What a week (and a half) this has been!
Berta and I were sure that we were as ready as could be for Baby Adam's arrival - but the universe clearly doesn't enjoy being considered "predictable". What was a picture perfect pregnancy ended up being a tad less conventional at the very end.
Tuesday before last (January 26th) Roberta and I made the long drive to TMC. It was going to be the first of several visits to perform non-stress-tests on Baby Adam. I was thinking it quite an inconvenience since TMC is not exactly
close to the house - it was bad enough that at some point we were supposed to make that drive while Berta was in labor.
Well that turned out to not be a problem.
The non-stress-test itself is fairly simple and is standard practice when it comes to advanced-maternal-age-pregnancies. We arrived at the hospital, Roberta was admitted to the triage area and was given a quick ultrasound. The nurse struggled with it a little bit so she decided they'd try to get an ultrasound technician from Obstetrix to give Berta+Baby a once-over. We were then moved her to another room where she had monitors attached to her belly in order to keep track of Baby's heart rate. Roberta noted when the baby moved so that they could get a good idea of how his heart was doing when idle and when moving around.
Little Adam turned out to be just fine - no obvious undue stress on his system.
After a longer-than-expected wait we walked on over to Obstetrix and had the second ultrasound done.. and that's when the day started to diverge greatly from what we had previously envisioned. It turns out that the amniotic fluid levels in Berta's uterus were a bit on the low side - low enough that they decided to call her doctor to determine what to do next. It didn't take very long before the word came in - it was time to think about inducing labor.
We managed to hit TMC during an unseasonably busy time in the Labor & Delivery area. All the rooms were filled so we had to wait for a few hours before a room opened up. We walked over to go eat lunch at the cafe in the hospital (surprisingly good) and came back to find out that there was still no room in L&D. I took this time to run down the street to Fry's to pick up some bottled water, snacks and supplies. Roberta spent that same period of time in triage answering health questions she had already been asked at least twice earlier in the day. Oh, and she also got had her arm turned into a bloody mess while attempting to get an IV set up. (Don't worry - blood loss was minimal, it was just quite a bit for something as simple as an IV!)
Finally by mid-afternoon a room opened up and we were walked over to the room where we'd be having our little boy. TMC tries to keep their delivery rooms more comfortable than the standard hospital room - a private bathroom with a tub, slightly warmer colors, lighting that can easily be dimmed, a recliner, a bench seat that can be slept on (for us Dads) etc. The only real drawbacks were the ridiculously broken TV controls built into the bed, as well as the slightly obnoxious use of the bed's speakers when a Nurse was being paged. Still. it was rather more comfy than you might expect.
After a number of quite uncomfortable vaginal/cervical/pelvic exams we found out that it was going to be a long while before the actual induction could occur. Roberta wasn't dilated or effaced enough to start the induction process.. so they had to place a drug/hormone (cervadil) to help encourage further ripening - requiring a whopping 12 to 18 hours. Thus began the first of many nights in TMC.
As an aside.. I use the phrase "uncomfortable exams" to describe
my witnessing them, I'm fairly sure Berta would file them somewhat closer to the "Made me wish I was
dead" category.
That first night was about as comfortable as can be - for me at any rate. Thanks to the monitors and the IV Roberta was confined to bed, only able to get up and use the restroom when the nurse was around. That and the nurses checking in every 45 minutes or so! Still, we both managed some rest. I had one surreal moment when I realized that Adam's heartbeat (audible through the ultrasound monitor) was helping lull me to sleep. An odd reversal given that Berta's heartbeat had been his companion for nearly 10 months.
The next morning Roberta was provided with a light breakfast - the last thing she was going to be able to eat once induction began. Any other day I'd have considered it a perfectly good meal - but it seemed to be rather skimpy for someone that was going to be in labor at some point later in the day. Especially when you consider that women that go into labor naturally are encouraged to snack a bit before their contractions are close enough together to go to the hospital.
After breakfast Berta's doctor stopped by to determine how well the cervadil had done its job. Unfortunately it had managed to dilate her only a small amount. This led to Plan B - a medieval torture device known as the Cook Catheter. It consists of two balloons that are placed on either side of the cervix and then filled with a saline solution. The pressure they apply then physically forces the cervix to ripen and dilate.
