Who knows what to expect? Part 2 - The Necesarean

After the BPP, things began moving. My nurse came back into the room and announced, "I was right! You're being admitted and we're going to deliver the baby." She had prepared us for this possibility earlier, when Bob and I had still thought that it was likely that we'd just be monitored for a while and then go home. Of course, after the baby completely failed the BPP I knew that it was time for him to be evicted. During the time we'd spent monitored at the hospital, the contractions I'd been having started becoming more regular and distinct, although they were still not that strong. His reaction to the contractions also became more obvious. I heard the resident doctor and nurses discussing the fetal heart rate strip in preparation for calling my own doctor, and I was surprised to hear them using terms like "some late decels, little to no variability, no accelerations." There are different kinds of deceleration patterns, some worse than others, and I knew enough about fetal heart rate monitoring to know that this terminology meant that the fetal heart rate pattern was worse than I'd thought.

The resident doctor called my doctor, Dr. D, while she was in my room and while they were finishing up my admissions paperwork. I was surprised that after she'd spoken to him for a while, she handed the phone to me and said "He'd like to talk to you himself." He asked me what had brought me into the hospital so he could hear what had been happening in my own words, and he talked about the test results from the heart rate monitoring and the BPP, and why he thought it was best to go straight to a cesarean. I was in complete agreement with that, though I'd never have predicted before hand that the word "cesarean" would be a relief to me. I wanted to know my baby was safe, and I didn't see how he could tolerate stronger contractions when he couldn't handle weak pre-labor ones. I handed the phone back to the resident so the doctor could give his orders, and I started getting prepped for the section.

I absolutely thought this section was the right choice, medically, but I was completely terrified. I was worried about the baby's safety, but I was also worried about the section itself. I'd never had significant surgery, and since I'd had four natural deliveries I'd never even had an epidural. I wasn't sure what to expect from the experience itself, it was totally different from what we'd done before and what I'd been preparing for.  While they weren't wasting time, it was also not a desperately urgent section. Baby continued to be monitored while we prepared for the section. I talked to the resident doctor, the anesthesiologist, and signed the necessary paperwork. The nurses tried to keep the mood as light as possible to be reassuring. We joked about how good Bob looked in the blue surgical scrubs, and lamented the fact that the camera was out in the car, we hadn't expected to meet baby that night. My OB arrived, and I was never more grateful for his sense of humor. The first thing he said was, "See what happens when you choose an OB for prenatal care? You have all kinds of complications."

Still, by the time we got to the OR I was terrified. The nurses and anesthesiologist were wonderful, but it was still very difficult for me to relax. The idea that I'd be able to feel what was being done, but it just wouldn't hurt, was very scary. I finally began to relax some and was able to chat with the anesthesiologist and the nurse once I was pretty sure they'd begun the surgery, and I hadn't felt any pain. When the doctor ruptured the amniotic sac, he noted that there was a lot of meconium, another sign that baby had been significantly stressed in utero. They suctioned out his mouth and nose before he was even all the way out, then unwrapped and cut the cord (it was wrapped around his neck and shoulder twice) and handed him to the nurses. He shocked everyone by making his first weak cry on the way over to the warmer. They'd been prepared for a medically compromised baby, but he really did quite well. Bob tells me that he was purple and limp when he was born, but he began to breathe on his own right away and soon began to pink up and regain his muscle tone. I was so happy I was practically crying as I watched them examine him in the warmer. His wiggles and stretches were all the more precious because they'd been absent for the last several hours before he was born. Soon the NICU pediatrician attending the delivery said that he was obviously not needed here, they quickly weighed and measured the baby, and he was brought over to be with me while we waited for them to finish the closure of the incision. Everyone thought he was beautiful, of course, and there was much discussion about whether or not he had red hair.

After the section, Dr. D told me, "Your tubes and ovaries look great, and the incision is a low transverse one. You should be good for four or five more vaginal deliveries with no problem." Bob appreciated this, but I don't think we'll take him up on his suggestion. We joked that I'd "gone over to the dark side," since I'd had a completely medicalized delivery after four natural, low intervention ones. The dark side seems to have cute babies.

When we got back to the same labor-delivery-recovery room that I'd been monitored in, they unwrapped baby and we got the skin-to-skin cuddle and breastfeeding time that we'd missed out on right after the delivery. I got some juice and crackers to snack on. Bob fell asleep.  Overall, the experience was far, far better than I had thought a surgical birth would be, and luckily the recovery has also been easy so far. I hope that stays true. In any case, I have a beautiful healthy baby.

Here's a gratuitous cute baby pic -- Julian at two and a half days old, ready to go home.

Who knows what to expect? AKA Birth Story - part 1

Sunday was a day of waiting and anticipation. It was two days past my due date, and I was hoping that it would end up being The Day. My doctor was on call during the weekend, but was going to be off most of Monday, and I was afraid I'd end up delivering during the one day he wouldn't be available. Bob had been predicting a birth date of the 18th, which would be Monday, for some time, so that just encouraged me to hope for baby on Sunday. Saturday evening I'd had a good string of contractions about eight minutes apart, but they stopped once I went to bed.

