Friday, April 22, 2011

Labor and Delivery


My next appointment was at 37 and 5/7 weeks. I think Dr. Wang was surprised to see me come in since she had done some work to try and strip my membranes the weeks before. Following that appointment I had some seriously uncomfortable contractions that she told me were probably labor pains and that if that happened again I should be sure to come in to Labor and Delivery. She told me that I probably had a high pain threshold since I had been enduring contractions for so many weeks and she was worried I would show up to the hospital on the verge of delivering. I thought to myself that it was a nice compliment, but with how uncomfortable I was feeling with the standard pregnancy pains I figured I probably didn't have as high a pain tolerance as Dr. Wang assumed. At this appointment things were still right on target. My fundal height was increasing which meant that Baby Girl Bell was still growing and doing well. My cervix was very soft at this point and dilated to a 2. Dr. Wang said she was going to put 1 1/2 in the notes so that if I did go in to labor it would look like I was progressing and they wouldn't send me home. Once again she tried to help move things along by stretching the cervix. I left Dr. Wang's office figuring I was most likely going to be seeing her the following week on my scheduled appointment the day before my due date. I felt fine the rest of the day and was somewhat disappointed at not having any contractions that felt close to the way things were last time she tried to stretch the cervix.

There are plenty of methods suggested to help induce labor. I started to think more seriously about some of them, though there are some rather common ways that people use, but that I would steer clear from. Namely, castor oil. I didn't want to be in labor and have diarrhea at the same time. The one rather benign method that seems to have some of the best outcomes is simply to walk. That afternoon Chris and I took a walk around the apartment complex and went up and down the stairs at all of the buildings that had 3 flights. It wasn't anything more strenuous than the elliptical or stationary bike, but I figured it was worth a shot. Once again Chris and I said our prayers and went to bed with me still pregnant.

At about 2:45 the next morning I woke up to go to the bathroom and was having another one of my middle of the night contractions. I went back to bed and quickly fell back to sleep. Only a couple of minutes late I woke up again with another contraction. A few minutes after my uterus relaxed I got a contraction that was remarkably strong and lasted for what seemed like at least ten minutes. I thought that I would wait an hour and see if things kept up. I didn't want to wake Chris up unless it was necessary. However, after waiting about 10 more minutes I couldn't help it and I woke Chris up. I told him 'I think I'm in labor'. I thought he might be more sleepy, but he responded appropriately and asked if I was sure. I laid in bed 'making sure' while Chris quickly packed a bag of stuff to take to the hospital. With Chris being a physician and having experience with the birth process he checked my cervix to see if anything had changed. He supposed me to be at about 3 cm dilation. As we were driving to Fontana the contractions were a dependable 3 to 5 minutes apart and were getting stronger.

Because it was the middle of the night we had to go through the ER. We wandered through the halls trying to find our way to the elevators that would take us to the third floor. The contractions were now strong enough that I couldn't walk when they hit. With some directions from an employee we made it to the check in desk on the Labor and Delivery floor. Now that talking was out of the question with each tightening of the uterus Chris did most of the talking and answering questions. We got our name bands and only had to wait a minute until the triage nurse came to get us from the waiting room. In triage I changed into my gown and shed my maternity clothes for what I figured to be the last time. As it is with the Kaiser Permanente system we had to go through all of the processes to make sure I was in labor. I was connected to the monitors and answered all the necessary questions. By this time there was no doubt in my mind that Baby Girl Bell was coming today.

The contractions had become remarkably painful and I now had a one track mind as to how quickly I could get an epidural. I was surprised that couldn't walk, or talk, or hardly even breathe with each contraction. I would hold my breath and cringe through each minute long tightening. At times I started to get lightheaded and see spots because I held my breath for too long. I never bothered with lamaze knowing that most women threw it out the window once labor ensued. I did need some reminders to take a breath, though. My eyes stared at the monitors watching the numbers and graphs. Dreading when the numbers would start to go up and the line on the graph escalated, and waiting desperately for the second when the numbers started to decline. Though it's all relative, occasionally the line on the graph would completely max out the height it could go, and I felt like I was maxed out as well. On top of the contraction pain, my irritable uterus didn't want to relax completely between each uterine spike and I felt like I didn't get much of a reprieve for the 3 or so minutes before another one came on. Chris was wonderful and supportive, even though there wasn't much he could do. I was one of those that didn't want anyone touching me while I was in pain. The nurse checked my cervix and found it to be completely effaced and at 4cm. Things were moving along. I laid in the triage bed staring at the television watching whatever channel the previous occupant had left it on, waiting impatiently to go to my labor and delivery room.

Finally (because all pregnant women are somewhat impatient), we walked to the room we would spend the majority of the day in. We once again went through the whole rigamarole of getting settled. The contractions now felt so strong I thought for sure Baby Girl Bell was forcing her way imminently. I have never felt any pain so exquisite as being in labor. My uterus felt like it was in one long contraction with waves of dramatically increased pain. I couldn't help but grunt and moan. I was surprised how well the actors on tv and in the movies got the laboring woman role right. As Chris stood at my side, helpless to do anything to ease the pain he was anxious for the epidural as much as I was. The nurse informed us that we were 'next in line' for the anesthesiologist. NEXT IN LINE!?!? I figured that if it took a half an hour to start an epidural on someone else that meant I would have to endure 10 more contractions before any relief came. I asked if there was more than one anesthesiologist who could come. The nurse left the room to check to see if the on call anesthesiologist was available. In my helplessness the next few contractions seemed overwhelming and both Chris and I were momentarily overcome. I couldn't fathom how any woman could, or would want to, go through labor without any pain control.

Thankfully the on call anesthesiologist was open for business and close by. He immediately became my favorite person (as I'm sure happens with most laboring women). I had seen many epidurals and spinal blocks while working in the operating room and so felt comfortable with the whole process. Kaiser rules are that no family members are supposed to be in the room when the epidural is given, most likely due to past mishaps, but with Chris being an employee and a physician he was able to stay as long as he remained seated the entire time. The epidural went smoothly and started working quickly. Over the next half hour the strength of the contractions abated and I became amazingly comfortable. My legs became warm and tingly which made me feel warm and tingly. I loved it. Some women hate that sensation and the fact that you can't move your legs very well, but it was just about as good as being in a spa. I felt that relaxed. A few more procedures later: catheter placement and checking of the cervix, I found I had progressed quickly to 6 cm dilation. It was only 6 in the morning and I was sure Baby Girl Bell would be here before noon. Chris finally had time to go move the car from the emergency room temporary parking and grab our bags.

Throughout all of the morning commotion Baby Girl Bell had shown very resilient. Her monitoring strips looked great without any signs of distress. However, as is common with the administration of epidurals, the strength of my contractions lessened, though they were still 3 to 5 minutes apart. Without the pain of the contractions both Chris and I could breathe easier and we had some time to hang out and enjoy our last time as a family of two. We talked about what names we were thinking of. Our list consisted of five names: Maylin, Katelyn, Naomi, Emersyn, and Maren. We still hadn't decided and it was coming down to the wire. Still, we couldn't choose without seeing her in person. While I sucked on ice chips Chris went to the cafeteria and got some breakfast. Strangely enough I wasn't even hungry.


We had packed some things to keep us busy while the labor progressed, but weren't interested in doing much. We called my mom and let her in on the big news so she could start looking for flights out. Not more than a couple minutes later I got a text from Richard wishing us good luck with the delivery. Wow, news sure does travel fast. After a couple of hours I was dilated to 8 cm but my water still hadn't broken. The nurse said she had a few things to do and then would get the nurse midwife to come and rupture my bag manually. Another two hours later they showed up to get things moving along. I was now nearing 9 cm and figured things would be quickly once my water was broken. The large warm gush was followed by continuous smaller pockets of fluid and leaking of water, which I wasn't a huge fan of. Along with the continuous wetness, a side effect of the epidural is involuntary releases of gas. It made for some awkward moments as well as a few funny times. I told Chris that if he was ever feeling bloated getting an epidural will make it easy to release the pressure.

With the passing of time the effectiveness of the epidural wore down, even after pushing the bolus button. I was in need of a topping off. The anesthesiologist that came in did a great job and sending me back to the 'spa' and I settled in for another few hours of laboring down. Two hours later, at about noon - when I was expecting to have delivered, the nurse checked my cervix again. I was completed, meaning 100% dilated and effaced. The only problem is that Baby Girl Bell wasn't moving down the birth canal. The continuing pockets of fluid being released meant her head had not yet sealed off the opening by progressing through the pelvis. The nurse gave us another hour to see what would happen and then we would start pushing. I again petitioned the anesthesiologist for a small topping off. I didn't want to have to feel more than what was necessary once Baby Girl Bell actually starting making her way out.

