Kaitlyn's Birth Part 1
Nov 29, 2013 • ∞
When my family gets together for thanksgiving and christmas we always have to set two tables. The larger table in the dining room and the samller one in the kitchen. My parents, grandparents (on both sides), and 3 of 4 siblings all live very close, so one table just isn’t big enough. This year however with a cleverly positioned extension to the table we were able to gather around just the one table. As we all got seated at the table, my mom asked us to go around the table sharing what we were most thankful for. I’d like to share with you what I was most thankful for this year.
Lindsey has blogged very openly and honestly about the troubles and challenges we’ve had in trying to start our family, so I won’t go into all of the details, but I will provide a little bit of background.
When we got married at 21, we agreed on a five year plan: three years for Lindsey to complete her credential program and become tenured, a large summer vacation to Hawaii, and a large summer vacation to Europe, then it would be time to have kids. Lindsey is nothing if not a planner, and it seemed logical and reasonable to me. Unfortunately God’s timing didn’t line up with ours, and when we thought that it had come time, we miscarried. Fast forward to August of this year, and as we pushed past Kaitlyn’s due date we were more than a little bit excited for her to arrive.
On Friday the 23rd, Lindsey woke me up at ~8:30 to let me know that she had been having contractions for a few hours and while they weren’t unbearable yet I should probably work from home just in case. My bosses were very supportive and encouraging, and so we spent the day going for quick walks in the neighborhood and tracking the time between contractions hoping that the time would come at any moment. Rather than use any number of free or cheap apps to track the contractions I quickly wrote a few Drafts actions to update a simple text file in Dropbox. It wasn’t particularly efficient, it ended up not being particularly accurate, and it didn’t make it easy calculate the gap between contractions, but looking back on it now I think it helped me stay focused and calm by giving me a little sort of logic puzzle.
That afternoon we had a monitoring appointment scheduled, just to check in on the baby (she wasn’t yet ‘Kaitlyn’ as we hadn’t decided between two final names yet) and we took all of our stuff in with us, hoping that when they began monitoring they would say “Oh! these contractions are close enough and strong enough that we should just go ahead and admit you!”. Sadly it wasn’t yet time, and so we went home to keep tracking the contractions. It wasn’t until later that night that the contractions started to get significantly tougher on Lindsey, and I did the best I could to help in any way I could. We found that by standing behind her and pushing her hip bones together it helped diminish the pain somewhat (a move that we learned in one of the many Kaiser classes we attended1).
Sometime around the middle of the night we decided to call the Labor and Delivery team and get their opinion on the contractions and whether we should come in. I made the call and spoke to the nurse, and she didn’t seem particularly interested in talking to me and so she advised us to labor at home as long as we possibly could as it would be more comfortable then in the hospital, and Lindsey’s goal was a completely natural childbirth. At this point we were just laying on the floor in the living room while the Friends marathon continued to play in the background, so Lindsey decided we should try to sleep in our bed for awhile. I was able to catch an hour or two of sleep because Lindsey decided to let me and so didn’t wake me up with each contraction even though she herself couldn’t sleep through them.
By 5:00 in the morning the contractions were bad enough that after Lindsey called the hospital and talked to a nurse we loaded up and headed into the hospital. We were fortunate enough to be arriving just as Lindsey’s (I developed a tendency to call her “our”) OB/GYN was just finishing her shift and was able to check her out. She was only at 4 cm but that was good enough to get admitted and stay in the hospital. Over the next several hours we hung out, walked around the Labor and Delivery ward and worked with the nurses and midwives to try and get the heartbeat monitor to work consistently. It never really did work all that well for us, and there were periods of time where they asked us to stop walking around so that they had a better chance of getting decent readings. The concern is that the strain of labor can put the baby at risk and so they want to know if they need to move to more drastic measures.
At approximately noon we were told by a midwife that Lindsey was dilated to 6 cm which meant we could move rooms and Lindsey could labor in a tub of warm water. Kaiser doesn’t currently have tubs that you can deliver in (both Lindsey and I didn’t think we could handle a water delivery anyways) but you can labor in a tub as long as you’re advanced far enough. The concern is that laboring in water can slow the labor process down, so if you’re not far enough advanced it can actually stall out your labor. Up to this point labor hadn’t really been that bad, and Lindsey was working her way through the pain like a champ. I kept coaching her to take deep even breaths in, and then to gently breathe the pain out. This was a mantra that I would be keeping up for quite awhile.
After a few hours (we can’t remember exactly when) we were told by a midwife that Lindsey was now dilated to 8 cm! We were really excited at this point as it meant that we were into the hardest part of labor (transition) and Lindsey was still handling the pain and discomfort really well. 10 cm is fully dilated, so it also meant our daughter was just around the corner.
Up until this point, I had never had any major issues with any of the Labor and Delivery staff or any of the midwives. Oh sure, I had groused during some of the classes about the quality of the teaching, and I STILL think that calling the act of being a midwife midwifery (pronounced mid-whiff-ery, seriously I’m not making it up) is one of the dumbest things I’ve ever heard, but truthfully everything had gone pretty well. We’d been through a number of nurses with shift changes, and now we had a new midwife as well. It was 6:00 PM and it had been several hours since someone had checked on Lindsey to see how dilated she was and she was no longer laboring in the tub as we thought we were getting near the end and the tub had cooled down.2 The new midwife checked Lindsey and stated quite simply that she couldn’t “give her an 8” in her estimation Lindsey was dilated to 6 cm, maybe 6 and a half.
I think that this was the moment (and not unfortunately the last one for me) where the air seemed to be completely sucked out of the room. I didn’t have any kind of response initially and wasn’t sure how to help Lindsey as she was almost inconsolable. Pretty quickly though I was angry. Angry at the earlier midwife who had been “generous” with her assessment. Angry at the new midwife for dropping what amounted to a nuclear bomb in the room with an unbelievably casual lack of regard for its consequences. Ultimately angry at the entire medical establishment in general, and Obstetrics in particular. This was also when I learned from the nursing staff who were trying to be helpful that “measuring dilation is very subjective”. We requested that a doctor verify the midwife’s assessment and he concurred, 6 or 6.5 cm at most. So to recap what I had now learned - this “test” is done by the doctor or midwife inserting their hand, spreading their fingers, and ESTIMATING the distance. I’m frankly still angry that we can put a man on the moon but can’t reliably determine how dilated a woman in labor is.
As we tried to collect ourselves the nurse and the midwife began to recommend an epidural to manage the pain and pitocin to kickstart the labor. Apparently when you kickstart labor with pitocin, it comes on more suddenly leaving you less able to cope with the increased pain - hence the recommendation of an epidural. Unfortunately we know someone who had a bad experience with an epidural, and we already know from past experience that Lindsey does not handle pain medication very well - she ends up very unhappy. We really wanted to eliminate anything that pose even the slightest risk, even if it was statisticaly improbable. Fortunately we had one additional option, although the midwife was very dismissive of it, believeing it wouldn’t be enough. They can manually break the bag of waters3, which can have the effect of dropping the baby lower and speeding up labor.
Lindsey and I talked and while I let her know that whatever she needed she could have, I believed that she was strong enough to continue on without the epidural and that the biggest hurdle so far had been the emotional pain brought on by the misguided generosity of the earlier midwife and the insensitivity of the current midwife. The physical pain had been relatively manageable. She agreed and so we presented what I believe to have been a very reasonable plan of action and one which the midwife or nurse should’ve recommended rather then trying to force us to use pitocin and an epidural. We would have the midwife break the bag of waters and if that didn’t move things along quickly enough we would have them administer pitocin. If we had to administer pitocin and the painw as too much THEN we would get an epidural. If I may digress for a moment - the nurse tried to enlist my mother-in-law into a pseudo-conspiracy to try and convince us that it really would be better to just get the epidural. I know that sounds melodramatic, and my mother-in-law can call me out if my memory is turning this into more of a soap opera than it really was, but it felt to me like they were tired of the long labor (at this point over 20 hours active and over 34 hours awake) and just wanted it over.
Once the bag of waters was broken things really kicked off. The pain got much more intense for Lindsey and it seemed like one contraction would barely be over before another one was on top of her. She argued back with me about how well she was doing which she hadn’t done earlier, and at times it didn’t seem like she was able to focus enough to get her breathing under control. I believe that the extra time wasted in labor thinking we were almost there and the potential impact of moving into the water earlier than we should have (man I love generous midwives) had simply drained her of too much energy. Fortunately there was another trick up these doctor’s sleeves, an option that hadn’t been discussed much earlier. Fentanyl. A quick acting narcotic that wouldn’t stay in Lindsey’s system (at these dosages) long enough to pose any substantial risk to the baby.
The fentanyl proved to take just enough of the edge off that Lindsey could catch her breath inbetween contractions and while I don’t think she actually slept between them, she was able to close her eyes and seemed to relax just enough. During this period in the process time doesn’t really have any semblance of meaning for me, but I do know that the first shot wore off, and they gave Lindsey a second one. That would be the last medication Lindsey needed to get through childbirth. About one hour after breaking the bag of waters, the midwife came in and checked on Lindsey and reported definite progress. One more hour later and at 3 AM on August 25th, Lindsey was finally dilated to 10 cm.
Even at this point the midwife was stil not particularly helpful she told (and not particularly quietly) my mother-in-law that it could still be several hours before the baby came. Both Lindsey and I heard this and neither of us was appreciative. Lindsey however was determined to prove her wrong. All of the family that was still in the room left for the waiting room at this point as our plan was to do delivery on our own as a family, welcoming our daughter into the world and then spending some time just the three of us getting to know each other before finally deciding on a name. The midwife had Lindsey change positions in order to expedite pushing, and with the next contraction told her to push. I’m certainly no expert in how these things are supposed to go, and I thought for sure that I would want to stay up by Lindsey’s head throughout the delivery portion of the process, but I didn’t and even I was impressed by how effective the first push was. The midwife who had been so sure that we would need pitocin, and then so sure that it would take hours before the baby delivered suddenly excused herself from the room to go change and come back with the necessary tray and tools for delivery.
The delivery itself was an amazing and unbelievable experience. Lindsey says she never “felt the urge” to push but she was able to go from being declared 10 cm to successfully delivering our daughter in almost exactly an hour. At 4:18 AM on Sunday the 25th of August our daughter came into the world. This was the first thing that I was thankful for this year.
There probably weren’t really that many, but in my opinion not all of the teachers were very good at teaching. I think a lot of people just assume if you know the subject matter sufficiently well then you can teach, but having a wife for a school teacher and having gone to school to become a teacher myself, thats just not true. ↩
Sadly we were never able to figure out how to get it heated back up. I’m still not really convinced the staff tried all that hard, supposedly they called a technician but to my recollection no one ever came into the room to check on it. ↩