Archive for the 'birth' Category

The Gory Details

Monday, May 26th, 2008

It started with an innocuous trip to the Ob/Gyn.

This was the weekly checkup, and all previous checkups had been uneventful. This checkup, as well, was predicted to be uneventful. However, Amalia was also a few days overdue, so a routine ultrasound was in order. This was approximately 11am, on Thursday, 22 May.

The ultrasound revealed that the volume of amniotic fluid in Amalia’s uterus was abnormally low. I don’t mean “slightly below average”, but running on fumes. Typically, the fluid volume should be between eight and twenty units (whatever the units are; I never caught this). Amalia’s volume measured roughly between one and two units.

Amniotic fluid is good, because it provides cushion to the fetus. Like air in a tire. When the fluid is low, the fetus can compress the umbilical cord and cut off its own oxygen supply, and this is more likely to happen during labor, when the contractions are in high gear. Compression of the umbilical cord can lead to fetal distress. Fetal distress is bad. Stillborns happen because of this.

The low fluid volume was confirmed with a second ultrasound. This meant that the induction of labor was nigh.

I got the standby signal about 12:45 p.m., and then the go signal at about 2:30 p.m. I took a taxi to the hospital and arrived around 3 p.m. (I had run to work that morning, and Amalia had taken the car to the appointment. Stupid logistics.)

Induction started upon my arrival. This was accomplished by the topical application of a cervical ripening agent. I don’t remember the name of this, but it was regarded as a preliminary step before the employment of Petocin. (Petocin, another labor-inducing pharmaceutical, can cause problems that lead to fetal distress, and thence increase the likelihood of a c-section. It was our preference to avoid a c-section.)

I thence took the car back to the house, picked up the hospital bag and other sundries, stopped by QFC en route to acquire some food and cash, then arrived at the hospital. We ate, and switched rooms, and passed the time, and all during this time labor was quietly kicking in.

Waiting for cervical dilation

Labor began in earnest a few hours later. Active labor, with Amalia managing the painful contractions, lasted for probably a total of twelve hours. She worked this pretty well, although during this time it turned into back labor, and the pain got intense enough that she felt that an epidural seemed like a good idea. The epidural didn’t kick in as soon as hoped, but eventually it did, and her contractions were either painless or manageable. Dilation went up to three, and then to four. This was good progress, but not as fast as hoped.

All during this time the nurse was monitoring the fetus’s pulse. If things were good, it was in the neighborhood of 140. If things were bad, it was much lower, in the area of 70 or thereabouts. Initially, the sensors for this monitoring were external sensors strapped to Amalia’s abdomen, but when the fetus’s pulse dipped low, they needed to make sure that it wasn’t just a bad connection and opted to have the sensor applied directly to the critter’s scalp. Yep, they had to reach up there through the dilating cervix and manually attach it.

By this time it was approximately 6 a.m. Everyone was tired. With Amalia on the epidural, it was hoped that she could get some sleep. (Hypothetically, a laboring woman on an epidural won’t feel any pain from the contractions and can even sleep through the process.)

I fell asleep on the bed-like platform reserved for supporting partners. When I woke up, the room was astir, there was talk about surgery, and as soon as I was able to stand up I was being handed a set of scrubs.

Amalia hadn’t received much more warning either. Apparently the critter wasn’t taking to the contractions very well; the pulse was dropping and it was feared that he was undergoing fetal distress. The morning-shift Ob/Gyn explained that they needed to perform a c-section. They said what they were going to do without why they were going to do it, and they weren’t asking for acceptance. It wasn’t emergent, they said, but it was urgent.

From here everything got hopelessly dramatic.

(From XKCD:  http://imgs.xkcd.com/comics/delivery.png)

Like a SWAT team, the doctors and nurses had both of us rushed into the operating room. We weren’t told a lot about what was going on. There was remarkably little preparation — apparently it was easier to perform since she already had the epidural, which made administration of the anesthesia trivial — and I was cordoned behind a hanging sterility barrier which was erected roughly across Amalia’s ribcage. I crouched near Amalia’s head, holding her hand, with the anesthesiologist nearby, who was saying absurd things like, “Okay, you’re going to feel a little pressure”, and “Okay, now you’re going to feel some tugging”, which made the imagination run wild. It seemed like this transpired for only a minute or two until the anesthesiologist said, to me, “If you want, you can watch them pull the head out.”

Whoa.