More than an hour later there was no change in progression. So, the pushing began. The nurse gave me a quick tutorial on how to push effectively. My first attempts were pretty useless and sad. The topping off of the epidural had left me more numb than ever and I couldn't feel what I was doing. The nurse kept telling me not to push with my face but it's pretty hard to have a relaxed face when every other part of your body is tightened. For the next hour I made steady progress. For each contraction I pushed 3 times for 10 seconds each push. The last of the three was more like 7 or 8 seconds and was pretty much all 'face' pushing. To keep Baby Girl Bell's heart rate where we wanted it I was put on oxygen via an O2 mask. This made the breaths I was supposed to take between pushes difficult and I felt more like I was rebreathing my own carbon dioxide each time I sucked in. The combination of the oxygen mask and the heavy breathing made my mouth very dry and ice chips just weren't enough to keep my mouth from feeling like the Sahara Desert. Chris was standing on one side and had the job of holding one of my legs up and in while I held the other. Sometimes Chris got distracted looking to see what was going on down below. Because Baby Girl Bell was taking so long we assumed that she was not going through the birth canal face down like is standard. This made complete sense since the last month of my pregnancy I could tell from her movements and kicking that she was vertex and turned a little bit to my right side. As Baby Girl Bell's head moved down and the opening expanded Chris would give me updates as to how much of the head he could see. Ever so slowly she made her way down until she was crowning and her head was partially sticking out. The nurse practitioner suggested that we think about an episiotomy. Not having thought about that before and with Chris' suggestion I decided to keep pushing for a while longer. The labor and delivery nurses shift was over more than 10 minutes ago and the baby nurse was waiting, what I felt to be impatiently. I felt a lot of pressure to get the baby out so when the nurse practitioner told me that the vaginal opening just wasn't big enough and that Baby Girl Bell was compeletely out of the birth canal but the tight skin was holding her in, I decided to go for the episiotomy. On the next round of pushes our beautiful Baby Girl finally gave up the womb and entered this world... Our wonderful crying bundle of joy.

Somewhere in the flurry of activity after her arrival Chris cut the umbilical cord and our Baby Girl was placed on my chest. She cried vigorously and I loved the sound of her voice. She was roughly dried off and I held her for a couple of minutes before she was taken by the baby nurse to weigh and measure her. I couldn't believe she was finally here. Chris being the dutiful dad stood close by our baby snapping pictures and taking in the moment. Baby Girl Bell weighed in at 7.0 lbs and measure 20.5 inches. Her tiny head of 13 inches would have easily come out if she was facing the right direction.







I was stitched up and cleaned up before Baby Girl Bell was returned to me. Chris, Baby Girl Bell and I sat in the bed together enjoying the standard hour of family time the hospital gives to new parents. We loved her so much after only knowing her for a couple of minutes. Not sure how to go about it we tried breastfeeding and it seemed to go okay. Chris and I examined our gorgeous baby taking in every moment of this new life together.




Once our postpartum room was ready we were taken down the hall and deposited in what looked more like a closet than a hospital room. Knowing from the hospital tour that the rooms were small I don't think we were quite prepared for what the next couple of day s would entail. We squeezed our stuff into the room and got settled. Nurses were in and out giving me ice packs and changing my pads, checking on our baby and going over paperwork, etc. Every two hours or so I would work on my breastfeeding skills. It seemed like Baby Girl Bell was latching and eating, but I quickly became very sore. Being a new mom I knew it would take time. Baby Girl Bell was cleaned and given her vaccinations and settled in for a quiet nap.



My mom had taken an afternoon flight that landed about 4 pm, just 20 minutes after our baby was born. Not having had much to eat the entire day she brought with her some much needed food. The hospital only brings food at meal time, which left much to be desired, and didn't provide any snacks. I felt like I had to survive on water and orange juice. The gorgeous bouquet of flowers she bought took up half the room. She was so excited to be able to hold her new grandchild that was only hours old, something she hadn't yet been able to do.



Because of the epidural every time I wanted to get up to the bathroom I had to call the nurse for help. After about 9 hours of having the catheter out I hadn't even felt an urge to go urinate. I thought for sure with all the fluids they were pumping in me I had a full bladder. However, no matter how hard I tried I couldn't go. After 10 hours the nurse had to catheterize me. This was extremely painful due to the trauma from the birth. I had multiple tears and lots of swelling that made the regular size catheter too difficult to insert. A smaller catheter was used, but didn't have the capability of being an indwelling catheter. About a liter of fluid was drained, but I hadn't even felt like my bladder was full. Chris and I figured that some of the nerves were temporarily stunned from the head passing through the birth canal. The nurse turned up the fluid going through the IV in order to stimulate the need to go to the bathroom.

Throughout the night I nursed Emersyn whenever I thought she seemed hungry. And, like everyone said it started to hurt. I figured that the swelling on the right side of Emersyn's face kept her from opening her mouth as wide which made latching more difficult. Being a first time mother is difficult enough and breastfeeding wasn't a smooth ride at all.

In the middle of the night I rushed around our tiny room feeling like my bladder was going to explode, trying to get the IV pole through small spaces to get to the bathroom. However, things still weren't working right and nothing came out. I called the nurse in to start a catheter again. However, with the increased swelling things were even more difficult than the first time. After a few attempts and some help from Chris, who was holding the flashlight and directing, and another nurse I finally got some relief. I was worried that extreme measures would have to be taken and I was nervous and extremely uncomfortable.

The bladder fiascos combined with trying to nurse Emersyn made for an extremely rough night, not to mention that we were rooming in a closet between two labor and delivery rooms where laboring mothers were heard through the night. The next morning Chris' fellowship friends showed up. It made me realize how much new mothers probably don't want anyone seeing them the first day post-delivery.

I opted to stay an extra day in the hospital with a catheter in just to make sure everything was okay. Chris and I spent the day sleeping off and on and trying to figure out breastfeeding. Emersyn was as adorable as ever and we took turns holding her. I just wanted her close to me as much as possible. Chris even joined us in the hospital bed for a family nap.




We were notified early that first morning after Baby Girl Bell was born that the people over the birth certificates were going to be coming by so they could make the official record and needed the name form filled out. Chris and I still hadn't decided on a name. We had it narrowed down to three from our five that we went in to the hospital with: Maren, Maylan, and Emersyn. Unlike what we had hoped for, Baby Girl's birth didn't give us an epiphany as to what her name should be. We had both agreed that Elizabeth was what we wanted for the middle name, the same as mine. Chris and I talked for a bit about how we needed to decide on a name. We kind of sat there for a minute, quietly, and then Chris said how about Emersyn, Emi for short. Going in to the hospital I was secretly leaning toward that name and instantly agreed. But how about the spelling. E-m-e-r-s-e-n, or E-m-m-e-r-s-o-n? As is the spelling that originally got the name on the list we went with Emersyn. After thinking about the name later I realized that two of the criteria for which I would pick a name were not met. I wanted a name that was easy for others to spell so she wouldn't be correcting people all the time. There are so many ways to spell Emersyn, and with the 'y' being at the end, she is sure to be getting some incorrect spellings from others along the way. And, I preferred a name that was clearly male or female. In my mind Emersyn seemed all girl, but I realized later that it could easily be a boys name as well. Nonetheless, the name Emersyn Elizabeth Bell suited her perfectly.

The second night wasn't much better as far as sleep and laboring women go, but was glad for the extra help with breastfeeding. Emersyn had lost a lot of weight, going from 7 lbs at birth to 6.5 lbs in two days. It is normal for babies to lose weight when they are first born and before the mother's milk comes in. However, Emersyn had lost as much weight in two days as most babies lose in two weeks. We had so supplement with formula and an supplemental nursing system (SNS) which consisted of a reservoir of formula hooked to my bra strap with a tube running down that went into Emersyn's mouth. The contraption was cumbersome and we were told to feed every 2 - 3 hours, even during the night. With Chris' help we made it through the first two weeks until we were able to get a lactation appointment.



Being cleared to go home was wonderful. It was my first time being a patient and I could understand completely why everyone is ready to leave, even if they have to come back the next day like we did to get Emersyn's weight checked.


The prospect of going home is a little more daunting when it comes to the responsibilities involved in caring for a new life. In all my meticulous planning I hadn't packed an outfit for Emersyn to ride home in. My mom picked out something cute and made sure to bring a blanket (another item that slipped our preparations). I had, however, installed the car seat and reflective mirror a week earlier. It was still strange to be putting her in and strapping her down. As a new parent I was worried about her warmth, breathing, comfort, etc. But I was more than happy to have these worries if it meant that Baby Girl Bell was finally here.