The Gory Details, Part 1: The World Turns Upside Down
Before I get started on this story, I want to make a couple points up front:
- This isn't intended to be a horror story; it's just what happened to us. (I realized that what I thought of as a fairly straightforward birth experience might sound somewhat horrific when I related the story to my mom.) If you're pregnant and reading this, please don't let any of the details worry you. Overall my experience was pretty darn good, and it really does make a difference that you get a beautiful, healthy baby at the end. Pain and trauma fade the longer you stare at your baby's face.
- I was cagey about the due date, but I wasn't being as devious by saying "around Christmas" or "during the holidays" as the actual birthdate would suggest. The three estimates I alluded to in previous posts—mine, the doctors', and the ultrasound technician's—were December 10, December 7, and December 5, respectively. As you'll see from the details below, however, there came a point when I knew for sure that Austen would be born in November, not December, and I withheld that information from the blog.
The story really begins on the day that I declared radio silence for a while. What happened at our 38-week OB visit that day is what made me not want to talk about the pregnancy on the site anymore: namely, that we found out Austen was breech. Dr. Beshara, whom we met for the first time that day, did a pelvic exam and declared me 3cm dilated... but then said that something didn't feel quite right. He wanted to do an ultrasound, "just to make sure the baby really is head down." We were a bit surprised, because I'd been under the impression that the baby's head had been engaged since week 35. "It's just a precaution," Dr. Beshara assured us. "It's probably fine, but usually when I do an exam at this stage, I can feel a nose. I couldn't feel a nose on your baby." I'm not sure whether it occurred to us then, but a noseless, head-down baby probably would have been worse than a breech baby whose nose was just pointed the wrong way.
Anyway, we moved on to the ultrasound room, where Dr. Beshara coated me with blue gel, stuck the wand on my belly, and said, "let's see. There's the spine, and there's...a femur. Your baby's breech." It turns out that what had been engaged since week 35 was Austen's butt, not his head. His feet, hands, and head were all over on the right side, under my ribs (which explains a lot, actually). I said, rather matter-of-factly, "we have to schedule a C-section then, right?" The answer was "generally, yes, unless an external version is successful." Unfortunately, an external version requires a certain amount of amniotic fluid, and fluid levels usually start to decrease after 36 or 37 weeks. We didn't have enough.
Since Austen couldn't be turned manually, and at this stage he was unlikely to turn on his own, a C-section would be scheduled for us at 39 weeks. Using the doctors' due date of December 7, 39 weeks was November 30—six days later. Dr. Beshara went to check who was on call that day, in case it was someone we absolutely hated. It turned out to be Dr. Chen, with whom we already had an appointment scheduled (our first with him) on November 29, and whom we'd just seen deliver a baby by Cesarean on an episode of Birth Day. We accepted this slot and agreed to arrive at the hospital by 7:30am on Tuesday.
I think it wasn't until we were walking back down the hall to the front desk that I started to cry. All of a sudden it hit me: Everything I'd been preparing for, with my reading and childbirth classes and breathing exercises, I was going to miss. I wasn't going to need the birth ball or my bag of "labor-saving devices," which was already packed. I wasn't going to be able to labor in water (either in my own tub or in one of the whirlpool baths that had made me choose HUP as my delivery hospital in the first place). I wasn't going to have a C-section at the end of a difficult labor in which I couldn't get the baby out, making surgery something of a relief (and the epidural injection relatively painless compared to the contractions). Every bullet point in my (to my mind) amazingly flexible birth plan was now moot.
I hoped to wake up on Thanksgiving day having gotten over the sadness and shock of missing out on labor; I mean, really, when had I started to look forward to labor? It was probably going to be painful and messy and could quite possibly ruin part of my life. But I hadn't gotten over it: I was still a wreck on Thursday morning, still sad, still angry, still in mourning. I ended up writing an e-mail to our childbirth educator to tell her that we'd be missing the last class, and why. I suggested that in future class series she spend some time talking about scheduled C-sections, and how to prepare for them. I also explained what I'd been having trouble explaining to anyone else I'd talked to.
My friend Stacy said to me, "you know how people say that the way to get through the stress of your wedding day is to think to yourself, 'whatever happens—if the flowers don't come, or the bridesmaids' dresses don't match, or Uncle Fred falls in the cake—at the end of the day we'll be married'? That's the way you need to think about this birth: It may not be the way you expected, but at the end of the day, you'll have a baby." I thought it was a fine analogy... except that what this feels like to me is the officiant coming to our door on the morning of the wedding to say, "the ceremony's cancelled. I now pronounce you man and wife." Yep, we'd be married, but we'd have missed out on something special.
Writing that e-mail made me feel better, and I think it helped me turn the corner. By the end of the day, I was ready to accept and plan for the birth experience I was going to get rather than mourn the loss of the one I'd expected. The only possible wrench in the "start preparing for a Cesarean delivery on Tuesday" plan was that at 10:30 that night, my mucus plug fell out. I was obviously continuing to dilate at a steady pace.
The Gory Details, Part 2: Til Tuesday
On the Monday preceeding my appointment with Dr. Beshara (that would be November 22), I'd had about two hours of consistent contractions, and I started to wonder whether I was in labor. Since my strategy was to labor as long as possible at home before heading to the hospital, it didn't much matter; I figured if the contractions got more intense and closer together as the day went on, or if my water broke, I'd call Al at work and the doctor. Eventually the contractions subsided, and I went about the rest of my day as usual.
When we got the news that the baby was breech and that we were headed for a C-section, Dr. Beshara asked about whether I'd been having any strong contractions. I mentioned the Monday session, and the fact that I was more likely to wait too long to go to the hospital than show up with false labor. Dr. Beshara's response: "Don't wait. If you see any signs that you might be in labor, go to the hospital."
All of a sudden, all the signs of labor beginning—signs that I'd been looking forward to with great excitement—became things I wanted to avoid at all costs. My belly, which I'd been looking at as a birthday cake someone might jump out of and yell "surprise!", was now a ticking time bomb.
So when my mucus plug fell out on Thursday night, I didn't know whether to be excited or afraid. I resolved to call the nurse at my OB practice the next day and ask. The problem was that, like most offices around the country, the OB's was closed on the day after Thanksgiving. I felt silly having to page the doctor on call for something that might be nothing, but the guy manning the answering service switchboard assured me that it was better to be safe than sorry. When he said that it was my least favorite doctor who was on call, however, I almost called the whole thing off.
The doctor returned my page about 35 minutes later and said that my mucus plug falling out was no big deal, and not to call unless I was in active labor or my water broke. Since these are the guidelines for when to call if you're heading for a vaginal delivery, and they seemed to contradict Dr. Beshara's "don't wait" advice, I didn't know what to think. I decided to just go about my day as planned and see what happened. The plan was to go to BJ's, ACME (aka Albertson's), and Home Depot to stock up for the recovery from surgery, buy some parts for a few home repairs, and pick out a Christmas tree. If we had time, we'd go to the Han Ah Reum in New Jersey to buy a case of Korean pears.
Meanwhile, I was now peeing at least once an hour if not more, and about every third time I went, more of the mucus plug fell out. Who knew there was so much brownish glop in there? My sister called mid-morning to see how I was doing, and I reported on the mucus plug and the advice from the doctor. "You do realize," she said, "that if you'd gotten a different doctor, you might have gotten different advice, right?" Thinking of Dr. Beshara, I responded in the affirmative. "If I were you," she continued, "I'd spend the day on the couch and act as if the doctor had ordered bed rest. It certainly couldn't do any harm." I conceded her point.
Al went out to BJ's, ACME, and Home Depot without me, though he opted not to shop for a Christmas tree. I wouldn't let him go to New Jersey because I was nervous that labor would start, and he'd be too far away. I spent most of Friday, Saturday, and Sunday on the couch, alternately watching the original Star Wars movies with Al and the first season of '24' on DVD. The rest of the time I spent sitting on the birth ball or clutching the stand-up mirror in the living room, attempting to breathe through increasingly intense contractions that sometimes lasted upwards of 10 minutes. "Where... the... hell.... is... the... peak???" I panted. There are still index cards and receipts littered about the house with contraction counts on them; some only list a single, 5-minute-long contraction, while others list 10 or more with intervals ranging from 1 minute to 12 minutes.
