Tuesday, August 28, 2007

The Birth of Baby Boy C

The Birth of Baby Boy C
Monday, August 20th at 2:17 am
2 lbs 14 oz
Original due date: October 30th
1st baby, premature (pre-30 wks) hospital birth
It had been about four weeks since I’d met Mommy M. We had our initial interview consultation at the Mall in Salem, since neither of us were terribly familiar with the area. Mommy M and Daddy P had just moved to Salem, and I had never attended a birth in the area yet. Our meeting went very well. Mommy M was a music therapy major and has plans to be a music therapy doula in the future. We found a number of crazy similarities between us, and felt we’d make a good match during the birth. I looked forward to our prenatal meetings and to meeting her husband, Daddy P. Little did I know I’d be meeting him in the operating room at Salem Hospital…

It was a Sunday night when my phone rang at around 9:15. A glance at the number told me it was someone in Salem. I wasn’t expecting anyone, but since I knew Mommy M had a similar phone number, I figured I better answer. I was glad I did. It was Daddy P, Mommy M’s husband. Mommy M was in the hospital, in labor, and she wasn’t even 30 weeks pregnant yet. Daddy P filled me in on some of the details. Her day started with a little bit of pink discharge, and progressed to more pink discharge that was darker in color and a low feeling in her belly. The doctor asked her to come in and get checked, so her neighbor took her to the hospital at around 5:30 pm. She was found to be around 3 centimeters dilated and 90-100% effaced with contractions getting started, so it appeared labor was here. She was given steroids to help develop the baby’s lungs, and magnesium sulfate to try and stop the contractions, but things seemed to still be moving forward. When he called me at 9:15, Daddy P said she was 4 centimeters dilated, contractions were 3 minutes apart and quite painful, and Mommy M was doing well. Daddy P asked me if I could come up. I briefly spoke with my husband and decided I could do it. I hadn’t planned on attending any births until October, when my newborn would be 5 months old. But it just so happened that my son (barely 3 months old and still nursing 24-7) had just gone to sleep for the night, so I figured I could disappear for quite a while and he would perhaps only need one bottle from my husband. So I called back and got Mommy M and Daddy P’s neighbor on the phone and told her to tell them I’d be there by 11. She shortly called me back and said the nurse indicated the baby might be here by 11, so I hurried to leave as fast as I could.

I rushed around, gathering all my doula gear, and jumped in the car. On the drive, I called a friend of mine who works in a NICU and asked what I could expect from a pre-30-weeker. She gave me good info, and I raced my way up to Salem, arriving at around 10:45 pm. The hospital was easy enough to negotiate, despite major construction. I arrived and was buzzed in quickly, and then told to wait in the hospital room where I found Daddy P and Mommy M’s neighbor. She got me caught up on everything, and we just waited for news. I’d been told at the nurses’ station that Mommy M had not delivered yet. At times, we could hear some moaning and were pretty certain it was Mommy M. It was so frustrating to be so close and not able to help!

At around 11:10, a nurse came in and got me suited up with the booties, hair cap, and full-body apron. Mommy M was in the operating room, which the nurse explained to me was standard for any births pre-34 weeks. I walked in to find Mommy M flat on her back with tubes and hoses and belts everywhere, Daddy P at her side, two nurses assisting with paperwork, and Dr. H doing a cervical check. Mommy M was 9 centimeters and feeling pushy when I walked in the room. Wow!

I expect this will be one of the most restrictive births I will ever attend. With the baby being so premature, it was very important for Mommy M to keep pressure off her cervix to protect the baby’s head. It was also medically the best choice for her to avoid pain medications, as any medication could interfere with the baby’s alertness and ability to breath after the birth. Mommy M needed continuous fetal monitoring because of her early gestation, and because the baby began having more difficulty with maintaining his heart rate towards the end of the birth. Mommy M also had an IV and a catheter, again, to keep pressure off the baby, ease his passage down the birth canal, and keep her prepped for surgery if it was needed in an emergency situation. So here she was, basically strapped down to the bed in the worst position to labor. Mommy M had a back injury too, so this was really a bad place for her. Many of the things we had discussed using during labor were not available – no birth ball or Jacuzzi tub, she couldn’t be mobile, she didn’t have her music with her, and changing positions was not really possible with all the attachments (and it was vetoed by the doctor too). As the doula, I was left with only verbal encouragements and hand-holds as the tools I could use to help her. That said, Mommy M did an ABSOLUTELY AMAZING job.

I immediately took up position at Mommy M’s left side. Daddy P was on her right. Together we held her hands, gave her verbal encouragement, and fanned her or applied cool cloths when she would tolerate. I realized I forgot my camera, and Mommy M and Daddy P didn’t have one either since they had no idea they’d be having their baby today. I checked in with the nurses about bringing my cell phone in the operating room to use it to take pictures. I’d been told I could not bring my bag of doula tricks (most of which were not helpful given Mommy M’s position anyway), but bringing my cell phone was okay. So I briefly left to retrieve it. Mommy M and Daddy P said they wanted pictures, and I wanted to give that to them if at all possible. I knew the baby would be taken away almost immediately, so a few snapshots with my cell phone might be all they got to see for a few hours.

Arriving at the peak of transition was tough. Mommy M was really struggling. I could tell things were happening very quickly in her body, because her sensations were changing and overwhelming her right-and-left. At times she would ask for a cool cloth because she was too hot, but then she could throw it across the room when it annoyed her. Mommy M tore her hospital gown off at the top when she had a hot flash. Both Daddy P and I were chastised for having bad breath. J She berated the doctor (when he was not in the room) for not doing his job and taking the baby out. It was all the classic signs of an intense transition. Despite the lashing out, Mommy M really was doing great. The contractions were taking their toll, but she took them head-on. There were a few times that she seemed to be trying to crawl away from them, but after I reminded her that staying relaxed instead of tensing up and trying to crawl away would make them more manageable, she welcomed them more openly.

By 11:45 pm, Mommy M was completely dilated during contractions with only a lip of cervix left. My midnight, she was completely dilated. Now, in a normal hospital birth, I would have expected the doctor to suggest she start pushing at this point. But because this was a premature birth and Dr. H was so gentle, he encouraged her to keep breathing through contractions and allow her body to move the baby down more before pushing. Mommy M’s water still had not broken either, and the doctor refused to break it at that time because it was giving the baby’s head a nice cushion. When Mommy M begged for them to please do something, the doctor and nurses calmly told her the best thing for her baby right now was to avoid pain medications and breaking her water. She was doing a great job and her baby needed her to be strong. Knowing this was the attitude of the hospital staff, I adopted this reminder to keep telling her when things got really tough again.

Now that she was fully dilated, Mommy M really found her rhythm. The next 90 minutes passed relatively quickly and peacefully. Daddy P and I maintained our positions, holding her hand. I made a makeshift fan out of a paper handout Daddy P had been given, and Daddy P and I took turns fanning Mommy M to keep her cool. Something visibly changed in Mommy M during this time. She was no longer crawling away and struggling with the contractions. She was welcoming them fully and breathing beautifully through them. I wish I’d had a video of how she was during this time – it was an amazing example of a naturally laboring mom at the very end of stage one. We were mostly quiet during this time too, as Mommy M had retreated into herself and was taking things on inside. She later told us that holding our hands and maintaining our vigil at her side was giving her immense strength, as she could feel the circle of love and support surrounding her. Daddy P was amazing as well, keeping a constant presence as his wife’s side. There were a few tender moments they shared during this late transition time where they kissed and exchanged I-love-yous and mini-hugs.

During this extended time at full dilation, the nurses and doctor kept checking in. Baby was moving slowly down, but was still not ready for pushing and the waters were still intact. Finally, at around 1:45 am, after observing some shifts in the baby’s heart rate, the doctor suited up and prepared for catching the baby. At 1:50 am, the doctor had Mommy M do some practice pushes to see if she would be effective at bringing the baby down. She must have been great, because he then told her to breathe through a few more and be ready to have her baby. Meanwhile, the doctor got all the equipment out and within reach. They also notified the NICU team to be prepared. The NICU nurse with warm blankets arrived and stood ready to catch the tiny baby.

At around 2 am, the doctor broke Mommy M’s water and it came out clear. Mommy M immediately felt more pressure from the baby’s head and was in more pain. Despite this, she was great at listening to exactly what the doctor’s and nurses instructed her to do. She continued to breathe through several more contractions. At around 2:10, the real pushing began. I held Mommy M’s left leg, and a nurse held the right. Mommy M was great at pushing! She curled up just like the nurse suggested, and brought the baby down with each push. The doctor was instructing her to hold her breath and push for long periods, and she did exactly as she was told. As the baby moved down, his heart rate really started to fluctuate a lot with the contractions. Sometimes it was around 160 beats per minute, sometimes it was under 80. This was an obvious concern for everyone in the room. It became imperative the baby be born soon.

Mommy M pushed and pushed and soon felt burning in her perineum. This sensation really shocked her and challenged her coping skills. But she pushed right through it. I could see the baby’s head as it slowly emerged. It was the most distinct cone shape I’d ever seen – almost pointed really. It was also very blue. Very quickly, the baby’s head was out, and with a quick motion the rest of the baby was born. It was 2:17 am and Baby Boy C was here!!

Most of the amniotic fluid came splashing out after the baby, and there was quite a bit of blood in it. I got splashed a bit too – my first time getting splashed with fluid. J Mommy M showed immediate relief from the pain. She and Daddy P hugged and kissed and cried at the little tiny sounds coming from their baby’s mouth. I snapped pictures as quickly as my camera could, but still only got three because the doctor moved even faster. He cradled the baby in one arm while clamping and cutting the short cord with the other arm before handing the baby off to the NICU nurse. And within a minute, the baby was gone. This was a very odd time for me. A beautiful baby boy had just been born, but here we were – the doctor, nurses, mom, dad, and doula, just standing around without any baby nearby. I showed Mommy M and Baby Boy C the pictures I was able to snap. Mommy M had not seen the baby before he was taken away, so this was her first glimpse. She laughed and smiled and seemed to be instantly in love. We were all so hopeful he was going to be okay. From my totally uneducated eyes, it seemed to be a good sign that he was born making noises and moving around frantically.

Dr. H’s attention turned to check Mommy M for tears. She had a small one inside her vagina, so he prepared to repair it. Unfortunately for Mommy M, she and I are similar in that lidocaine doesn’t seem to do the trick for pain relief when getting stitched. She could feel much of the repair. It was over quickly though. The doctor waited a bit on the placenta, and then used traction to extract it. The placenta was tiny and showed evidence of a very large clot. The doctor posited that labor had started because of this partial placental abruption. The blood that came out after the baby was also a big clue. So while the early birth was a challenge in many respects, continuing the pregnancy may have been an even bigger challenge to Baby Boy C’s survival. The catheter was removed, also with incredible discomfort for Mommy M. Mommy M, Daddy P and I chatted about the baby and what he looked like. The doctor said he guessed he might be around 3 lbs or so. Mommy M got cold (the operating room was freezing, but she’d been too hot for the entire labor) so we covered her in blankets. The nurses prepared to move us all back into her regular delivery room. It was around 2:45 or so when we got back in the room. By now, Mommy M and Daddy P was both feeling worry over the health of their son.

The neonatologist came to report on the baby fairly quickly. He said he was doing okay, fairly well actually. They had immediately inserted a breathing tube because of the late-delivery heart decelerations. With the breathing tube in place, they administered a surfactant to help further develop his lungs. Shortly after that, they removed the tube and put him on CPAP (continuous positive airway pressure). This machine controlled the pressure, oxygen, and moisture of the air he was receiving, but meant baby Baby Boy C was breathing on his own. What great news! Mommy M and Daddy P made calls to family, announcing the arrival of their little boy. After a couple more brief visits, the doctor finally reported Baby Boy C’s weight – 2 lbs 14 oz – just about right for a baby shy of 30 weeks.

Mommy M and Daddy P had just been through one of life’s greatest roller coasters, and it was beginning to take its toll. They were concerned about their boy and anxious to see him. Sometime around 3:30, Daddy P was taken back to see him. He took my phone so he could snap another picture and bring it back to show Mommy M. Mommy M and I stayed and talked a bit about the birth. She was obviously so proud of accomplishing it without medication, and I was very proud of her too. She overcame so many obstacles, but stayed her course and made the best choices for her little tiny boy. The picture of Baby Boy C that Daddy P brought back brought tears out from all of us.

Finally, at around 4 am, a nurse arrived and asked Mommy M if she’d like to go see her son. I assisted with getting Mommy M in her fancy postpartum panties and pads, and settled into her wheelchair. Somehow the nurse had been informed Mommy M had received an epidural, and when she learned that was not true, she was visibly impressed. We all walked over to the NICU and Mommy M and Daddy P were given instruction on how to enter. After scrubbing our hands several times, we walked back to Baby Boy C. He was attended by NICU Nurse C.

All I can say is wow. He was TINY. I was prepared to see him with the wires and hoses attached. His eyes were taped shut to protect them from light. His chest heaved with each breath. It looked so violent, but the nurse said without any fat, it was just very visible. There were a few moments where he let out some tiny gurgles and moved his hands and feet. Mommy M and Daddy P spoke to their son, both in English and Chinese. It was impossible not to be swept up in the love they felt for him. I found myself crying too. NICU Nurse C explained many of the wires and tubes, and how his care would be handled over the next few months. I was encouraged to hear what a central role the parents play in his care. It sounded like Mommy M and Daddy P would be practically moving into the NICU. Finally, at the end of the visit, Mommy M and Daddy P were encouraged to touch their little boy. It was a beautiful moment. I got pictures as best I could.

After we returned to the regular hospital room, there were many tears shed. We talked a bit about his features, and how he obviously had Daddy P’s full lips. The nurse gave more information on Baby Boy C’s care, and they prepared to move Mommy M up to her recovery room. Once there was a lull in the action, I took my time to say goodnight. It was around 4:30 am, and time for me to depart. We all exchanged hugs and information on when we would talk again. I desperately hoped it would be good news. As I walked out to my car, I couldn’t help but reflect on the beautiful event I had just participated in. If only it had been 2 months later…

No comments: