were very, very nonchalant. They were chatting, and multi-tasking, and answering phones, and doing paperwork, and after a few minutes they very casually asked me something like "Can we help you?" They had my charts because my doctor's office (in the building next door) had sent them over, so they started processing my paperwork, gave me a bracelet, etc. I must have been standing at the front desk for about 10 minutes waiting for all this to happen, and during that time had 2 big contractions. I remember thinking "I should start remembering all these details so I can blog about it later." ;-)

So they took me back to a triage room, I changed into a gown and gave a urine sample, and they hooked me up to an external moniter to record my contractions. This involved a large elastic band around my belly, which I found to be fairly uncomfortable- although I think I blamed a lot of discomfort on that band that was actually just, you know, LABOR. (I was still somewhat in denial!) Then they said the doctor would be in in awhile to check me. I remember asking the nurse "Is it likely that if she's born now [36 weeks 2 days] her lungs would be developed?" and the answer was something like "That's why they do amniocentesis to find out..." and I thought, no way do I want to have that done... but no one mentioned it again so it wasn't an issue.

I spent 1 1/2 hours in the triage room, and was increasingly uncomfortable during that time. It seemed like it took a really long time to wait for things- I kept watching the clock and trying to time my contractions, but kept losing track... I know they were every few minutes, sometimes less than 5, I think. I was also trying to read the monitor tracking my contractions, but wasn't sure I understood how to read the print-out. Eventually the doctor came in to check my progress (this was the FIRST time anyone had checked me to see if I was dilated- my doctor's office hadn't even started that at the routine visits yet because it was too early! they would have started next visit...). He was young and sounded like he had a French accent, and was nice. When they were unpackaging the speculum I heard him say to the nurse, "Is this geriatric?" and I think she said "It's labeled medium..." HINT for those of you in labor (or any time you're going to have an internal exam when you know you're really sensitive...): DON'T be shy about saying "CAN YOU PLEASE TRY THE SMALLEST SIZE AVAILABLE FIRST??" It hurt so bad when they put it in; it was just because I couldn't relax. They kept telling me to relax and I kept telling myself to relax, but the contractions made it nearly impossible. I asked "Why does it hurt so much?" and the nurse said "Because you're 36 weeks pregnant." They took samples to check for amniotic fluid and Strep B (I'd had that done at my last OB appointment, 35 weeks, but the results weren't even back yet so they were checking again.) Then he checked on dilation (that involves pressing HARD!) and said I was 2 cm, 70% effaced. I was relieved to hear that I was at least starting to dilate because I would have been upset to be having contractions at that level and not progressing yet. So they left me alone again for awhile, waiting for the test results to see if my water had broken I guess. I found it really hard to get into a comfortable position on the table; I can't remember what else I was hooked up to at that point, maybe a heart rate moniter and automatic blood pressure cuff? It's all a little blurry. The contractions really picked up and I started to get more upset; I had this sensation of not being able to cope with the pain. I think I remarked to the nurse at some point when she came in, "Maybe I SHOULD have taken Lamaze after all..." During the times I was alone, I would have a contraction and think "OKAY, as soon as this passes I'm going to press the button to get the nurse and ask them to give me some pain medication!!!" but then the contraction would pass and I would think "Well, I don't want to bother them... I can wait a little while longer..." It was weird because for some reason I didn't seem to understand why it hurt so bad... even though I'm sure that I KNEW that contractions are more intense after your water's broken, somehow I wasn't thinking about that. I just remember thinking, "This must be EARLY labor, and if early labor's this bad, what is the middle and the end like?? MUST GET EPIDURAL!!"

Anyway finally the doctor came back in and told me, "Yes, your water is broken, so you will probably be having the baby within 24 hours, and we will give you pitocin to make that happen if you don't progress enough on your own." By that point I wasn't at all surprised, and still didn't really feel scared or freaked out; I told him "That's fine [ie in regard to the pitocin], but I would like an EPIDURAL. Also, probably some IV pain drugs even before then." He seemed surprised that I was in so much pain already, but said I could have what I needed. He also told me I had tested positive for strep B, so they would be giving me antibiotics.