Despite this, labor never did seem to progress, and my water never broke. On Monday morning I was going a bit stir crazy, and I had a library book that was due that day, so Al and I walked, very slowly, to the library, the Whole Foods, and back before returning to the couch.
At around 1:30 we left for our appointment with Dr. Chen, who turned out to be just as nice and just as calm as he'd appeared on the episode of Birth Day. We were surprised, however, when he brought up the subject of attempting an external version. He said Dr. Beshara had talked to him about the amniotic fluid levels being on the low side of normal, but he said if we wanted, they could measure the fluid again on Tuesday morning and see if an external version were possible. We wanted to know what would happen if we went that route. Dr. Chen explained that if the procedure were successful and did not cause fetal distress, we'd be sent home to await the onset of labor; if was not successful and did not cause fetal distress, we'd proceed with the C-section that day (although probably later in the afternoon rather than at our scheduled time of 9am); and if it caused fetal distress, regardless of whether it succeeded or not, I'd be rushed to the OR for an emergency C-section under general anesthesia. We said we'd have to think about it. In any case, Dr. Chen said I should stay off my feet until it was time to leave for the hospital in the morning. (I guess my sister was right; the morning walk was probably not such a good idea, but the weekend spent watching '24' had been.)
We discussed our options later that night, and as appealing as being able to have the vaginal birth we'd originally planned for would be, there were several downsides to attempting external version: (1) the procedure is usually extremely painful, and Dr. Chen preferred to do it without the use of an epidural so that he could gauge whether he was hurting me too much; (2) the baby might be breech for a reason, and by attempting to turn him by force, we might cause fetal distress by entangling him in the umbilical cord or by some other means; (3) we'd finally come to terms with the inevitable C-section, and having to change mindsets back to awaiting the onset of labor was a U-turn I'm not sure either of us could handle; and (4) we'd already told our parents that the baby would be born on November 30. All the "have you had the baby yet???" phone calls we'd hoped to avoid now might happen anyway if the version were successful. I think we were both hoping that the fluid levels would be low enough to take the decision out of our hands, since it was obvious that Dr. Chen had a bias toward attempting the version.
We set our alarms for 5:30am (me) and 6am (Al) and went to bed at around 8:30 or 9 that night, wondering if we'd actually meet our baby the next day, and if so, under what circumstances.
The Gory Details, Part 3: Pin Cushion
One of the things we asked Dr. Chen at Monday's office visit was whether there was a certain point at which I should stop eating and/or drinking. I knew that HUP had a policy of preparing for a C-section under general anesthesia, even if general anesthesia was a slim possibility. In our case, if we went ahead with the external version, the possibility wouldn't be quite so slim, so respecting any restrictions on eating and drinking could be very important. Dr. Chen said I needed to stop eating 6 hours prior to surgery, and to stop drinking 3 hours prior. Surgery was set for 9am, provided there were no emergency C-sections that took precedence. Technically this meant that I could eat up until 3am.
As I mentioned in the previous installment, we went to bed at about 9pm on Monday night. Since my thyroid medication had to be taken on an empty stomach, I'd last eaten at 6pm. Between 5:30am and 6am on Tuesday morning, I drank as much water as I could suck down and then cut myself off. We left for the hospital around 7am, parked the car at Penn Tower, and headed up to Labor & Delivery. After signing a bunch of insurance and consent forms upon check in, we waited for a little over an hour for someone to come get us or to tell us what to do next. While we waited, Al snacked on turkey jerky while I tested posting to the blog from his blackberry, chatted with a woman we'd met at childbirth class who was in for some tests, and started making lists of food I would eat when I was finally allowed to eat again.
At 8:30 a nurse came to show us to the room we would wait in until the surgery. She gave me a gown to change into and said that someone would be in to talk to us shortly; they were fairly busy that morning, and both ORs were currently in use. Dr. Chen came in and asked us what we'd decided about the version. We said we were leaning against it, but we wanted to see the results of the ultrasound and get some odds on whether the procedure was likely to be successful. He said OK.
We sat around waiting for a while longer, and then I finally got into the hospital bed and went to sleep. I think it was close to 10am when a nurse came in to hook me up to the monitors and to try to place an IV. Well, she got out all the supplies to place an IV, anyway, and then we never saw her again. Another nurse came in a while later and said that she'd be with us through the surgery. (She was, and she was great.) She searched my arms for a suitable vein, but since my veins aren't exactly "available" under the best of conditions, and I was now completely dehydrated, she had some difficultly. Apparently my veins are also very "valve-y", which means that while a few would have been suitable for drawing blood, almost none were good for placing an IV.
Consequently, this nurse (Erika) blew the first vein she tried. Rather than turn me "into a pin cushion," she called another nurse to come in and give it a try. Boom, another vein blown. This nurse decided to try a second time, using the same vein Erika had tried, but from several inches further up. Boom. (Sixteen days later, the bruise from that double stick has yet to fully dissipate.) They then called in a nurse with 42 (yes, *42*) years of experience, and she was able to get a line in near my thumb on the first try. (It did jam up later, but Erika was able to flush it.)
Meanwhile, the monitors showed that the baby was fine, and I was having fairly strong contractions on a regular basis.
I can't remember what time the obstetrical resident came in to perform the ultrasound and measure the amniotic fluid, but it was probably around noon. She confirmed that the baby was frank breech (butt down, in pike position), and she reported that the amniotic fluid index was 55. I have no idea what the scale is or where 55 falls, but from her tone and expression, we surmised that she agreed with Dr. Beshara that there wasn't enough fluid to attempt a version. She said she'd report the index to Dr. Chen.
While we waited for Dr. Chen to come back, the anesthesia resident came in to talk to me and take my history. I mentioned that I was one of those people who needed three shots of novocain (or whatever cain it is that dentists use) to get numb... and then I'd be numb all day. My numbness threshold just seemed to be higher than the average person's. I also mentioned that it always puzzled the dentist that my lip wouldn't get numb on the first or second try. I gave my height and weight, answered a bunch more questions about my medical history, and signed more consent forms.
Dr. Chen finally came in and asked us if we wanted to attempt the version. We were surprised that it was still an option in his mind. We said that we didn't think we wanted to bother, since we didn't have any faith that it would actually work. Al again mentioned odds, and since Dr. Chen didn't seem to have any good ones to offer, we decided that we'd skip the version for sure. We'd be going for the C-section in about an hour, as soon as the OR opened up.
At this point it was about 1:30 or 2pm, and Al, despite the turkey jerky, was starving. (So was I, but I couldn't eat any of the foods on my now quite lengthy list of cravings.) I asked somebody (I can't remember whom) if he had time to go get something to eat, and whoever it was said yes. He ran out to the lunch carts outside... and within about 10 minutes, Erika came back to take me to the OR "so they can place your spinal." I said I thought I was getting an epidural. She said she could swear the anesthesiologists had said something about a spinal, but she might be wrong. I called Al on his cell and told him that I was going to the OR but not to worry; he should come back to the room, eat his lunch, and change into the outfit they were leaving for him, and that somebody would come get him when I was all prepped.
When I got to the OR, it was FREEZING. Yikes freezing. Erika got me a blanket straight from the warming oven, which took the chill off for about five minutes before I started shivering again. Meanwhile, I found that Erika had been right about the spinal: the attending anesthesiologist had decided that since this was my first pregnancy and the surgery was likely to go quickly, a spinal made more sense. So I assumed the position (hunched over, hands in lap) while they placed the local. For some reason it made me light-headed, so I asked if I could put my head on Erika's shoulder. She said sure. Next the spinal needle went in, and then they laid me back on the table and waited for it to take effect.
It did, but strangely—just like the 'cain at the dentist. One leg—but not the other—went completely numb. The attending tilted the table. Finally the other leg started to get numb. Meanwhile, Erika shaved my abdomen. "Can you feel this?" she asked. Me: "Yep." The attending kept testing me with alcohol-soaked cotton balls swabbed along my ribs, chest, and arms: "Does this feel cold? Does this? Does this?" The answer was always yes. After about 10 minutes, he finally admitted defeat and decided to place an epidural. "You've got a great block for rectal surgery, but abdominal surgery would probably be pretty painful at this point." The resident leaned over and said, "you told me this would happen." Me: "Yes, I did."
