Thursday, November 19, 2015

Birth Story Part 5

**Note: This post and Part 6 both contain pages from Alex's birth story book. In case the text on those pages is too small, I've included it a little bigger underneath each page.

I started pushing at 12:30am on August 5, and pushed for 2 ½ hours. The whole pushing phase carried this odd sense of urgency. I mean, again, it took hours, but it felt comparatively short because it was like I was solving a long series of mini puzzles: how to get through this contraction, what to do before the next contraction, how to breathe more effectively during the next push, how to adjust my pushing techniques for the next push, etc. I was very engaged and focused on those kinds of things the whole time. It’s a strange phenomenon, being focused on a “project” like that but also not having a lot of control over when everything will be finished – having to have the endurance to stick it out until an unknown finish time, but being so focused that you’re concentrated a bit more on the puzzle of the moment than you are on the finish line.
I never had an instinct to push, the nurse just told me it was time. Actually, she said, “It will be time soon, let’s do some practice ones.” I was on my right side at that point, and she wanted me to roll to my back. I told her I didn’t want to push on my back because it hurt too much to lie on my back right then, so I suggested I try it on my side first since that was where I was. She said it would be much easier on my back, so I just said, “Well, can we at least try a couple times on my side, and then if I’m bad at it, we can move to my back?” She agreed and we got started. (My back did end up being easier, but I did plenty of side pushes, too, since Alex needed some positional help moving down as well.)
I was feeling the contractions really strongly during the pushing phase, and the main physical reason I pushed (aside from, obviously, to get him out) was that, for some reason, working my abs negated the feeling of the contraction, and it was a huge relief. Occasionally, the nurse would tell me to give the baby a rest and not push through a contraction here and there, and those ones really hurt (similar to the ones I was having on the way to the hospital, and right before I got the epidural.) My mom said I acted way more in control than I had pre-epidural, though. I think I had had a lot more practice by that point, and also I had endured enough pain by then that I had a different scale for what was really bad. I was doing tons of low-voice breathing. Additionally, the nurse told me not to use the epidural clicker anymore. I had been hanging onto those fifteen minute intervals like a lifeline, but like I said, I couldn’t really feel anything different from the supposedly increased meds anyway, so maybe it didn’t matter. I was supposed to lay off of it because they wanted me to be able to feel when to push better, but more importantly because Alex was taking his time coming out in part because they said the medicine was chilling him out a little, so they also wanted him to be more active in helping himself get out. This did, however, make things a lot more painful throughout the pushing phase, because if I wasn’t actively pushing, I was fighting the back pain. So, no breaks; never not painful. Great. It was a marathon.
I was wearing both a contraction monitor and a fetal heart monitor at this point. They were having some trouble getting the fetal heart monitor to work at first, because he had dropped so low, so they asked if it was all right to put an internal fetal heart monitor on him. I said yes, and the minute that went on, I asked if they could take the external one off. One of the monitors was right over the spot on my abdomen that correlated with my back pain, so it had really been hurting.  Especially when Jon and my mom would push my legs up, it would squish the monitor onto my stomach. Thankfully, they agreed and took that receptor off, which was great.
Right around this time, Alex’s heart rate started dropping sometimes during contractions, so they gave me an oxygen mask, which helped a lot. When his heart rate dropped, the nurses and doctors would tell me in very urgent tones to “breathe in! breathe in!” or “roll over! roll over!” My mom felt like that was a bit panic-inducing, so she decided that was a job she could take over (“I didn’t need to hear a doctor or nurse freaking everybody out. I looked over at the monitor myself and thought, I can control this.”) She used as calm a voice as she could and would make suggestions like, “Put your arm over here and grab on to this thing.” When the doctors and nurses would say things roughly, it just made me annoyed (especially if it was something physically difficult to do) until I realized that their tone of voice meant that I needed to do something quickly. It was much easier to follow Mom and Jon’s instructions when they were nice and calm about it, and by that point, I knew that everything needed to be pretty quick.
Effective Pushing and Getting Oxygen to the Baby: Video Games and Choir Classes
Breathing through the oxygen mask was tricky! At least, breathing in a way that gave him the most oxygen was. The heart rate monitor was situated behind my head where I couldn’t see it. Thankfully, Jon and my mom started telling me the heart rate readings, which was great because it meant I could be more goal oriented with my own actions. (This was good for both effectiveness and for a focus to distract me from the pain.) Knowing the heart rate allowed me to try to ‘beat my score’ with different techniques – it was nice to be able to focus on whether this breath or that breath made his heart rate come up highest the fastest, etc. (I also do this when I donate blood. It’s awesome to go with a partner and then race to see who can bleed the fastest. Haha.) It was interesting to try to balance my own experiments with what people around me were saying.
I felt like his heart rate went up more efficiently when I breathed through my mouth, and it seemed like the nurse usually got frantic when I was breathing through my nose and out through my mouth. OK, check. Mouth breathing it is. However, when I breathed through my mouth, people would say, “No, no! Through your nose!” That was confusing and provided me with a challenge;  I had to try to figure out if there was a way to breathe through my nose that would be better than both my current nose breaths AND my more-effective mouth breaths. That’s when I remembered the whole diaphragm breathing technique you learn in choir – to take a good, deep breath in choir, they teach you that your belly should expand and your shoulders shouldn’t lift. It’s counterintuitive to what people often think, but it’s much more effective. I was actually already kind of trying to do that, but at this point, I focused on expanding my diaphragm as much as I possibly could with each breath, instead of just sucking in a lot of air. It worked really well.
Pushing, Etc.
This section was too hard to organize, so it’s just a list of thoughts and observations to do with pushing.