At some point when I was in triage a lady came in with a cordless phone, and it was my dad... he had figured out how to call the hospital and track me down. I have no idea what I told him, but I assume I told him that I was really in labor and they could go ahead and leave for PA if they wanted to. I don't think I talked long. I kept hoping Nate would be back soon and around 3:30 maybe I called him and was relieved he was back in his office; told him my water was broken and the baby was on the way, and he said he and Adrienne (who was in town for a job interview) would be there soon. They got there around 4 pm and shortly after that a nurse came in and said they would move me to an LDR room. She said I could walk if I wanted to, and I asked how far it was and she said "right down the hallway." I got up and sort of leaned over the table, deep in pain from a contraction and starting to get kind of light-headed, and finally she said "Do you want a wheelchair?" and I said yes. So they took me to the LDR room and got me settled in bed, and re-hooked-up to a contraction moniter.

The time frame from 4-6 is a little blurry. I had a nurse named Jeanne who was nice and sort of funny. It seemed like she spent a long time coming in and out, filling out paperwork, asking various questions (I guess- I really can't remember), starting my IV, etc. I started asking for a cup of ice water (unfortunately I hadn't had nearly enough to eat or drink before leaving the house), but she kept getting distracted doing various things so finally someone else (Sara? Adrienne?) found a cup of water for me. The contractions were bad and I still had this feeling of not being well-equipped to deal with them; I couldn't relax, or breathe properly, or anything. Every time one came I sort of writhed for awhile and moaned a lot; back in triage I had told myself "Try vocalizing the pain," something I had read in the hippie natural-childbirth books, and I don't know if it really helped but at least it gave me something to do. I said "OH!" over and over again through every contraction. At some point I started asking Jeanne for pain medication, and told her I definitely wanted an epidural, and she said "You can go ahead and have one now!" and I said "Great!" but it was still some significant amount of time after that that I actually GOT one. During this time while I was waiting, I worked on a list of things to pack in a bag for the hospital- the plan was for Adrienne to go back to our apartment and get things together. (It was also during this time that she got a call from Bethlehem school district offering her a teaching job for the fall- Yay!) I checked the checklist in What To Expect When You're Expecting and was typically OCD about it so it took forever, but it was really good for me to have something specific to do between contractions to distract me.

At some point someone checked my progress again, and I was 4 cm, 80% effaced. I was relieved to hear I was still progressing well. Jeanne said the anesthesiologist was finishing up a C-section and then would be on the way. Eventually I said, "I'm not sure how much longer it will be til the epidural- if it's going to be another half hour or something, I'd like some IV pain relief now." She asked if I needed to go to the bathroom first, saying "I don't like helping a drunken sailor walk," and she made me sign some forms (which, of course, I didn't read first- that would have delayed the drugs!!) She gave me the Stadol, and literally about 60 seconds later, the anesthesiolgist got there!! The Stadol made me woozy and unable to keep my eyes open. If I had known the epidural would be there right away I wouldn't have asked for it, because as far as I could tell it didn't really relieve the pain of contractions (although it didn't have long enough to work to really tell) and just made me groggy. But I guess it was nice to be a little out of it during the epidural installation, although the pain from that really wasn't significant compared to the contractions. Once the epidural kicked in there was sweet, sweet numbness, and I felt absolutely no pain whatsoever for the rest of the day!!! Then I was all peaceful and mellow and happy.

A little while later I was excited to see Judy and Sara show up- I had invited them to come to the hospital when I was in labor, mainly in case Nate had issues with seeing childbirth stuff (especially if I needed a C-section.) They were completely awesome and were really good company the whole time. Adrienne came back, having found everything on my list in our apartment (what a great sister-in-law!!) Also Mike and Rich stopped in brieflly; then they waited outside until after the baby was born. I made and received a few phone calls during this time, but don't really remember what I said to people, or who called when.

Sometime between 7:30 and 8 I think, they checked my progress again (painless checking, this time!) and were shocked to find out I was 9 cm! Earlier when I had asked how long I would be staying in the hospital (48 hours literally, or, discharged at some point on the second day after delivery), a nurse had said, "Oh, your baby will surely be born after midnight, so you'll stay until Saturday." So it was surprising (and thriling!) to hear I was so far along. They told me it would be time to push soon, and someone said that first-time labors usually involve 1 to 3 hours of pushing. I was a little bit apprehensive about the pushing part because I was so numb that I didn't know whether or not I would be able to push properly, and I was terrified that they would suggest turning down the epidural so I could feel more.