So anyway, they propped me up, slumped me into the position, and placed the epidural (again, with two shots). By this time, my teeth were chattering. Once again I was laid back on the table, tilted this way and that, and swabbed with alcohol. Finally, I got numb enough for the surgery to start. The resident injected some painkillers into my IV bag, noticed that I was shaking and chattering, and got me a plastic drape that was hooked up to something like a hair dryer to warm my shoulders. Al came in, and all systems were go.
The Gory Details, Part 4: Austen and Aftermath
From the point when Al entered the operating room until I finally got to hold Austen is kind of a blur. I remember specific things, but there are huge gaps as well. Al has helped me figure out the timeline and flesh out some of the details; here's what we've pieced together (most times approximate):
3:20pm ~ Al arrives in the OR. My arms are spread out on tables or boards on either side of me, kind of like I'm being crucified. I am shivering really badly now; I have a choice between my teeth chattering or my arms shaking—I'm unable to control both at once. I remember chatting with Al for a few minutes between the chattering teeth, but I don't remember what we talked about. The resident anesthesiologist hangs the drape in front of my face and says, "don't worry, we'll tell you what's going on." Me: "Please don't." Attending anesthesiologist: "See? That's normal. It's the people who DO want to know who aren't normal."
3:25pm ~ The surgery begins. I'm still shaking like a madwoman, despite the plastic bag + hairdryer contraption. I think I'm also still talking to Al occasionally; I make him promise not to look over the drape. I hear someone say, "you might want to put some Epi in that bag."
3:36pm ~ I hear Austen cry for the first time, and I remember seeing him. (Al tells me that they held him up; I only remember magically being able to see him, not how.) My only coherent thought before I break down in hysterical tears: "That's the pinkest baby I've ever seen."
3:40pm ~ I continue crying, and so does Austen. Al holds back the drape a bit so I can see the huddle of pediatricians rubbing and suctioning our son.
3:45pm ~ I hear someone announce Austen's weight: 7 lbs. 2 oz., exactly as I predicted. I ask about his length, and someone (I think Al) tells me that they'll measure him in the nursery. The gaggle of pediatricians is taking Austen to the NICU because he's breathing funny even after all the suctioning. I think, "he must be fine, or he wouldn't be so pink."
3:50pm ~ Al brings a swaddled Austen over so I can see him before handing him back to one of the pediatricians. I overhear her say, in response to a query from Al, that he'll probably be kept in the NICU for 5-6 hours... or as long as two days. TWO DAYS??? When am I going to be able to feed him?
Al's dilemma of whether to go with the baby to the nursery (as friends and baby books suggested) or to stay with me (as he wanted to do) is resolved when Austen is whisked off to the NICU: he has to stay with me.
4:10pm ~ The surgery, which had continued through all the crying, is now complete. The drape is removed, and near my feet I see a stand on which hangs what looks like one of those clear plastic shoe organizers you'd hang on your closet door. Instead of shoes, however, each compartment holds several blood-soaked rags. I'd be horrified at the quantity of blood if I weren't so cold, tired, and overwhelmed by recent events.
The resident OB, Dr. Lee (who's about half my size), stands on my left side, and Erika and another nurse stand on my right. I'm told to cross my shaking arms over my chest so they can move me from the operating table to a gurney. I'm tipped sideways, and I reflexively flail and grab the nearest pole (the one that was holding up the drape, I think). Dr. Lee pries my fingers off the pole and says, "Don't worry, I haven't dropped anyone yet." I look at her dubiously.
4:15pm ~ We arrive back in our labor and delivery room. The resident anesthesiologist slides a thermometer under my tongue, checks the reading, and says, "it has to go UNDER your tongue." I mumble, "ih ith" around the thermometer. He pulls it out, reinserts it, waits a second, and checks the reading again. "Is it broken?" says a female voice to my right. "I don't know," says the anesthesiologist. "It says 95.4." Female voice: "Well, she is shivering..." Just then someone else announces my blood pressure: 85 over 49. I think vaguely, "and that's with the Epi in the bag." Erika and Jen (the nurse who taught the Wednesday childbirth class) cover me with about 10 blankets.