I was encouraged Sunday morning by a couple episodes of bloody show. That meant labor couldn't be too far away, but it certainly didn't promise that it would happen the same day. Unfortunately, the rest of Sunday was disappointing. Despite walking around at Target to encourage things, overall the day was quiet. I seemed to be having less frequent pre-labor contractions than I'd been having. Around four in the afternoon, I noted to Bob that the baby had seemed quiet all day. He hadn't been active during my nap like he usually was. I just assumed that I'd been focusing so much on the absence or presence of contractions that I hadn't noticed his movements as much as usual. I figured I'd lie down later and he'd be moving just fine, but right then I had things to take care of. In retrospect, I wish I'd taken the time right then to lie down, drink a cold sweet drink and count his movements. Instead, I fixed dinner, did household chores, and stayed busy until bedtime. At that point, I remembered that baby had been quiet, and after thinking about it, I actually couldn't recall when I had last felt a distinct, strong kick from him.

I was a bit worried, but not too much. I lay down, and tried to stir him up a bit. Usually, if you would push on him a bit, he'd poke back, or move away, but definitely be responsive in some way. Both Bob and I had enjoyed "playing with him" this way in the past, and it was pretty reliable. Sunday night I couldn't wake him up. When I pushed on him, there was no pushing back, no moving away, no resistance. It just didn't feel right to me at all, especially combined with the thought that he'd been quieter all day. I desperately tried to remember when I'd last felt him move, and all I could come up with for sure is that he'd been very active after I'd gone to bed the night before. I thought that he had made some small movements throughout the day, but I couldn't be sure, and that terrified me. I went and drank a Dr. Pepper to hopefully wake him up, and I called the doctor's office nurse helpline, but I was pretty panicky at that point. I went ahead and called my mom to come up and watch the other kids so we could go get checked out. I was supposed to wait 30 minutes after drinking the cold, sweet drink to go in, but I knew I needed to go in for my peace of mind, regardless. I wasn't sure whether I was being reasonable, or was being unnecessarily paranoid, or if I'd already messed up by not going in earlier.

On the way to the hospital, I felt one soft movement that I was pretty sure was Julian. After we checked in, I felt one more brief movement. At that point, I figured that I just hadn't waited long enough for the soda to kick in, and we'd find out that he was fine. Still, I think the sound of his heartbeat when the nurse first found it was an amazing relief. They wanted more than a brief listen, so I assumed we'd be monitored for an hour or so, find out he was fine, then get to go home. It didn't turn out that way.

It wasn't long before I noticed the first deceleration -- or slowing down -- of his heart beat. It was noticeable just from listening, I couldn't see the EFM strip from where I was. The pressure sensor for the monitor wasn't in a good position, after a while they moved it so that it would pick up the small, prelabor contractions I was having. It became clear to them (I could already tell) that the decels were definitely related in time to the contractions. While I heard the decels, I wasn't aware of something that is actually more significant: he wasn't having any accelerations in his heart beat. This lack of reactivity is a significant sign that baby may not be tolerating the uterine environment. The doctor ordered a biophysical profile, which is an ultrasound that looks at particular measures of baby's well being, to find out what was going on.

When the ultrasound tech arrived to do the biophysical profile, I was well aware of what to expect. I'd already had a couple BPPs this pregnancy, because the doctor had wanted extra monitoring of the baby due to my exposure to fifths disease, which can rarely cause problems with the baby. In those BPPs, the whole thing was over fairly quickly, as the necessary movements were noted quickly. The BPP Sunday night was different. The ultrasound tech took the measurements to estimate baby's size, and measured the amniotic fluid index, then tried to meet the other criteria. She was looking for body movements, extension and flexion indicating good muscle tone and practice breathing motions. She had to note the presence or absence of these movements over a thirty minute time period. As I noted before, with my previous BPPs, all the movements were noted quickly, and the whole procedure took 15 minutes or less. This time, we spent most of the thirty minutes watching a perfectly still baby on the monitor. Poking, prodding, shaking, speaking to him, etc. did not elicit any kind of response whatsoever. The tech kept asking if I was feeling any movements, she didn't want to miss recording something. I wasn't feeling anything. She'd periodically check his heart rate again, which did provide some reassurance. Still, the ultrasound made it clear that something was very wrong with the baby. It was not easy to watch.

Julian Pictures!

Here are some pictures. They aren't perfect, but they'll do. We just ordered a CD of the pics they took here in the hospital, and we'll post those when we get a chance.

 Julian's a grumpus.

 This pic looks a lot like his daddy's baby pics.

 The older kids enjoying their baby brother. Verity is not in the picture since she's busy climbing the walls.

 Julian was mimicking Pauly's facial expressions, and cracked all the kids up.

This last pic, Verity had asked to hold the baby and Grandma helped her out. She held him about 30 seconds, then screamed "No, I don't WANT the baby!" and pushed him away. Thank goodness grandma was right there to help Julian.

Eggs

Roger made himself lunch today. I was mean and would not let him have cold cereal because he'd already wasted nearly a whole bowl when he didn't finish it at breakfast, so he decided to make himself some scrambled eggs. Four, to be precise. I warned him, "You'd better eat everything you fix."

