Thursday, January 20, 2011

Catching up - the graphic birth

In this blogisode we discuss the very graphic birth. I warned you!

I have been absent from the blagosphere [sic] lately as I was somewhat distracted with the birth of my son, Patrick Dylan Carr. Having recently gone through the frenetic and confusing dance that is childbirth, I thought that it might be timely to write down some of my thoughts. By its nature, I expect fully that there will be graphic things covered within these posts so if you are squeamish then be warned. As well I should note that I am not a doctor nor am I a lawyer - I try to cover the medical issues as best I can as a layperson. No guarantee is implied. :)

I'm probably going to sound like I'm casting stones here so I should pause and say that the nursing staff and doctors at PGRH/UHNBC were exceptional throughout. Our baby was born healthy and without complication. We were well served on many levels and if I sound a bit whiney in parts it's in the interest of being honest and transparent, not because we have the metaphoric axe to grind.

Prenatal classes teach you a number of things but one important lesson was the imporantance of creating a birth plan. This, basically, is a small list of things that are important to you during the birth. Ours, for example, covered things like "Carol doesn't want drugs offered to her but does want an epidural", "We would prefer that interns/students be used in an observing fashion only". We spent a lot of time crafting our birth plan and were relatively happy with it.

So we went to bed on Sunday, January 2nd fully expecting another week of trying to get the labour going. With January 9th as the due date that the medical community was using, this meant that we had until January 19th to be medically induced (due date + 10 days). Carol wanted to get things started but we were content to wait.

At about 2:30 AM on Monday, January 3rd, Carol woke me to tell me that her water had broken. I was somewhat skeptical as was personally expecting the mucus plug to shed but she was quite clear. "Seriously, there is way too much fluid for this to be anything but my water breaking" was followed by "omfg get me some towels already". Lesson to those who are expecting and aren't sure if you'll know: seriously, you'll know.

We packed up again for hospital along with many towels for the car seats, I picked up the now obligatory week pass for hospital parking, and we went into LDR. The LDR nurses were skeptical that Carol's water had broken - she wasn't showing any of the big signs of labour and it's more common for mucus plug to shed. They wanted us to collect some fluid to test to make sure that it wasn't urine as well. As Carol put it, she was passing more fluid than she could ever hold in her bladder, but the hospital folks are necessarily paranoid about false positives.

In short, her water had definitely broken and at that time the hospital gave us a pair of options:

(1) Go home and wait (up to 24 hours) until contractions were coming hard and 5 minutes apart.
(2) Stay in hospital and be bed ridden for remainder of labour.

Now, we both knew that Carol was Group B Strep positive for this kid (roughly it's 50/50 on each birth) so we knew that we needed antibiotics so sending us home wasn't entirely doable. Also, our birth plan never involved bed ridden labour. We had wanted to stay mobile as long as possible, use gravity to accelerate the labour, and so on. Neither of us was a particular fan of induced labours with interventions. If you're wondering why, basically this tends to result in more damage to mom's body, is less "natural" and generally speaking increases risk of heading towards a C-section delivery.

But, once you're into the delivery cycle you are to some extent at the mercy of the doctors and hospital staff. Carol and I elected to walk around LDR a couple laps to see if we could get labour started and very quickly the growing trail of fluid around LDR confirmed that we shouldn't be discharged from hospital. The doctors ordered IV antibiotics and from that point on pretty much kept Carol in bed. This was frustrating and I think if we had to do it again we would have gone with a midwife who could have overridden the doctors back to our birth plan. (That is one definite complaint I have and I can't think of a medical reason why they forced us down the path they did.)

At 6:30 AM (hour 4) the doctors started Carol on oxytocin which accelerates the labour. Briefly they cranked the dosage up again and again approx every half hour until Carol was on max dose by 9:30 AM (hour 7).

At 10:10 AM we met the doctor would would be delivering our baby and he did the first physical exam of Carol thus far. He confirmed that she was 4 cm dialated and baby was in LOT position. So for those who are expecting, note that we went almost eight hours before the first physical exam. I personally had expected within a couple minutes of being hospital them getting out the gloves and checking.

For those who don't know, a woman goes through approx 10 cm of dialation in labour and the scale is roughly exponential. That is, it takes far more effort/time to get from 1 cm to 4 cm than it does from 4 cm to 7 cm, and so on. As I recall there are four real stages - 1-4, 5-7, 8-9 and then 10. So almost 8 hours into labour with a very large dose of oxytocin, Carol was almost through the first stage.

I don't know if I can explain the environment well but I will try. In LDR (at PGRH/UHNBC) you move from an exam room to a labour room to a recovery room during your stay. We had been in the labour since about 4:50 AM.

There is a very fancy bed that the mom labours in which costs a LOT of money - nurses said it's comparible to purchasing an Escalade - which has all sorts of weird and whacky positioning equipment in it. For example, head part of bed articulates seperately from torso articules seperately from feet. Generally you want to have the head up, feet down, which means that gravity is helping the baby come down the canal.

The room has a nice bathroom which has an enormous whirlpool bathtub for mom's who are doing water deliveries. The bathroom is a bit odd in that it has no fan and has a vented door so they can quite easily hear everything from the main room. As you'd expect there are emergency pull ropes to call for help if you need it.

The labour room itself has a couple of different areas - the nurses have a charting area at the front with their gear, the bed is center of the room, far side of the room is for the family and includes a double bed on casters along with a fridge for family in the corner. There was a curtained section off to the side of the room which had all the sanitized delivery equipment.

When we first came into the room I had correctly sourced and laid out the vomit basins, filled up one with water/ice so I had cold compresses ready, and so on. This was pretty much the bulk of my contribution to the experience.

So when Carol went into this room I had the expectation that I would be having to put my mellow pants on, keep things calm and organized and help to move things forward. I was mentally envisioning an air traffic controller. I didn't really work out this way in practice. For one, I didn't personally anticipate how keyed up I was going to be feeling. From the moment we walked into the room I felt almost violently ill and for the next day I didn't consume any calories. After getting the basins organized I went into a routine of getting a large amount of water, pounding it back, peeing it out and repeating. Carol joked after the fact that I went to the washroom more than her - I figure I was going to washroom about every 20 minutes throughout labour. This seemed to keep my nausea under control but looking back was probably my OCB manifesting itself as it was about the only thing I had control of.

Carol, unexpectedly, was the air traffic controller. She spent almost the entire labour, except the "pushing part" at the end, with her eyes closed in bed. By the time the third nurse had come by and said (metaphorically) "Holy crap, is she awake? She's the quietest delivery ever", I knew it was going to be an unusual labour. No word of a lie, she sat in a hospital bed stretched out, feet down, eyes closed and didn't make a noise for hours. I tried occasionally to hold her hand which she didn't like ("don't touch me!") and pretty much force fed her water every hour-ish but otherwise she did her own thing.

If I have never said it publicly then let me say it now: my wife is an amazing woman with incredible pain tolerance and clearly stronger than I ever could be.

So after that first doctor exam at about 10:20 AM (hour 8-ish) the doctor came back and said something to the effect of "Wow, Carol, it looks like you're in pain. Would you like some drugs to help that?". This completely was against our birth plan and no surprises at this point Carol was willing to try anything if it would help. They then proceeded to inform us that the epidural she wanted was an hour and a half wait, but they could supply some lovely morphine in the meantime.

(As an aside, my dad was a junkie and I hate morphine. I have debated getting a Medic Alert bracelet saying "don't give me effing morphine". It's an ugly disgusting drug.)

At this point Carol decided she'd try the morphine as she needed something to take the edge off. For the record, we did discuss it privately and come to an agreement at the time, and for the record the decision to give her morphine was ultimately the right one, but for the wrong reasons.

When all was said and done it wasn't until 11:10 AM (hour 9-ish) that they administered the drug, and frankly it didn't really do squat for Carol. It made her dizzy, nauseous and didn't do much for the pain regardless. It did however buy us another hour where she was waiting rather than sitting in pain. She did re-iterate that she wanted the epidural.

At 11:45 AM our knight in shining armor arrived in the form of the hospital anesthesiologist who administered the epidural. I didn't want to see the needle so helped Carol instead. Basically they raised the whole bed up (it can articulate feet in the air, it's crazy), had her sling her feet over the side so they were flush on a chair, and then she leaned forward with her arms around me holding her weight. The doctor then got into the back of her spine, put in the block, and we were through it.

It was maybe a 5-10 minute process but the results were invaluable for Carol. Immediately she confessed that she felt better than she had for hours. Pain was almost gone and instead only pressure remained. We had many nurses come by and check her with various tests, i.e. pressure, temperature, at various sites on her body and all agreed that it was one of the best epidurals ever. Incredible work.

When the doctor came back on rounds at 12:15 PM (hour 10-ish) he checked Carol and quite to his surprise found that she had jumped up to 9 cm. Basically the epidural saved hours of labour as Carol's body relaxed from the pain and baby quickly moved through.

They didn't want her running off to the bathroom so stuck in a catheter at 1:30 PM (hour 11) and we moved into the final phase of labour - the pushing.