5:20pm ~ Al calls his parents to tell them about the birth. Erika tells me that I won't be going to the post-partum unit on Silverstein 8; instead, I'll be going to Silverstein 9, to be with the other moms whose babies are in the NICU.
5:50pm ~ My pain level, which had been at a manageable 5, starts spiking to 7, then 8, then 9. I ask Al to ring for the nurse, who calls in a doctor.
6:00pm ~ The doctor arrives. The pain is at 11, and I'm sobbing and shrieking. Even though I know the crying makes the pain worse, I can't stop. The doctor starts asking questions, like "where do you live?" and "what's your last name?" I point to Al, who answers for me. The doctor says, "no, I need you to answer me yourself. What day is is it?" "Tuesday," I gasp. "Where are you?" "Ha..ha..HOSPITAL," I manage. The doctor orders Dilotted (sp?) to be administered through my IV.
6:30pm ~ I'm asked to wiggle my toes. I send the command very clearly from my brain to my toes, but nothing happens. The epidural is obviously wearing off, but the spinal isn't. (Again, just like I told the resident.) Al calls the NICU to see if he's allowed to visit Austen. He's told that Austen has been moved to the Well Baby Nursery.
7:00pm ~ I feel the pain start to spike again. 7...8... I ask Al to go flag the doctor down himself. 9...10... There's some discussion about whether to give me Dilotted or Torredol. The concern is that Torredol can aggravate bleeding. Another dose of Dilotted is administered.
7:10pm ~ The Dilotted is working, and the nurses ask me to wiggle my toes again. Nothing doing. I feel hot now, so I ask Al to remove most of the blankets.
7:30pm ~ Here we go again. 7...8...9... Torredol it is.
7:45pm ~ I think I can feel my left knee. I can't actually move it, but I feel like if my lower leg weren't a giant block of cement, I would be able to wiggle the knee. Al goes to visit Austen in the nursery.
8:00pm ~ I can feel the toes on my left foot, and I can lift my left knee. I think I can also feel my right knee. The Torredol is still working.
8:20pm ~ I can now wiggle the toes of both feet, and the Torredol is still working. Yay! Erika tells me that they're going to move me to Silverstein 8 after all. I call Al's cell phone to tell him that I'm going to be moved in a few minutes, so he needs to come down and collect our backpacks and my clothes from the labor and delivery room. He's holding Austen and doesn't want to give him up.
8:30pm ~ I arrive in room 813 of the post-partum unit. The IV that was placed hours ago is clogged, and the line can't be cleared. The nurse tries to place another one, and we do the blown vein dance again. I now have bruises on both arms, at the base of my right thumb, and on the back of my right hand. A line is finally opened just below my right wristbone.
8:45pm ~ Austen is wheeled in, and I'm allowed to breastfeed him, finally. I'm told that he was cup-fed some formula in the nursery "or else he would have brought the walls down with his screaming," according to the nurse. This makes me a little sad, but I'd rather have him be fed formula than starve. Anyway, I've got him now, and all is right with the world.
Here ends The Gory Details; at some point in the future I might blog about the four days Al, Austen, and I spent in the hospital recovering from the C-section and getting to know each other, but I'd rather not dwell on them now. Instead I'll just thank the nurses who cared for us during our stay, especially Sara, who taught me how to breastfeed and got me out of bed without hurting me too much; Trish, who made me a little bundled blanket (henceforce known as the egg roll) to hold against my incision so I could get to the bathroom and back without crying, and who sat with us for about an hour answering all our questions about baby care; Karen, the traveling nurse who spent her last day at HUP with us, helping me manage my pain and just generally being really cool; and Patty, who entertained Austen in the nursery for a few hours each night so we could get some sleep. All four listened as well as they handed out advice, comfort, and medicine, which set them apart from all the rest. Thanks, guys!