When he got up from the table to go play I asked him, "Did you eat all the eggs?" "No!!" he exclaimed. "Why not?" I ask. "There were a whole lot of them and I was full!!" I looked at his plate and saw that it was empty. "What did you do with them, did you throw them away?" "No!!" "Then what happened to them?" "I was full, I couldn't eat them!"

Finally, I figure out that he thinks I meant all the eggs in the fridge when I asked him if he'd eaten all the eggs. The whole time I was thinking, "What the heck happened to those eggs, then?" and he was likely thinking, "Is mom nuts??"

Two and a half weeks left

until my due date. Things are now going swimmingly with the pregnancy. All of the various issues I'd been concerned about have cleared up and things are going along normally now. Hopefully it will stay that way through the delivery!

Are we ready? Not in the slightest. I haven't gotten the infant seat from out of storage at my parents' house, haven't washed and organized the baby's clothes, and in fact don't even have drawers or a box or anything to put the cleaned and organized clothes into, and don't have a place for such drawers even if we had one. We haven't gotten the cradle out and put it back together (and I'm not sure where the cradle's sheets are!), or packed a hospital bag, or collected phone numbers together so we can call people after the birth (my address book has met a sad an untimely end). The house is still a pig sty, no meals in the freezer, I'm sure I could list more things that are undone. The child has no socks at all, but does have a fedora waiting for him. Don't you love our priorities?

In other news, the boxes containing all our homeschooling materials for next year are now in the state, and will be delivered tomorrow! Ten to one those things will be gone through, organized, and carefully put away before I even think about the baby things.

Should we trust birth?

"Trust birth" is a phrase that I've commonly heard among those in the natural or home birth advocacy movement. There are even Trust Birth groups springing up advocating this. Such groups may state that trusting birth is natural, and fearing or distrusting birth is unnatural and has simply been taught through our culture. Is this correct? Fear of childbirth has in fact been common throughout history, in all times and cultures. Why? Because while birth is a natural process, it is also naturally a dangerous process. Childbirth in humans is an evolutionary bottle neck, where the advantageous feature of large, well developed brains conflicts with the advantageous feature of narrow pelvises, to aid bipedalism. It is also a complex process, to which no other natural process can be an adequate comparison. Pregnancy itself precariously balances the needs and health of the fetus against the needs and health of the mother. The result is historically high rates of both perinatal (around the time of birth) mortality for the babies involved and maternal mortality. This has the evolutionary purpose of keeping head and pelvis size in check, yet as a human event each loss represents a tragedy. We are not willing to accept the death of a human being as simply "evolution in action."

Improved sanitation and nutrition and modern medicine -- including antibiotics, safer cesarean sections, improved ability to monitor the health of mom and baby during pregnancy and childbirth, and developments in neonatal resuscitation and life support, among many others -- have dramatically decreased the perinatal and maternal mortality rates, although attempts to further reduce it are constantly being made. We now take these improvements in mortality rates for granted. We assume that mother and child will come through birth and be fine. Ironically, it is these very improvements that allow us to assume that birth is low risk and worthy of trust.

If we cannot trust birth, should we then fear birth? Are all interventions good and necessary, with no harmful side effects? Is the best response to make birth a completely medicalized event, attempting to remove all uncertainty? This position forgets that birth, as a natural physiological process, is not fully understood by science. We know of what can go wrong, but still often do not know why it goes wrong. We don't fully understand the purposes of the natural physiology of birth -- we can't know for certain what elements in the process of birth serve a purpose in the health of the mother and child, and we don't always know the long term effects of medical interventions.

I propose the best attitude of a birth attendant is not "trust birth," nor is it "fear birth," but rather is "respect birth." That is, respect birth both as a natural physiological process which goes well much of the time, AND respect birth as a complex event with inherent and natural risks. Birth attendants need both to allow labor and birth to unfold, and to exercise vigilance and intervene when deviations from normal begin to put mother and child at risk. This balance isn't easy, it likely takes significant training both in normal births and potential complications. It means accepting and responding to the scientific evidence on birth practices and interventions without prejudiced ideology. It means abandoning simple catch phrases or black and white positions and truly grappling with what we know, and what we don't know.

30 1/2 week update

Less than 10 weeks until my due date! Only 10 more weeks of stabbing pain when I walk, joy!

Mostly I am doing the same, feeling gigantic, getting plenty of "Is it twins?" comments, and being exhausted. I had another ultrasound yesterday, to verify that my previously low-lying placenta had moved up (it had) and to check on baby's growth, since I've been measuring big and have been getting increasingly bigger -- I'm now measuring 5 cm ahead. I have never measured big this early, and it is definitely making me more uncomfortable. I'm already experiencing shortness of breath and I can't see how I'll have room to grow for 10 more weeks. The ultrasound showed a baby on the bigger side, but not gigantic. It also showed what my doctor called "a generous amount of amniotic fluid." In my understanding, this can be problematic but at this point we will just need to continue to monitor it, so I'll likely have another ultrasound in a few weeks. Baby is already head down and hopefully will stay that way. Here's some pics: