On parenting and birth... Part 2

About 7 months ago I told the first part our natural childbirth experience and I ended by saying, "Check in soon for part 2!" Umm... yeah, sorry about that. I've been keeping a standard of "promptness" if you choose to think about it in galactic terms. Hillary Hull said that one of her friends was thinking about doing natural childbirth but was waiting to hear the finale before deciding. Mmm... sorry about that too. It's taken me some time to find a rhythm to life that allows me to get back to the blog so I hope I can jump back in every now and again. But before I do anything else, let me finish what I started...

So when you left us last we had just checked into Fayette Piedmont at about 5:00 am on memorial day. I was pretty well rested and excited, K8 was excited, but in lots of pain every 2 to 3 minutes, and had been awake since 9 or 10am the previous day.

If you haven't done it before, it can be a bit of an interesting experience wandering into the hospital with a laboring woman. The parking lot was almost abandoned and the entrance that we normally went in wasn't open so we came in right by the ER. I don't know why, but I expected everyone to kind of drop what they were doing when we walked in and rush to help us.

"OMG! She's having a BABY! CODE 9!! Delta Team MOVE!"

I imagined them wheeling in a gurney and strapping Keight down and us running down the halls to get her to a doctor STAT! So I was a little disappointed when we burst on the scene and there were no balloons or sprinting nurses. In fact, I had no idea where to go. So I hurried over to the ER desk and said, "My wife is having a baby, what do we need to do?" To which the woman behind the desk sleepily replied, "Maternity. 3rd floor." And pointed off to her right, all without looking up from her computer.

Right. So with significantly less fanfare than I imagined, we waddled to an elevator and eventually made our way to the Maternity ward and got checked in.

I can't remember if we mentioned this way back when, but our OB office had 4 doctors that rotated being on call and a conversation that Keight and I had been having throughout the pregnancy was, "Who do we want to deliver the baby?" and "Who do we think is going to deliver the baby?" Our choices were between Dr. Cook (head guy, super down to earth and likable), Dr. Ralsten (goofy but funny, did his undergrad at Tech), Dr. Turner (straightforward but also warm, she delivered a set of twins naturally), and Dr. Beckford (spacey and looks like she's 24, but funny and nice). We went back and forth between men and women, but eventually we decided either of the guys because they seemed the most willing to let us do our thing naturally as long as Keight and Judah were okay, and then finally that we'd love to have Dr. Ralsten if we had to pick a #1, but we figured that we would get one of the women with our luck and we were the most squeamish about Dr. Beckford. Simply because we literally were not sure she was old enough to have a medical degree (she looks YOUNG!) and she seemed likely to be quick to "intervene" medically rather than let the birth process play out as naturally as possible. Plus every time we had seen her for our prenatal appointments she tried to talk us into an epidural even though we were pretty clear.

At this point I would have liked to show you all 4 of their pictures but their stupid website is in Flash, and one of the doctors (Turner) left shortly after our birth (unrelated...maybe). So in their place here is a picture of Justice Ruth Bader Ginsberg from one of the exam rooms in the OB office. You can imagine that she is the composite image of all four (actually not that far off).

SO, when we decided it was time to go I called ahead to the hospital and told them we were coming in and found out that currently Dr. Turner was on call. So maybe not ideal, but we were happy about that because we knew that she would likely be very willing to allow us to stick to our birth plan provided there were no serious complications.

Upon arriving to the Maternity ward on the 3rd Floor we were greeted very warmly by the nurses and Keight got settled in nicely. After extensive amounts of paperwork that basically amounted to promising not to sue the hospital that they made Keight fill out while contracting even though we had preregistered, we were finally able to be alone together for a little while and get back to the business of having a baby. One of the things they asked us at check in was when her water broke. Since we knew the hospital's policy of 18 hours of broken water before IV antibiotics were required, we kind of just said "um, one" since it was 5 am the nurses assumed we meant 1 am (because who waits all day at home after water breaks?!? we do!). actually it was 1 pm the day before. we didn't lie, but we were pumped to get 12 extra hours without being wired up to anything. Throughout all of this Keight has been a complete champion. She's getting retrofitted with fetal monitors and a Hep-Lock IV port, and getting poked and prodded every second it seems, but about every 2 or 3 minutes, she would ask them to hold on and she would relax her whole body and allow the contraction that had come along to do its amazingly beautiful and painful work.

About 30 minutes after all the paper work was done and we'd been settled in, Dr. Turner finally came in to check where Keight was and talk to us for the first time. We quickly found out that Keight was at 3-4cm and 70% effaced (for you no pregos, that means her cervix was open 3 to 4cm [at 10cm you're pushing a baby out] and effacement is basically a measure of much your cervix has thinned [think of pulling a thick turtleneck sweater over your head, how the material thins as you pull it tight]). This was good news because it meant that something had been happening during all those contractions, but it also meant we still had a ways to go. The BAD news, was that her shift was ending at 7am and so right as we were getting settled in with nurses and doctors it was all about to change.

It would turn out that the change would be VERY significant to the outcome of this story. We quickly learned that Dr. Beckford was the doctor with the next shift. Which definitely was a mixed bag of emotions for us, simply because we really did like her a lot. She's funny and kind of spacey, but very approachable and warm. The only hesitation that we had was that she would probably be the hardest of all the doctors to convince to let us proceed without any interventions.

But before we even had much time to even think about all of that, we were introduced to our new nurse who was going to take care of Keight. Our previous morning nurse was very sweet and encouraging southern girl who had a great knack for when to help us out and when to give us some space, so we were kind of bummed to lose her. In her place walks in our new nurse, and she is spunky. She's what we here in the south would call, "Northern" (she's from Ohio). She immediately gets down to business, "So I hear you guys want to go au naturale? Well that's great, you can totally do it. I had both of my children naturally, so I know what you're going through. But its going to take a lot of work from both of you." Then she proceeds to explain to me how birth coaching works. Ha, little did she know I had a coaching card already.

Still keep it in my wallet, in case we ever happen upon a woman in labor

So after Nurse Adrienne left, Dr. Beckford came in and did her own check, which just confirmed what Dr. Turner said. 3-4cm, 70% effaced. So she said that basically she was cool with us doing the whole natural thing, but if time passed and it looked like things were stalling out then we needed to consider using pitocin to speed up the labor if things weren't progressing "normally". We both reasserted that we weren't ready to consider that yet, and so we decided that unless something big came up, Keight would get checked again at 9:30am and then again at 12pm and we would go from there.

After the doctor left, Keight and I began an awesome time of being able to go through the birth process in peace for the most part. The thing that I loved about our chosen method was that it truly brought us so close together. Every contraction was an opportunity to see Keight doing what only she could for our family and to help her in ways that only I could. The wave of a contraction would come up and Keight would gracefully navigate its waters. She would relax her body fully, close her eyes, and breathe deeply all the while tuning into the amazing process that her body was leading her through.

team dukes!

My main job was simply to try to do whatever it took to make Keight comfortable and encourage her along her journey. I like to imagine it was like Keight being led down a path in the woods to a place that she had never been before. Her eyes are closed and she's being led by her body, who by the grace of God and the mystery of time and genetics, has already learned the way. I'm following along not doing much of anything, but just encouraging Keight when she doubts herself and making it as easy as possible for her body to take us where we all want to go.

Sometimes that was massaging the small of her back, sometimes that was rubbing her temples, sometimes that was letting her hang on my neck, sometimes that was encouraging and cheering her on, sometimes that was shutting up.

I remember sitting by the fetal monitor and watching the contractions build on the little graph and massaging Keight's hands as the pain would build. I remember moving from the birthing ball, to standing up and hanging on me, to standing up against the wall while I pressed hard on Keight's back to counteract Judah pushing on the other side. I remember how kind all of the nurses were and how thankful I was that they were there, but letting us do our own thing. It probably didn't hurt that we brought them gift baskets full of candy and goodies (thanks Tiff and Jorge!!).

But most of all I remember time slipping away. During labor, the contractions just keep coming and coming and coming. There are no time outs. There is no way to tap out and let someone else do the work. They just roll on and on every 3 or 5 or sometimes 8 minutes. 10 or 12 go by and there goes an hour. At some point I looked at the clock and it was 11:50. That meant Keight was about the get checked again, and hopefully she would have made enough progress to end the whole pitocin discussion for good.

So Dr. Beckford and Adrienne came back in for the exam as promised and sadly it was not good news. She had been 4-5cm, 70% effaced at 9:30 and now she was 5-6cm. That means we'd gotten 2cm closer in 4.5 hours. Come on uterus!! Are you kidding me?!? I watched the life drain out of Keight's face as they told us that, because we both knew that was not going to make things easy, and it was kind of a slap in face for all of the pain and anguish that she'd been going through since this started. At this point she had been up for more than 24 hours straight and was pretty exhausted. She would get almost to the point of sleep and then another contraction would come like a cruel uterine Chinese water torture.

Dr. B reminded us of our options and then left to go check on some other patients. It then that Adrienne sat down on the bed with us and we had a heart to heart. She was still very encouraging about us sticking to our birth plan and being able to deliver naturally, however then she told us that we would probably have to be willing to make some compromises simply because of our situation, with Keight's water having been broken for several hours (so they thought, we were getting close to 24 hours, since we had let them believe that "one oclock meant 1 am and not the 1 pm that was the truth).

She told us that if we got close to the 18 hour mark from when the water broke, we would be forced to go on IV antibiotics, which would mean staying in bed and no more walking around during the labor as we had been (because that's the hospital's policy to prevent infection since the womb is not longer a "sterile environment" after the water breaks, actually you can go up to 2 weeks with broken water and be totally fine). So to prevent that, we had to be willing to be flexible about some of the items on our birth plan. Specifically the use of Pitocin.

Now you may ask, "What's so bad about Pitocin? Isn't that meant to speed things up? Isn't that a good thing?" Well, you see we have this crazy idea that since women have been having babies for a LONG time, that maybe their bodies have a good idea how to do it on their ownsome and on their own timetable. Sometimes this is fast, sometimes this takes 2 or even 3 days. I understand that to our efficiency crazed, schedulemaniac culture, this could be hard to understand, but sometimes faster is not better at all.

The devil-juice!

The fact is, pushing out a baby is work. I'm guessing that's why its called labor. Put another way, it's an athletic endeavor. In our birth classes I learned that a uterus is covered with a very large muscle and contractions are simply (sic) that muscle contracting to pull open the cervix and allow the child to pass through the birth canal. Pitocin is the synthetic reproduction of the hormone oxytocin in your body that tells your uterus to contract. A woman in labor already has this hormone in her system. What pitocin does is force it into overdrive, stronger, longer and more frequent contractions come when propelled by this chemical. This can take a process that would take say 6 hours and convince your body to do it in 1/3 of that time. Which seemed to mean for example that the pain that would have been spread out over the 6 hours, now gets crammed into two. Which is three times worse if it works mathematically. And since childbirth is not exactly a comfort-filled activity to begin with, this presents a problem.

To counteract this, most women opt for an epidural shortly after getting the pitocin, simply to escape the rapidly intenifying pain as soon as they feel it starting. The only problem is that many times the epidural causes labor to slow down and the contractions subside. to overcome this they sometimes give you MORE pitocin. this can then make it painful again so they give you MORE epidural. and this cycle can create stress on the baby since the contractions are coming really hard and fast (even though mom doesn't feel it thanks to the epidural) and this distress can lead to emergency c-sections to "save" a labor that may not have even been in danger to begin with if there hadn't been interventions. also, once the pitocin gets them to 10 cm and its time to push the moms often can't feel enough of the process to know when/how to push, but the uterus is still pushing like crazy and this action on the baby can cause the heart rate to drop because of the added stress, which means an emergency c-section is necessary to get the baby out safely in this case too.

Now, please take this moment to realize that this is by no means always the case, or certain to happen. But the process I just described is known as "pit to distress" and if you care or have the time, throw that in the ol' goog and see what comes up.

When it comes to your own child that you've prayed for, hoped for, sacrificed sleep/money/time/your girlish figure for, you really don't want to do anything that is likely to end up causing it "distress". And from my perspective, I had Keight to be worried about as well. I didn't want her to have to get a c-section and I didn't want her to have ANY unnecessary pain. She had enough necessary pain to deal with.

But we were running out of options at this point. So after some serious soul searching and praying we made a deal with Adrienne that if Keight didn't make any more progress by 2:00, then we'd go ahead and go on pitocin.

God, you know the exact time that Judah is supposed to be born.

In fact, you already know how many hairs he has on that precious head of his.

We don't want to do anything necessary that would harm this boy that you're giving us. So we just ask that you help us make the right decisions and protect him through whatever happens.

We love you.

Amen.

2:00 pm came and went. No change.

They hooked Keight up the IV and administered the smallest dose possible, and we would see what happened from there.

this would be the last smile for a while...

Drip drip, no turning back now.

God help us.

the conclusion of the story is here