More Delivery Notes
I believe that I left off as we were leaving for the hospital.
I had already put the various items that I could quickly gather into an overnight bag including what looked like Sarah’s clothes and the dragonfly patterned bag holding Madeline’s smallest infant outfits for going home. I went out alone into the rain to move the car closer to the doorway and drop off the overnight bags Although it was about 3:30 AM and I was happy to see that I hadn’t gotten a parking ticket since they normally drop the $30 tickets on your car at about three. As I walked towards the car a stroke of lightning came down and I thought about how bizarre and tragic it would be if I were to be struck by lightning as I went to prepare the car for Madeline’s birth at the hospital.
We managed to dress Sarah in a pair of my pajama bottoms and my blue Ralph Lauren cotton robe. She had a blanket draped over her back because she was shifting between hot and cold. I thought about taking her picture because she looked very regal in this outfit but decided to keep the camera in my pocket to prioritize the work of getting to the hospital and delivering Madeline. The walk down to the car with Sarah and Joyce was slow because Sarah needed to stop each time she had a contraction. We had to go through four contractions stopping at each level on the stairwell to break for the contraction. I led Sarah holding her hands as I walked backwards down the stairs to make sure that she didn’t fall.
In order to drive over to the hospital from St. Paul Street it is only about a half mile and I took Aspinwall to Brookline Avenue. The route was unfortunately very slow because I kept hitting red lights. Sarah was facing towards the back of the car with her butt facing to the dashboard. I spent a few moments struggling to get my seatbelt on. The worst light was the left turn onto Brookline Avenue because while there was no traffic the light just hung on red for over two minutes. Joyce was in her car behind me and she was probably wondering whether I would run the light but I waited it out only to get to the next two red lights.
When we arrived at Beth Israel I parked the car in front and Joyce acted as doula and valet for me. I took Sarah through to the 10th floor where the deliveries occur. When we got to the 10th floor in the elevator Sarah had a double peak contraction so she couldn’t leave the elevator when it was time to go. I was stretched thin holder her hand with one side of me and holding the “OPEN” button on the elevator with the other hand. When Sarah finally made it out of the elevator she walked the five feet to the admitting desk. While the woman was making-up the official bracelets Sarah was by the desk leaning forwards. From the hospital’s perspective we were a few hours late since we had called near midnight and were arriving at 4:30 AM. The nurse came out of the doors for the ward to walk Sarah to a room but it took two contractions before Sarah was ready to leave her position of leaning over the desk. In that time Joyce had managed to get through security to come upstairs.
When we got to the delivery room the nurse immediately went into hospital procedure mode and this was less than enjoyable for Sarah who had been in labor for 8 hours already. The nurse wanted Sarah to go to the bathroom and produce a urine sample and then get right onto the table for an internal exam and to get connected to the external fetal monitors. Sarah managed through some internal strength and some grumbling about the nurse to generate the sample and move onto the table. The nurse also gave us some trouble about how because Sarah is Strep B positive and they needed to provide 4 hours of antibiotics intravenously that they weren’t going to have time before the baby was born to pump her with the antibiotics so Madeline would need to get more antibiotics later.
When the nurse examined Sarah she said that the water hadn’t broken yet but Sarah’s cervix was dilated to 9.5 cm. We were then given the option once the obstetrician on call came in to have the artificial rupture of the water done. Sarah wanted to think about it and the nurse was being a little too pushy for my taste. In general our natural childbirth classes had a ringing on our ears about every intervention leads to another so we were worried it might cause things to get harder rather than easier. But Sarah was starting to get tired and because we were taking a long time to decide the nurse gave us some high pressure trick by saying that she was going to walk outside and when we were ready to move things along that we could call her back in to have the procedure done. So with some agreement from Joyce we buzzed the nurse back in and had the doctor break the water.
The idea was that after the water broke that the cervix would quickly dilate to 10 cm and Sarah could begin pushing. So after the water broke the OB did an internal exam and saw that the cervix had receded a bit from 9.5 cm to a little less. Apparently the amniotic fluid can open the cervix wider and when the water breaks the cervix can contract. The internal exams do come at a price and the price is that Sarah’s contractions increased and became longer and more powerful. That was one of the reasons she didn’t have an internal exam until nearly 4 in the morning. Joyce had gotten out her special sterile glove more than three times and every time Sarah didn’t appear to be in a position to get the internal exam.
Sarah was very close to delivering Madeline but she couldn’t seem to get past the last bit of dilation. Joyce had Sarah change positions a few times and it wasn’t trivial with the wires all hooked-up to Sarah. The external fetal monitor is the main focus of the folks in the hospital because it is the big liability monitor. If the baby heart rate starts to drop below 70 regularly they come rushing in with all knives drawn for an instant C section. To monitor the baby the external fetal monitor needs to be in the right spot so when Sarah was on her hands and knees the fetal monitor wouldn’t properly pick-up the rate. Joyce had tested the heart rate five times during the evening and each time it was a strong 140, right where it should be. So Joyce was trying to hold the monitor in the right place but the nurse kept coming into the room. The OB tested again to find the cervix wasn’t going anywhere and the nurse became quite interested in placing an internal fetal monitor onto Sarah. This could also have been a result of the nurse trying to reposition the monitor on Sarah after they had gotten the buzz that the baby heart may have stopped. Sarah’s response to this was to tell her to stop F’ing with the monitor. At some point Joyce gave Sarah some natural remedy that looked like pop rocks and contained something to help her to get through the labor. I can’t even recall if it was before the baby was born or after.
So the OB made the decision during the exam to spread out the last bit of Sarah’s cervix using her hands. Madeline pushed through that bit and Sarah was ready to push. The nurse had been annoying also at this point because she made a smarmy remark to Sarah something to the tune of “wouldn’t you rather do something useful like pushing than just going through those contractions and getting nothing done?”. It made it seem like the contractions weren’t useful in the first place so I was pretty fed-up with the nurse but we were moving forwards once the OB got Sarah’s cervix out of the way and Sarah was on to pushing.
The pushing was fast and the nurse redeemed herself a bit because the OB left for the pushing and let the nurse bark out commands for how to push the baby out. The main order from her was for Sarah to hold her breath as she pushed and force the baby up. I could see the head even when the OB was futzing around and it looked like a slimy patch of alien turf. The top of her head reminded me a bit of the spinach artichoke dip from California Pizza Kitchen. It wasn’t clear where the part of the head that looks like a human would arrive but with each push the bulge of hair and skull would press forward a few centimeters and then recede back inside of Sarah. As Sarah became within a few pushes the nurse looked at Sarah and decided that she was starting to get tired. It wasn’t clear why she did it but the nurse gave Sarah some Pitosin to help get through that last surge of pushing to get the baby out. Sarah consented to it although with any intervention I wasn’t sure if it was needed or helpful. Right after the Pitosin came in the nurse told Sarah to just pant for a bit and then paged the OB to come into the room for the catching.
When the OB arrived again they wheeled over a cart that had been sitting in the corner of the room. I had imagined that the cart was filled with the various knives for a C-section. The cart was actually filled with the “Vaginal delivery kit”. The OB now was wearing a mask with a face screen for either sterile purposes or to avoid blood splatters. She also had an orange splatter proof plastic bag jacket. The OB used what looked like an iodine paintbrush to cover the area where Madeline was going to come out. They then gave Sarah the command to make the final few pushes.
So with no understanding on my end of where the head was coming out and holding Sarah’s right leg up to help her to get the baby out I had a great angle to see what I must admit is one of the most incredible things I have ever seen or may ever see. From inside of Sarah and pointing sideways with a sudden release from having crowned was a plastic looking but very real human face turning and pointed right at me. Her face was surreal to look at because it was moving but was so much like a dolls face. For a moment the face just rested outside alone and not appearing to be connected to a full human body. She was just a head turning and struggling to begin life. Then from within Sarah a single arm reached out so that an arm and face were clearly in view. Finally the rest of Madeline’s body quickly slid into the arms of the OB and she held up my beautiful daughter.
Madeline’s eyes quickly opened and she was suctioned. Lots of events happened fast that are difficult to remember but the OB handed me that crooked scissors to cut the clamped cord. Madeline’s head was long and cone shaped from the birth and her face looked elongated as well to the look of an elf. She also reminded me of the aliens from the alternative ending to Scary Movie 3 with their wide eyes and stout physiques. They placed her onto Sarah to hold her briefly and Sarah was wide awake and ecstatic that the labor was over and that she could see and feel her baby. I had pulled my camera out of my pocket at this point and asked permission to take photographs. Joyce had placed a warm washcloth on Sarah’s head that she had been heating below in what looked like a pressure cooker connected to the same socket that the doctors connected to their mycomeum suctioning system.
Sarah had a tear of joy in her eye as she looked at Madeline. I could see she was in love with her daughter and I too got teary eyed to see the two women that I love together for the first time.
When they removed her from Sarah it was to take Madeline to the warmer. Madeline wasn’t having the easiest time breathing. She was taking deep breaths and looked like she was hyperventilating. The yellow jacket NICU folks moved me over to see her at the warmer and surrendered the oxygen flow to hold over her mouth so that she could get some heavy breaths of high oxygen content. Madeline was like a climber on top of Everest at this point getting oxygen to make it to the very peak and return to earth. As her lungs filled with the oxygen her breathing became more regular. Sarah and I were very tired but wired with adrenaline and pride. We wanted to spend the day with our newborn child. The NICU wanted to put an IV into Madeline to deliver antibiotics for 2 days and the OB found Sarah had a fever so Sarah got more antibiotics. While I had been watching the fan fare with Madeline Sarah had delivered the placenta. I took a look at it and noticed it looked like someone had grown a giant tomato with too much miracle grow and then let it get old and soft and turned it into the mushy canned tomatoes you use to make spaghetti sauce.
Sarah and I went upstairs to the post-partum room. Our room was gigantic compared to what we were expecting. Many people claimed we had the best room in the post-partum ward so we didn’t want to complain. They had already brought Sarah a breakfast of a crappy omelet and cubic home fries. It wasn’t very inspiring and Sarah wasn’t hungry so I at most of it. We slept for thirty minutes and then spent the bulk of the rest of the day in a daze with family members and Madeline for her first day in the world.