Now this is one area that they don't teach you in prenatal because basically they don't want you accidentally pushing before it's ready. Body needs to have that 10 cm to play with and hospital staff need to be ready. What the last phase involved was many different positions - all gravity enhanced positions - and having Carol push hard along with the contractions that were occurring. This was difficult for the nursing staff as Carol didn't really make any noise/indication that contractions were occurring but basically she took my hand and would squeeze as they'd come and I'd verbally indicate this to the staff. This worked for a long while up until the last 10-15 minutes where the nurse directly put a hand on her belly and could feel the contractions herself.

To set the mental stage and to pick a common position, you have your wife with her legs up like she's getting a pelvic exam. You have 4-5 nurses scurrying around the room, occassionally checking on things but basically staying ready, and a doctor plus his medical student sitting across the room watching the pelvic region change. Now I had decided that I didn't want to watch too directly but could hear them talking about the different changes - how things twist and split, and so on. When you watch TV you only hear "baby is crowning" but trust me there is far more before you get to that late stage.

As we got into the last 10-15 minutes, Carol quit believing that the baby was coming. Personally it was easy for me to tell when we were close because the doctors suddenly suited up and a ton of machinery came out of the woodwork. Now, I had expected the forceps, suction cups, scalpels, and so on but at one point there appeared to be more machinery than people. The Monty Python sketch about the woman "and the machine that goes ping" was scarily accurate and completely inappropriately cracked me up. Of course Carol was too distracted to notice but I was enjoying myself.

In the end we finished with our favorite nurse taking a leg and me taking the other one, and I must confess that it was impossible to not see some of the details. Baby's head starts to pop out at first - this weird gray looking thing which to me resembled whale blubbler. In our case baby got stuck with the first third of his head sticking out for a good couple minutes which would have been funny at any other time. There were about ten people at this point all yelling at Carol to push because she was so close but she really didn't believe us. I said at the time and I mean it seriously that a person should really have a mirror handy just in case as it would have helped this last bit.

Anyways, head popped out and baby kept moving along. All of the sudden it was a panicked "stop pushing, pant instead!" as the umblical cord had got twisted around baby's throat on the way out. With my heart in my mouth I watched the doctor physically manhandle my baby and wife to get the cord away. That was shocking and alarming to say the least. After this the rest came out quickly - shoulders, waist, feet. I'm no medical person so I'll use a rough metaphor and say that the "stuffing and giblets fell out of the turkey" after that. I noticed that my child, although clearly grey, had little chunks of poo smeared on him... like a raisin sized poo had rubbed on him on the way out. I assume this is because baby poos/pees in the womb during his development.

All of the sudden there were nurses with big towels rubbing him vigorously - think wet puppy after a rainstorm - and he went from grey to blue. He then made his initial scream to the world - two big yells - and from that point on was basically quiet for the next six hours. They kept rubbing and he went from blue to pink in good stead and was passed to mom.

I don't have the right words to express this but the look on Carol's face when the baby was passed to her for the first time... this wet mass of pink baby reaching to her with dilated eyes... made the whole experience worthwhile. She exploded into happy tears as did many of us in close proximity. There was a profound sense of relief as our happy mellow son was finally with us.

Now there was much more than happened after that - they slathered him with cream in the eye, they gave him a shot of vitamin K in the foot, they did the full APGAR workup on him http://en.wikipedia.org/wiki/Apgar_score where he scored a 9. He lost a point on APGAR because his skin didn't change back to full pink quickly enough which was partially due to the constriction on his windpipe during birth.

I remember standing with the nurse at the APGAR table trying to keep my hands in my pockets as I wasn't sure if I was able to touch him or not. When I asked she said "he's yours, of course", which seemed particularly poignant at the time. I elected not to have the first cuddle - he went to his mom for a good five minutes - but I got to carry him around the room while she got all stitched up.

Not to overstate it, but I didn't appreciate how long it takes to sew everything up and get all the fiddly bits out of the womb. That was a surprise to me. I'd say at least 15-20 minutes later they were still stitching up Carol.

The nurses saved the placenta so I could take pictures of it, which they strongly encouraged, because "it was heart shaped". It was a bit graphic for me but I do have pictures if any sick people ever want to see it.

There was so much more after this point, between the first change, first breastfeeding, first trip home and then the first trip back into the hospital a couple days later (those effing week parking passes!) but I think I'll cap the story there for today.

We were well served by the nurses, doctors and students. Everything was handled professionally and without major complication. If I have any objection it's that our plans didn't work out the way that we had wanted to, and I do believe that they would have had a midwife been involved. I do believe that Carol ended up with more stitches than required had the labour proceeded naturally. At the end of the day though we have a health child to show for it - Patrick Dylan Carr, born 2:41 PM, 21" and 7 lbs 13 oz.

1 comment:

Eric Martin said...

Lovely. Thanks for sharing this amazing expeience, Mike...