  • The doctors and nurses were great about keeping me informed about more significant developments or issues as they arose. (There were some things I would have liked info about that they didn’t keep me informed about, but they were generally small things where I probably needed to have been a more proactive question asker. Stuff that not everyone is going to care to know.)
  • The doctors and nurses were also so respectful about answering my questions or presenting information to my face. It sounds a little weird now that I’m talking about it, but communication during delivery could easily devolve into calling back and forth to each other from one end of the bed or the room to the other. The nurses and doctors were great about coming up to the head of the bed and discussing things with me next to my face, where we could make eye contact and have a conversation. It made it so neither of us was preoccupied and we could both pay attention. It would also have been easy for them to just ask Jon about things, since he is the one already at their eye level (you know, they’re both standing and I’m lying down), but they made sure to clearly address me when they were talking about my body. Jon and I were both really appreciative of their considerate communication tactics.
  • I remember being so, so tired here and there. It was getting late and I felt this weird combination of exhaustion and adrenaline, mixed in with the whole ‘no choice but to stick it out’ thing. I remember wishing pretty fervently for things to be finished, but it was less because of the pain in and of itself, and more because I was so tired that I didn’t feel up to the job of dealing with the pain and exerting myself to push. Kind of like at the beach, when you get knocked down by a good wave that shoots some saltwater up your nose – you need a minute to recover, but you’re still in the water (strong currents and all) and the waves don’t stop. So you have to kind of recover at the same time as you handle each wave.
  • It’s true that when you push, baby isn’t all that comes out! You just basically get cleaned out of everything that's in you. That was a little embarrassing, but honestly I was so absorbed in everything else that it wasn’t nearly as big a deal (especially because, with the epidural, I couldn’t feel it.) The nurse was awesome about cleaning things up super efficiently all along the way, so I didn’t even have to be all that cognizant of it. Even better, getting cleaned out during delivery meant that I got to recover for a few days before I had to deal with that process again, post-stitches.
  • No one really coached Jon on how to help me push. My mom remembered things that my dad did to help her when she was giving birth, so Jon learned some techniques from her (as far as how to hold my legs, cupping a foot in their hands so I had some leverage to push off with, etc.,) but it would have been nice to get more training on how to coach someone who does have an epidural.
  • The ice chips were great during pushing. The nurses were awesome about refilling my bucket of ice for me. (I craved ice like crazy during my third trimester, and that didn’t go away until after my recovery.) Jon gave them to me in between each contraction, which was a little complicated because I had to move the oxygen mask out of the way every time. At first, I would make sure to swallow before the push, but then I realized that it really helped to have ice still in my mouth while I was pushing because it gave me a focal point other than the push itself. It was especially helpful during the contractions where we were giving Alex a break, because those were incredibly painful and it was REALLY great to have something else to focus on. Like ice cream after a breakup!
  • One nurse kept wiping my forehead, which was super irritating. Woman, I put makeup on before I came here, please do not wipe it off. I told her to stop, I told her it was uncomfortable and I didn’t like it, but she kept doing it. She kept making jokes about how she was ‘keeping me awake’ (I was awake!) or ‘making me angry so I would push harder.’ What?? No. I tried to take the rag and put it on my neck, which was actually both helpful AND left my makeup alone, and I TOLD her I wanted it on my neck, but she was undeterred.
Pushing: Techniques and the Episiotomy Decision
The nurses’ encouragement was a little confusing and frustrating on a couple of points. It was frustrating when they wanted me to push again right on the coattails of the previous push, before I had time to take another breath. I understand that when you stop pushing, you lose some ground and the baby sucks back up inside a little, but guys: pushing again immediately was literally impossible without time to get a breath. My mom also wanted to lecture them about it with all the things she never said to the nurses while she was having babies, but I guess she decided not to. Haha. She made a good point that they can see the baby moving back, so that’s why they get so adamant. But still.
For me, deciding how hard to push was a balancing act. I have always heard the ‘no purple pushing’ advice (pushing that hard typically makes for more tearing, and also you can pull muscles inside apparently, so anyway: the point is, they say to not push too hard.) I think they even taught us that in the hospital birth class. However, either no one told the nurses and doctors, or it was important for Alex’s health that he come out quickly -- they kept urging me to push harder, harder, harder every time. Maybe they thought it was encouraging? Or maybe there was urgency earlier on and not just toward the end? I wish I could have had more information in the moment about their motivation. Next time, I’ll ask.
Anyway, I pushed as hard as I felt like would be okay without overdoing it until, toward the end, the doctor came up to talk with me and said that they were concerned about his heart rate, and that they needed to get him out fast at this point. I think I had a small handful of options (they might have suggested a vacuum), but the ones I remember were that I could get an episiotomy or I could just do some crazy hard pushes. From our research (and the birth class or the doctor or someone), I knew that an episiotomy is usually something to avoid if you can. From what I can tell (someone feel free to correct me if I’m wrong – this was just our understanding), the main reason is that if you tear, the result is typically several smaller or more shallow tears in naturally smaller/weaker points in the muscle or tissue. Alternatively, an episiotomy is one or two scissor-cuts in whatever places make it easiest for the baby to come out. The cuts are (typically, not always) deeper and could be through thicker, more difficult-to-heal muscle areas (since it’s not the place you naturally would tear), so the healing process can take longer and be more painful.
In the end, in the interest of getting him out, I opted to overpush and take the consequences. Once I was in that mindset, my mom could feel it in my legs when I did really powerful pushes, which I was kinda proud of. Jon couldn’t feel it, but he could see it. So that was cool.

I was engrossed in the zen/pain (zenpain?) of pushing around 2:30a.m., when suddenly my room flooded with people in blue scrubs. I was so absorbed in the endurance-y, minute-to-minute focus of the pushing phase that it seemed completely unreal to me that the end could be anywhere in sight – I thought it best not to believe it, so I wouldn’t be disappointed if I was still pushing a week later.
The nurse came in and started getting a warming bed ready for Alex, which was weird … To think my stomach will need an independent place to warm up! Someone put my legs up in these individual … leg bed things, and then dropped off the end of the $50k bed I had been laboring in. (A far cry from the metal table my mom says she delivered me on.) The doctor got down where the action was for awhile. It was around this time we had the episiotomy discussion.
So then, I pushed my mighty pushes, and after not too long (around 3am), they told me he was crowning (thankfully, the epidural eliminated any Ring of Fire sensation I might have experienced.) Jon had seen some bottles of a sterilized, food-grade oil sitting off to the side earlier (he thinks it was linseed oil), and the doctor poured the oil on Alex’s head while he was crowning and worked it around the edges to help him come out. Mom saw a little of that, but she was so afraid that I would rip and that it would be terrible to watch, that she mostly stayed out of the way. Jon mentioned that everything looked so stretched out, like a rubber band that’s been stretched almost too far. Most of my tearing happened inside, I guess, so they didn’t have to worry too much.
Around this time, my mom knew we were so close that she stopped helping and grabbed the camera. She was the designated photographer, and she had a great time getting all kinds of awesome shots. They wouldn’t let her take videos, but she got tons of pictures. At 3:08am, I pushed and the doctor told me his head was out (what?! so crazy!), and then almost immediately I pushed one more small time and felt a massive suctiony feeling as his shoulders and the rest of him all came out in one go. It was a very big sensation – it was surprising and big enough that I gasped (the way I do for surprising things in movies) and my eyes popped. It was so fast. For some reason I felt like his shoulders should have been harder to get out than his head (since, you know, MY shoulders are wider than my head), but I guess that’s not how newborns are shaped. (When I held him afterward, I did notice how very small his shoulders were.)

1. Baby! 2. Finally taking off the oxygen mask. 3. Kiss! 4. Cry!

(Jon cut the umbilical cord. It was a short cord (they couldn’t lift Alex away from me really), so they had him cut it right away. Jon was not planning to cut the cord (I think he felt like it would be kind of gross), so when I saw them hand Jon the scissors, I thought, “Um, our birth plan says that Jon doesn’t want to cut the cord,” but then he said, “OK!” so I thought, “OK!” He said that, by that point, he had seen all kinds of things that were bloodier and more gross, so when they handed him the scissors, he thought, “Why not?” He knew that, if he didn’t want to do it, I wanted to, but since it was a short cord and the doctor seemed to be in a hurry to get the cord cut (maybe they had already clamped it?), he knew it would be difficult for me to reach and thought, what the heck! I’m glad he got to do it.)

They handed Alex to me immediately, then checked his heartbeat and a couple of other things, and then rubbed him down with a blanket to get the goop off of him and gave him right back. There was a lot less goop than we thought there would be – as Jon put it, Alex looked more like a ‘movie baby’ than he expected. In the movies, you always see babies born who look all pink and just a bit damp, but otherwise pretty normal, but we’ve always made fun of that, thinking that babies are usually way more purple-squashed-alien-coated-with-cottage-cheese-and-blood … or something along those lines. So maybe our expectations were just off, but he was kind of tinted purpleish white, and he had a bit of a conehead, but in Jon’s words, “I was amazed at how non-squished and non-bruised and non-bloody he looked… he looked good!” There wasn’t that much white or goop … much less dramatically messy than we expected.

(The nurse was super quick about cleaning him off, and then she laid him on my chest at 3:09am. He was a little sticky, but otherwise amazingly clean. Jon says she said my name or something to tell me she was about to hand him to me, but I don’t remember it at all – I just remember suddenly, there he was on my chest. I put my arms up to make sure he didn’t fall off, but my immediate thought, right before I registered that our baby was on my chest, was that he was very heavy. (I said so out loud, right away.) He suddenly went from being a concept to having the weight of a person who’s warm and moving and has mass and blood. It was an incredibly earth-and-clay, brick and mortar sensation.)

We Have a Baby: Thoughts?

(“I was just so relieved. Because, for one thing, you were okay and we didn’t have to do any kind of special thing to get him out. He cried, he seemed awake, and then when they put him on you and he was just kind of lying there with his eyes open, so calm and happy, it was just like, ‘Oh, he’s okay. He’s going to be all right. We made it.’ That was kind of what I was thinking … it was a lot of fun.” - Jon

"Everything kind of happened so fast that it took a minute for me to wrap my head around things – I was RIGHT THERE in the moment. Jon and I kept looking at each other and at Alex, and Jon kept saying, “He’s okay, he’s okay!” I just kept looking at Jon and thinking, “Oh my gosh, it’s over! We have a baby, it’s done, he came out!” It was euphoric and overwhelming and unbelievable – all these thoughts and feelings washing over me and I’m trying to just be in them and it’s so much. Of course, I’m pretty sure I started crying somewhere in there. Before, I expected to feel this big ‘done with a hard job, no more pain and pushing’ feeling, but my thoughts didn’t go there at all – just the stunned feelings crashing over me that all these months have brought us here and we have a baby and now we are people with a baby and he’s right over there where we can see what he looks like. Wow." - Brooke)

Alex laid on my chest for maybe 30-40 minutes. Jon e-mailed his parents right away to give them the news. It was pretty amazing. His eyes were open most of the time, which was pretty cool – Jon remembers thinking what pretty eyes Alex had. At the time, they were a very dark gray, almost a brown or a black (they’ve since turned blue.)
(Also, I delivered the placenta fairly quickly after Alex was born. I was just hanging out, and then the doctor told me to push a little. There was another suctiony feeling, just smaller, and it was out.

I took the opportunity to whisper some names to him while I held him, and I got more sure that he was an Alexander. I had known for some time that I liked the name Kendall for a middle name (partly because Kendall is my dad’s middle name and partly because I have always just thought my dad’s middle name was a cool name), but Jon and I hadn’t settled on it yet. We had briefly discussed how Alex would be inheriting the Evans last name from Jon’s side of the family, so it might be fun to give him something from my side for a middle name, but it had been weeks since we had discussed it. So, when Jon looked down at me and Alex and said, “I’m thinking I really like Alexander for his first name, and that name we were thinking of for his middle name,” I felt a little overwhelmed because I thought, “Oh, he wants to do it!” and it was pretty cool. (My mom was there and since we hadn’t decided, we didn’t say it out loud because we didn’t want anyone to get too excited until we were sure.)

Jon took his turn holding the baby for the first time at 3:49a… and then I got him back at 3:52a.

Our first picture of Alex out of my arms (besides when Jon held him) is when he was being weighed at 4:17a.
Meanwhile, while we’re doing all this baby holding and Mom is snapping pictures (and getting told off for going on the wrong side of the bed while the nurses are doing something over there, which is really too bad because there are hardly any pictures of Jon’s face because of that), the doctor was sewing me up and the nurses and everyone were collecting all their tools and cleaning up and everything. One nurse found the ice pitcher I had vomited in, and asked if it was somebody’s drink and tried to bring it to Mom. HA. Thaaaat was gross, and hilarious, but she didn’t even bat an eye when she found out what it actually was.
Also, it’s kind of weird to me that I was basically having surgery while we’re all just hanging out in there.

Once Alex was all cleaned up (we have a video of that first tiny bath, and it is SO CUTE), they laid him under kind of a heat lamp warming bed for awhile. Babies are used to being all insulated in utero, I guess,  so after they’re out and get a bath and all that, they get to go get warmed up again. Once all the action was done (the sewing and cleaning and weighing, and his first vitamin shot and eye ointment) and Alex was warming up, the room emptied out again and we called Jon’s parents and my dad to let them know that Alex was here. Jon had e-mailed his parents at 3:19am, about ten minutes after Alex was born. His dad responded at 4:21am, about an hour later. Both Jon’s parents and my dad are early risers AND in later time zones, so this wasn’t quite as early as it sounds. At the time, Jon’s parents were serving an LDS family history mission in Salt Lake City, so it was an hour later for them. They are super early risers, so Jon’s dad was actually already at work, but his mom was home. My dad - in Oklahoma, so two hours later - wasn’t quite awake yet, but it wasn’t like the dead of night.

