The Birth Story
Around 3:30pm on Wednesday Amber started feeling contractions. They weren’t too painful, and were in her lower back rather than her tummy area. Hungry, and not sure if it was “the real thing” we decided to have Chris run to McDonalds. When he got back they were but they were fairly regular and about 10-13 minutes apart. We were waiting until they were consistently 10 minutes apart to call the doctor. Shortly after Chris returned, they suddenly became 3-5 minutes apart. We called the after hours number for the doctor to have her paged. Typically, the doctor wants you to come in their office to check you before sending you on to the hospital. After waiting about 30 minutes for her to call back and not hearing from her, we called again and gave a cell phone number and decided to just start driving to the hospital.
In the car the contractions intensified until Amber was pretty uncomfortable. When we finally arrived at the hospital, we got our callback from the doctor. She explained that the call service had screwed up when they called her—she wasn’t on call and didn’t even have her pager with her; they were supposed to forward the call to the “on call” doctor, Andrea Campaigne, instead of her. Anyway, Amber’s contractions were now two minutes apart and the doctor confirmed that coming in to the hospital directly was the right thing to do. She spoke to the on-call doctor about Amber’s condition.
At the hospital, we went directly to the Labor & Delivery department just as they instructed us in the hospital tour we took earlier. At first we were placed in a triage room where a nurse put monitors on Amber, took some basic vitals like temperature and blood pressure, then proceeded to ask us a barrage of wild questions including:
- Do you have electricity in your home?
- What about a refrigerator?
- Did you happen to bring a prosthetic limb with you to the hospital with you today?
Amber’s blood pressure was still high at this point but not alarmingly high. The nurse did a cervical exam and said that Amber was 4 cm dilated and 90% effaced, just like the day before.
Amber’s pain at this point was pretty intense. She was constantly moving around trying to find a comfortable position in which to have the contractions. She never really found a good one. Ultimately the best one was standing and leaning over the bed while I rubbed her lower back. She later described the pain as similar to the extremely painful abdominal cramping associated with bad food poisoning—like the case she got on our first anniversary in Mexico—except worse.
Eventually the doctor on call, Andrea Campaigne, came in and spoke to us. She said we were going to be moved to a Labor & Delivery Room. Once there Amber could get her epidural and then they’d break her water. Andrea also said that she’d be at the hospital all night, which made us both very happy. Amber even cried since most doctors just come to catch the baby. It was reassuring for her to know that she would be in good hands.
Once in the Labor & Delivery Room, we met our nurse Jessa (who is in the previous picture with the tired postpartum Amber) who was great. She was with us throughout the labor and delivery and for a while in postpartum. At this point Amber was 5 cm. Jessa started an IV to flush two bags of fluid into Amber. This is apparently a necessity before an epidural can be administered, and takes around 45 minutes. The time actually went by pretty quickly, and soon the anesthesiologist was there. He put in the epidural pretty easily and Amber was pretty quickly feeling *a lot* better. Afterwards she also had to get a catheter, which, since you can’t feel your legs or walk with an epidural, is a requirement. With the epidural she could hardly tell when she was having a contraction.
While the anesthesiologist was there Amber started asking him some questions and he said something interesting. Amber asked if epidurals were linked to difficult deliveries and he said there was evidence that they aren’t. Apparently there was an older study that did imply that epidurals were linked to difficult labors, but since then it’s been shown that the study was flawed because the only labors they studied were difficult. More recently, different studies have shown no link between epidurals and complications.
With the epidural now in place, Dr. Campaigne came in to break Amber’s water. Because her blood pressure was elevated it would be best to help get things moving along. This is a pretty routine practice—most women need to have their water broken as opposed to having it break naturally. It also almost never gushes when broken—that’s usually just in the movies. At any rate, Dr. Campaigne went to do the procedure, but then stopped and said that Amber was fully dilated. Everyone was shocked by this because it usually takes about an hour to dilate 1 centimeter, but Amber had dilated 5 in a single hour. None of the staff had ever seen anything like it. So instead of getting her water broken, it was time to push! At this time it was around 11:15pm on the 8th.
At first the pushing was pretty casual. Amber’s epidural prevented her from feeling the pain of the contractions. We could only tell she was having one because either she felt some pressure in her abdomen or the monitors detected it. Neither of these worked consistently however. Since Amber’s contractions were largely in her back, the monitors didn’t do a great job, so there was some guesswork in determining when she was actually having a contraction. Often the nurses would physically determine when she was contracting by feeling Amber’s belly. There were only four people in the room—Amber, me, the doctor, and Jessa. The doctor just casually sat on the end of Amber’s bed and watched the action while Jessa and I each held back one of Amber’s legs—we didn’t really use the stirrups. The doctor asked if I’d like to cut the cord and I said yes. She said I could even ‘catch’ the baby if I wanted. I happily agreed and she put in an order for an extra set of scrubs when the time came. Amber asked for a mirror, which some nurses found and brought in for her to watch. The doctor tried to use this to help Amber know where to direct her pushing. The whole environment was actually very relaxed for Amber. The lights were dimmed, she was comfortable, and everyone was very supportive.
To our surprise, the pushing went on for about two hours, and was getting pretty exhausting for Amber. I was even getting tired of just holding her leg back :) It actually didn’t hurt at all; she was just frustrated that she seemed to not be getting the job done. The doctor was getting a little concerned at the baby’s heart rate monitor which was dipping during the contractions. The dips and the contractions weren’t perfectly correlated, so the doctors weren’t sure what the cause of the dipping was. To get a better reading, Andrea put in a direct heart rate monitor on the baby. This is a cable that is inserted in the vagina and attached to the crown of the babies head. This sensor gives a more reliable heart rate measurement. It’s a little scary because it is basically screwed into the kid’s head like a corkscrew, but it doesn’t permanently hurt them (there aren’t even any marks). Here are some pictures of the sensor I found online.
Andrea was visibly concerned with the heart rate behavior. While we helped her push, Andrea just stared at the monitors with a straight face. Her demeanor was much different from the cheerful doctor sitting on the edge of the bed. Also, Amber’s pushing seemed to be correct, but the baby wasn’t making much progress along the canal. More nurses came in the room, and the pushing continued. They had her pushing on her back, her side, and tried putting a raised bar over the bed that Amber would push her feet against. Andrea changed into scrubs and told some of the nurses to get the NICU ready (Neonatal Intensive Care Unit). This freaked us out. We knew the heart rate was low, but didn’t really understand how dangerous it was. Andrea kept us updated, but obviously didn’t want to scare us. Amber also had to wear an oxygen mask, which we later found out was because the baby’s oxygen level was low too.
At one point, Andrea mentioned that she may have to use the forceps if things didn’t improve. She said that, with forceps, you only get a few pushes, and if that doesn’t work you’re committed to doing a C-section. This was scary but a no-brainer decision for us—we wanted whatever was best for the baby and trusted the doctor’s judgment. Amber pushed a few more times, and after no improvement, Andrea put in the forceps.
The forceps looked like large salad tongs. Each side of the tong was as large as the kid’s head. The tongs are first split apart, then each side is inserted individually, finally the forcep joint is linked. Apparently there are many varieties of forceps out there—the pictures below are the closest ones I could find to those that Andrea used.
This next part was really scary for us. Amber pushed a few more times while Andrea tugged. The tugging was pretty rough, actually, but I suspect that’s all normal. When Audrey came out, she was limp, blue, motionless, and quiet—not screaming at all. Amber and I were totally freaked out. Andrea quickly cut the cord and Audrey was rushed to the other side of the room where the nurses did their Apgar assessment. (Agpar is used to quickly assess the newborn’s health--Wikipedia gives a good summary of the test’s criteria here).
I remember Amber asking the doctor “is she alright?”, to which the doctor had to reply truthfully “we’ll see”. After less than a minute which seemed like an eternity to us, we heard her cry and knew she was okay. In fact, she ended up scoring an 8 and 9 on the two Apgar tests they administer, which is normal (I’m told a 10 is practically unheard of).
I took a few pictures of Audrey at this point, which I posted in the previous posts. This is just right after the tests. I brought her over to Amber, who finally got to see her for the first time. Amber decided not to hold her yet because she was still delivering the afterbirth and needed some stitches from the forceps. She wasn’t in pain, but she was distracted by what was going on. When the placenta came out, Andrea showed it to us and pointed out where it was attached to Amber and where to Audrey. It looked like a raw pot roast. I looked to see how badly Amber was cut, but couldn’t make it out too well. There was a lot of blood but otherwise she looked okay. It was a 3rd degree cut, which is about as bad as you can get.