The look on Berta's face while the catheter was being put into place was enough to make me
magically grow my own cervix and have it start feeling pain. Definitely file this one away in the aforementioned "made me wish I was dead" category.
Catheter in place they then proceeded to begin the slow induction process. This was done by using Pitocin - a synthetic hormone that imitates Oxytocin. This causes the body to start having contractions, albeit differently than natural labor. The dosage is gradually increased to induce "active" labor.
It really didn't take long for the contractions to begin.. though they were carefully controlled so as to not push too far into labor before dilation was complete. The pitocin and the catheter combined resulted in much more uncomfortable contractions than might normally be expected in natural labor. This combined with the fact that she had to remain hooked to monitors left Roberta with very few avenues to deal with the pain. By late-morning the pain was bad enough that narcotics were just about the only recourse.
Contractions and pain all through the daylight hours.. Wednesday was a long, long day.
As things intensified I started massaging Berta's legs, feet, hands, and arms as a way to help distract her from the pain of the contractions. Her feet and Legs were most effective because it helped take her focus further away from the pain epicenter that was her abdomen and pelvic floor. All the while looking at the readout from the machines - they provided a provided a nice graph and let me see and somewhat predict when a contraction would start.
During one such massage session there was suddenly an audible "pop" from the heartbeat monitor and Berta's whole belly moved in response. Berta had just enough time to realize that her water had broken before the next contraction took hold.. and that's pretty much when all hell broke loose. I used the call button to let our nurse know what had happened and Berta suddenly started wailing. This frightened me to no end because up to this point she had never let out much more than smaller moans. By the time the nurse arrived she was in tears and experiencing some of the worst pain in her life (and this is including migraines!). Clearly it was time for an epidural.
Of course the wait for the anesthesiologist seemed like an eternity. Even though it was really only minutes according to the clock.
Naturally the epidural takes a bit of prep work.. so there was an extra eternity piled on top of the first. When it came time to put the Epidural in place Roberta was tasked with the daunting task of not moving at all - even through the (now truly torturous) contractions. If anybody doesn't already know, an epidural involves placing a needle into the spinal canal and then pumping anesthetic into it - you don't want to move because you need the needle just far enough in to reach the spinal canal, but you don't want to accidentally go deeper into the area near the spinal cord!
Chalk it up to fear of spinal cord damage (or desperation for relief) but Roberta stoically sat cross legged on the bed and stayed near motionless for the 5 to 10 minutes required of her. I have never seen her go more rigid than during those contractions. Her arms and legs felt like steel cables - and her face didn't look that far off either. I'm fairly certain that even the smallest, most remote muscles were drafted into the fight to keep motionless.
Finally the epidural was in and the anesthetic started flowing. According to Roberta it starts off as a very cold feeling down your spine that then turns into the feeling of having your lower extremities immersed in a warm bath. The epidural itself relies a lot on gravity to get everything properly numbed, so it took a couple of rounds of repositioning before the pain was more-or-less eliminated.
That period of calm allowed the doctors time to assess how well dilated Roberta was and what to do next. The dreaded cook-catheter was removed because Roberta had made it to about 6 centimeters (only to be followed by a real catheter since she was now numb from the mid-back down!). They also attached a small monitor to baby Adam's head so that his heart rate could be more reliably monitored through the stronger contractions and movement. Previously these monitors were held in place on the belly via an elastic band and had to be continuously fiddled with as Berta and Adam shifted around.
As an aside.. the time with the anesthesiologist introduced us to the running joke of the evening. Roberta's doctor (Dr. Ighani) recently cut her hair somewhat shorter than normal and apparently it was the talk of the hospital. From Labor and Delivery all the way to the OR. It was a strange little bit of levity.. but welcome nonetheless.
With all of the monitors and pain mitigation in place it seemed like we might be able to rest a bit while waiting for dilation to complete. Emphasis on
seemed.It wasn't long before it became clear that some of the pain wasn't being addressed by the epidural. Her whole right leg started feeling as if it was in the middle of a charlie horse - and it was a cramp that almost nothing seemed to make go away. The pain got so bad that Roberta started shaking uncontrollably and complaining of feeling cold - even her teeth were chattering. I tried to help as best as I could but there really wasn't much I could do since it seemed like her own nerves were working against her.
That was definitely the low-point of the entire experience, at least for me. At that moment I was just plain pissed-off. Especially after the epidural - which is pretty close to the strongest pain killer you can have short of undergoing general anesthesia. Of course all of the anger and frustration was really just a manifestation of how completely helpless I was feeling. I can only imagine what was going through Roberta's mind.
It got especially bad because the nurses determined that Roberta's cervix was dilating a bit unevenly, so they had to shift her position from one side to the other - anytime she was on her left side her right leg would really start acting up again. Eventually we ended up having to have the anesthesiologist come back in for a bolus of the anesthetic. It worked, at least temporarily. Throughout those next few hours we had to call for at least three more.
Midnight came and went and it still wasn't time. We weren't going to end up being parents on the 27th after all.
Sometime around 2 in the morning Dr. Ighani had been called in to perform an emergency C-section on another patient. She stopped in to check on Roberta beforehand and assess the situation. To her surprise Roberta had started running a fever - meaning that there might have been some uterine infection at play, possibly affecting the baby as well. Personally I didn't/don't think it was at all related to an infection - the way the leg pain was affecting her I was fairly well convinced that the fever was just a side effect.
Then it was time to start pushing! The nurse and I would help Roberta get started and Dr. Ighani would return later on to oversee the delivery. Finally the end was in sight, however difficult it might be. Apparently it was supposed to be
very difficult because in a strange slip of bedside manner the nurse said to Berta "Now this is the hardest part". Thanks?
Pushing ended up being a little awkward because neither Berta nor I had really wanted to do the flat-on-her-back-pushing-like-a-madwoman sort of deliver position. However the epidural (and it's extra-bolus'ed state) had resulted in Berta's legs being mostly limp - and it was going to be a little while before any sort of feeling returned. This meant that everytime a contraction came I'd lift Roberta's right leg up toward her chest and the nurse would lift her right. Roberta would then grab her legs and bear down with all her might. I worried about Roberta's strength/energy at this point because even I was being exhausted by this routine - and I only had to lift one of her legs!
Getting going was further complicated by all the different ways we accidentally broke Berta's concentration/focus. The nurse wanted her to push for counts of 10.. but managed to keep annoying Berta by counting from 10 to 1 rather than 1 to 10. I would distract Roberta by counting too loudly (which in my defense, I thought would help her focus on the count). This eventually resulted in me not counting at all -which then became doubly vexing because the second
I stopped counting the nurse would revert to the aforementioned 10 to 1 count.
The last annoyance was the nurse constantly admonishing Berta to stop "pushing with her face". Apparently not enough of the effort was going to her pelvic floor. I don't know how Berta put up with it since it even started annoying me.
After about 40 minutes Dr. Ighani returned to check on our progress. Adam had moved only a little during that time frame and his heart rate was fairly high - a quick reassessment was in order. Dr. Ighani determined that even though Adam was turned, he was looking"up" toward the birth canal - possibly in posterior position. This generally means that delivery will end up being more difficult (as if we needed that). Even worse.. she also noticed how narrow Roberta's pelvis was and how much her pubic bone was intruding on the space that Baby was supposed to pass through. It turned out a vaginal birth wasn't in the cards after all - Berta was going to need a C-Section.
There really wasn't much waiting around once the decision was made. A flurry of people came in to get Berta prepped. I was given a disposable clean suit, hair net, and surgical mask, while Roberta was disconnected from her IV and (of all things) made to sign paperwork. In searing agony? Baby in distress? About to go into unexpected abdominal surgery? Sign this please. Roberta even had to have the nurse lift her arm up to sign.
Roberta was moved into the operating room first and I had to wait while they set up. The halls/area around the OR is a bit strange - dark, almost industrial looking. Quite a contrast to the bright, clean (and on TV - all white and/or silver) looking operating rooms. The nurses had me sit on a small little stool near racks of hospital-strength cleaning supplies and disinfectant.