My OB was on vacation that week (at my previous appointment they'd told me he'd be gone that week), so I had asked Jeanne who was covering for him- she said Dr. W was supposed to be covering, but Dr. A was covering for HIM until 11 pm. So at some point I met Dr. A, and was really happy to find out that she was very nice- honestly, I liked her more than my own OB! What a blessing. [She delivered the baby, and I never saw her again! Funny how these things work...] Before pushing, I told her "I would rather risk tearing naturally than having an episiotomy" and it was a relief when she said, "Don't worry, I don't do them routinely" (which is not exactly what my OB had said...) so at the time, that was very reassuring.

So about 8:13 they said I could start pushing, and I thought about what I'd read/heard various places: Push like you're having a bowel movement! They said take a couple of deep breaths and then push, the next time a contraction came (I couldn't really feel most of the contractions, so a nurse watched the moniter/ felt my belly and told me when.) I scrunched up my face and really gave it all I had, and asked if I was doing it right, and was relieved to hear that I was. So I pushed for 11 minutes and she was born! Towards the end I asked for a mirror so I could watch, and I saw a long strand of her dark hair come out. That was pretty cool. Interestingly I wasn't at all disturbed by the sight of all the blood and things coming out of me; I just found it fascinating. (If I had been FEELING what was going on, I'm sure it would have been another story altogether!) Anyway, she came shooting out all at once (not the head first, then the shoulders, etc.) with a big gush of fluid. I can't remember if she cried or not, but I remember saying she's beautiful, and they wrapped her up and handed her to me. It was the most amazingly cool thing. They let Nate cut the cord and took her aside to do the standard newborn things (eyedrops, vitamin K) before giving her back to me.

Shortly afterwards I asked the doctor if I had torn and she said, yes, you tore a lot, part-way through your sphincter. So that scared me a lot- getting stitches was one of the things that scared me the most about childbirth, just because I'd heard bad things about the healing process. But Dr. A was very reassuring and said, "Don't worry, it will heal just fine." (Unlike the nurse who was in my room later and said, "You'll never want to have sex again!" Really encouraging, huh?) She and another person that she was teaching (some kind of med student?) spent a long time sewing me up- more than 30 minutes, Nate said. [Again, this was all 100% painless.] Nate said she was very careful and seemed to be doing a really good job. I asked her what degree the tear was and she said "partial 3rd degree"- later I was told that it went through about 75% of my sphincter. [This is more than you EVER wanted to read about my sphincter, isn't it...? Don't worry, I'm almost done...] I asked her how many stitches it needed and she just said, "Well... many layers." After a few minutes the placenta came out; when Dr. A looked at it she said it was a "Battledore Placenta," meaning the umbilical cord was attached close to the edge instead of in the middle, which *might* explain why I delivered 4 weeks early- but then again, might not.

So, my dad called and I told him the baby was already here- he and my mom were on the way. The nurse told me Madelaine's Apgar was a 9 and that she seemed completely healthy, which was so good to hear; they let me hold her for awhile and try nursing a bit, but eventually she was cold and so they had to take her to the nursery and put her under warming lights. I finally got to eat something (macaroni and cheese, and a PBJ) and they asked if I could use a bedpan and I said I'd try. Well, nothing worked; I was still too numb to even feel like I needed to pee, although they had given me so much IV fluid that I certainly needed to, so they put in a catheter (one of the other things which terrified me about childbirth, for some reason, but turned out to be completely not an issue! too numb to feel it) and they drained out way more urine than I thought my bladder was capable of holding.

[Commercial Break: It is now Monday morning. This post is now ridiculously long, considering I had a shorter-than-average labor. So something tells me I should stop telling you all EVERY little detail, and try to wrap it up here...]

I got moved to a private room (where I stayed until we went home Friday afternoon), and we waited for my parents to arrive. I didn't feel sleepy for a long time- too much adrenaline maybe. My family got in around 1 am and went to the nursery (where she was still warming up.) They came back to my room, and we waited for the nursery folks to bring her back to me. They finally did around 2, maybe, and after that my parents left to find their hotel. Nate left around 3, and after that I was alone with my baby. She was sleeping fitfully in her bassinet, and I knew she would sleep better if I held her. So I held her in bed with me for a long time. And together, we watched the sun rise. :-)



Love, Neb