Andrea explained that Audrey was face up rather than down (she called her a “stargazer”). Apparently this explains the heart rate issues and Amber’s difficulty pushing. A little while after the birth Andrea came in and said they’d done some tests on the cord blood—the tests confirmed that Audrey was in distress and was just about to enter dangerous oxygen levels. So opting for forceps at the time we did was the right decision. No amount of pushing was going to get her out.
Audrey has two lumps on her head from the delivery. The doctors believe that these were caused by Amber’s pushing—that she literal pushed part of Audrey skull out of shape. They refer to these lumps technically as cephalad hematoma. They believe they should go away by themselves, but we’ll have to keep an eye on it. Here’s a picture of Audrey’s “horns”.
Pretty much during the whole stay in the hospital, nurses were coming in every one or two hours to do something, like take Audrey’s or Amber’s vitals. This made it even harder to get Audrey to sleep. On some of these visits Audrey would get special treatments, like a jaundice test. Overall, it was a very busy time, with something happening constantly. It was hard to find the downtime to call folks and let them know what’s going on. It was even hard to find the downtime to eat; we had a few meals that we pecked at for a few hours because of constant interruptions.
About an hour after Audrey was born, they sent her to the nursery for a few minutes. I went with her on all her nursery trips. This is when she got her first bath. They also gave her a vitamin K shot, the Hepatitis B vaccine, and some eye ointment. On later trips she got blood tests for various maladies and her jaundice tests. She was also weighed in the nursery every night at midnight.
Diapers
It quickly became apparent that daddy is the diaper man. The nurse changed the first diaper and showed me how. After that I was on my own, and I’ve been changing most of them since. Since Amber has generally been busy with other things (e.g. recovery or breastfeeding) this is something simple I can do to help.
Audrey has been having good bowel movements. In the first few days, she was going through up to four dirty diapers a day. She went so well, in fact, that she was out of meconium by the 2nd day. This was great, since I’d been having trouble cleaning it with the crappy gauze they give you for baby wipes in the hospital. I was complaining so much that Amber asked Christy to bring in a box of baby wipes, which was a vast improvement.
Having frequent bowel movements is great because it helps combat jaundice.
Weight
Audrey was born at 7 lbs 2 oz. At the first postpartum weighing she was down to 6 lbs 12 oz, then at the second weighing 6 lbs 8.3 oz. This represents a loss of 8% birth weight, which is a safe amount of loss. We saw the pediatrician twice while in the hospital, and she was pleased with this amount and recommended that we stick with breastfeeding and don’t supplement.
Breastfeeding
All the nurses were trained in breastfeeding, and while none of them are specialists, we got advice from many of them during our stay in the hospital. Later we requested to see a lactation consultant. She came by and corrected Amber’s breastfeeding posture, which helped a lot. However, she was also very abrupt and didn’t spend as much time with us as we’d like. So we ended up having her come back a second time while in postpartum. This time she was really helpful. She must have been with us for an hour. We tried several different holds and she observed Amber try them several times on her own and corrected her errors. Fortunately, Amber produced a lot of colostrum, it was just a matter of learning how to get Audrey latched on correctly. If you don’t have a pro to help, you would never know you were doing it wrong and the baby would learn an incorrect technique. The other issue with feeding while in the hospital was that Audrey was always “rooting around” like she wanted to be fed, but then when Amber would try to feed her she would lose interest quickly. The nurses said that’s normal and what they call a “grazing” baby. After all the help, we ended up leaving the hospital feeling pretty solid about breastfeeding. The lesson learned is to always ask for help and not worry about bothering the nurses and consultant. That’s what they’re for.
Gifts
Audrey received her first birthday gifts in the hospital. She got a stuffed hippo and a balloon from Aunt Cindy and a stuffed lamb and a balloon from Uncle Michael. Audrey also got a nice arrangement of mums from Amber’s friend Christy.
Phew, that was a long one.
All for now!
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