It was during those few minutes that my anxiety finally caught up with me. It wasn't anything quite as dramatic as a panic attack - but my mind had enough time to start wrapping itself around the current situation and I started feeling scared for Berta and for Adam. They were both in capable hands - but I that didn't stop me from feeling very, very small. How are you supposed to feel knowing that in a minute you're going to walk into a room and your wife is going to have her abdomen sliced open and your (hopefully healthy) child removed? I whispered a quick prayer and then it was time to head into the OR.
There were a lot of doctors and nurses in the room. The paper screen/curtain had been set up across Berta's upper abdomen - both as part of the sanitation process and to shield Berta and myself from seeing too many grisly details. Most of the doctors and nurses were on the other side of the screen while I sat with the anesthesiologist next to Berta's head/arms. She allowed herself to zone out completely during most of the procedure. For the most part I just held her hand and tried not too think too much about what was going on on the other side of the curtain. Though I must admit there was a moment where I almost stood up and took a glance - but then thought better of it.
Then suddenly we had our little boy! Since this was a C-section there wasn't much of a cry at first (too much fluid in his lungs). Two nurses took the gray and slightly-shocked looking Adam over to an incubation table to clean him off and remove as much fluid from his mouth, nose, and lungs as possible. Berta managed to look up as they held him for us to see and I tried my best to not soak my surgical mask with too many tears. He was even more adorable than I could have imagined!
My one regret about the C-section (other than it not happening earlier!) was that Roberta wasn't able to hold him then and there. Alas, she was still only about 40% of the way through the operation and it was time for me and Adam to leave the doctors to their work and head back to Labor and Delivery. On the way out many people commented on how much he looks like me (though personally I see a whole lot of Roberta in him).
For the next few minutes I was pretty darn close to dazed - simultaneously amazed at our tiny little boy and anxious for Roberta to get out of surgery. Thankfully I had put my camera in my pocket before suiting up to go to the operating room - otherwise I might not have managed to capture these first few minutes of Adam's life. As it stands I almost can't remember the order that things happened in - the numbering of my photos is what let me piece together what happened when!
First the nurse took Adam over to the scale to record his birth weight. We'd had an estimate about two weeks earlier of 6 pounds, 4 ounces. So it was a bit surprising to see him weigh in at 6 pounds 6 ounces. Length-wise he came in at 19 inches long.
Adam weighing in at 6 lbs. 6 oz
Next the nurse moved Adam over to the incubation table where
he had his first bit of blood drawn and then had his footprints taken. Thanks to Berta's fever and the suspected infection he also got to have his first with that oh-so-wonderful anal thermometer. One left him looking confused, one didn't phase him, and one made him cry his little eyes out. I'll let you decide what caused what. =)
Adam getting his footprints taken
When all of the poking and the prodding was over with I was given a few moments to attempt to soothe Adam. We'd already noticed that he would move or kick in-utero whenever I would get home and start talking - but it was still overwhelming to see him respond to my voice and actually calm down. Of course this was before the nurse informed me that since he was a C-section baby we should be encouraging him to cry to help get his lungs clear of any remaining fluid.
It wasn't more than a few minutes and Berta was brought back into the room with us and I could not have been happier. I was glad the hospital had allowed me to stay with him from delivery onward.. but it felt right that he be reunited with the woman that carried and nourished him for so many months. Luckily I got a shot of this as well.
Berta (aka Mommy) and Adam (aka Baby) reunited
Our last hour in the Labor and Delivery was used up by Roberta getting a much needed rest while I got used to the feeling of holding my son. During this time I was also given the opportunity to be the first to have a feeding with little Adam. The nurse gave me a syringe filled with formula and I slowly fed it into Adam's eager mouth. It was awkward, especially since I was so nervous about giving him too much too fast, but he handled it all wonderfully. It ended up being my first chance to really look at his eyes - he rolled them all around while enjoying his meal. 20 milliliters in all. (Now he literally can eat that much in his sleep).
Eventually it was time to part our room and head to the postpartum wing. That experience - especially that first day - is a whole other blog unto itself. I'll try to tackle that one next.
Adam Winter Craig: Born January 28th at 3:52 am
Temporarily calm and totally rocking his new birthday suit
Adam watching the star fish turn in the new bouncer that Matt bought him