From the calm, narcotic serenity on my side of the sterility barrier, I stood up and looked over at the doctors and nurses performing the operation, and on the other side of that barrier was The Discovery Channel. Everything I saw was absorbed only in fragments. The Ob/Gyn had her hands inside Amalia’s abdomen, which was now undulating like a half-filled balloon, and blood was gushing, literally a cataract of fluid coming out, and with some groping — to my massive surprise — they yanked (I mean literally, yanked) out not a head, but a leg. This long leg was just pulled out, and these doctors weren’t being gentle or delicate, they were pulling that critter out of there like they were carving a turkey. I caught a glimpse of the umbilical cord, more blood, and the other leg, and the rest of the body came out with a gurgling sound, just in time for Max to vent both poop and pee all over the operating staff, who only laughed lightly at this.

And the hair. That full head of dark hair.

Somehow I ended over at the table with the warming lamp, and there was Max naked and screaming, and his skin was lavender. The nurses made him breathe with an infant-sized mask that essentially performed CPR with a button-activated bump, cooing to him gently, like they were trying to convince him to eat, while they primed his lungs and got him breathing for the first time. Within moments, he had pinked up.

Per tradition, they also let me cut off the remaining excess umbilical cord. During extraction, the operating staff cut his cord to get him free and clear, but there was still perhaps four inches that dangled from his abdomen. The nurses had applied a clamp to the stub right at the belly (see photo above), and yay, it was my privilege to cut off the remaining few inches. It seemed a little ridiculous, just trimming back a few inches of umbilical cord, but I did it anyway — I’ll take part in any way I can — it seemed a bit empty of meaning, not really much different than cutting his hair or trimming his nails. All things being equal, I would’ve rather pushed the button on the CPR mask when they were trying to make him breathe.

They weighed him, they measured him, and meanwhile the operating staff was zipping up Amalia, and Max was brought over to her and placed on her chest, where she could see him clearly for the first time.

So the drama ended there. That was 9:34 a.m. Breast feeding started as soon as we got back to the room, only moments after surgery. Max was placed on Amalia’s chest, entirely ministered by the nurses, while Amalia, still drugged and tired, managed somehow to stay awake while Max received his first nourishment.

Max was routinely breast-fed for the hospital stay, some of which went well, some of which was frustrating. These frustrations led to a couple of bottle-feedings, but largely everything went well. Max was given a hepatitis B vaccine and a hearing test, and was tended to very often. In the evenings I slept at home, coming back in the morning. During this time, Amalia was getting maybe five hours of sleep each night, punctuated every few hours by feedings. Other than the sleep deprivation, the two of them got along famously.

Like mother, like son.

(Trivia: after delivery, a Martha Stewart-esque Lo-Jack device is placed around the baby’s ankle, so that if anyone tries to run off with him, an alarm will go off and the doors will lock down. I had to be similarly tagged with an identity bracelet that identified me as Max’s father. I don’t know how much this is actually a problem, but there’s clearly enough hysteria for the hospital to take countermeasures.)

We stayed in the hospital for three days following the operation, leaving late Monday morning.

More trivia: the nurses won’t let you leave unless you have a car seat.

(Don’t get me started about the absurd, out-of-control situation with child car-seat laws, obviously written word-for-word by the car-seat industry. If the laws get any more draconian, the next logical step would be to require any child riding in a car to be encased in roughly 15 cubic feet of styrofoam — and not just any block of styrofoam, but a safety-certified block of styrofoam that costs a hundred bucks, can only work in one car, and needs to be replaced after only ten uses.)

And that’s it. We arrived home safely. Thanks, obviously, to the car seat. Without the car seat, everyone would’ve died horribly.

The rest is yet to come.

Max likes car seats a lot more than I do.

Hello world!

Friday, May 23rd, 2008

In summary:

Maximilian Leist Magaret was born on 23 May 2008, at 9:34 a.m.

Weight: 7 pounds, 9 oz.

Length: 20 inches

He was delivered via cesarean section after approximately 18 hours of labor. Both mother and child emerged healthy, albeit confused.
The world can be a strange place when you\'ve just been forcibly removed from your mother\'s uterus.

I’m not sure where the shock of black hair came from. I’m starting to regard the UPS man with suspicion.

The name “Leist” is a family name: the maiden name of my paternal great grandmother, and Max is carrying on the tradition of my great uncle, John Leist Magaret.