One of the nurses brought me some stuffed chicken and broccoli with orange juice, which was heavensent and much tastier than I expected it to be (it looked kind of … hospital food ish, and not in a good way), but I couldn’t eat very much (my appetite didn’t really return in full force for a couple of days.)

Then, it was Mom's turn to hold him:

(They came to take him off the warmer, give him his hospital bracelet/anklet (and gave bracelets to Jon and me, too – Alex’s had an alarm in it so we would know if he left the hospital), and then just before 5am, my mom got to hold Alex for the first time. That was pretty cool. She describes it: “When I was holding him for the first time, I was so sad that Dad couldn’t be there with us, but it was so fun to hold him. It was pretty exciting to watch the whole thing happen and even help with it, and then see the results of all the hard work we did! That was fun. I remember thinking how cute he was. I loved taking off his socks so I could see his feet. I love unwrapping him so I could see his tiny legs. It was way better than when you first showed me the sonogram picture before anybody else knew.”)

At some point before we left the room, they took out my epidural, and I just had the other IV bags still (saline and antibiotic, I think – I was GBS positive [group B strep – a strep that the mom doesn’t experience symptoms for but the baby can catch during birth, so they test for it near the end of pregnancy and keep you on an antibiotic during delivery if you test positive.])
A few minutes later, we called my sister, who was getting up early that day, and the mother/baby nurse talked to us for a little while. Then at 5:15a, Alex was passed to me (instead of thinking how heavy he was, that time I thought, ‘oh wow, he is VERY small’) and the nurses wheeled my bed (with Alex and I in it) to our recovery room. (I had said, “You’re going to just wheel me to the room, right? Because I don’t think I can get there myself.” That was pretty cool, to ride down the hall in bed. I could do that more often. ;)

(Jon gathered up our things, Mom readied the camera, and the nurses wheeled my bed [with Alex and me in it] to our recovery room. Before we left, I had said, "You're going to just wheel me to the room, right? ...Because I don't think I can get there myself..." They assured me that they would. That was pretty cool, to ride down the hall in bed. I could do that more often. ;) )

(In the new room, though, I had to transfer from the delivery bed to the new bed (which was, by the way, WAY more comfortable) mostly on my own. That was incredibly difficult, of course because of the epidural, but also because they didn’t line the two beds up quite right, so there was a gap between the two beds. I just thought, “Sooooo, I’m going to try this, but remember how you wouldn’t even let me move without people getting all of my limbs, like, an HOUR ago? Well, now I’m going to jump a CHASM.” I did fall off a little, and they were all, “Oh, oh, get her leg!” It was … not really how I would have expected that to go. But it all worked out, and I ended up unharmed in Bed #2.)

(They put Alex in a little bassinet next to my bed so I could finish eating, and then they did his footprints. They did it with this weird clear stuff that reacted with the special paper they used for the footprint paper, and that was cool, but I had brought scrapbook pages with me to print his footprints on, and their clear ink didn’t work on my paper. We decided to just buy some ink of our own and do his prints on my stuff later. Mom and Jon were taking turns holding him, and someone took some blood from his heel (sad) to be tested.)

(After all that, we tried out the whole nursing thing, which took kind of a long time. We were just getting both Alex and me some practice with the latch. They told me that he was probably going to be more interested in sleeping than in eating for the first 24 hours or so, but that we should still practice and try nursing every few hours so that he would know what to do when my milk came in. We finished up and Mom and Jon left somewhere around 6:30-7am.

I was EXHAUSTED for all of those last several hours, especially once I got into my room and they kept talking to me, giving me tons of information and trying to teach me things. My chin kept dropping onto my chest and my eyes kept closing, and then as soon as everyone left and I was alone (with Alex, who ha still not been named at this point) in the dark room, I couldn’t sleep. I could only look over at the bassinet and think, “What just happened??” I was so distracted by this whole brand new experience and trying to wrap my mind around this amazing brand new baby right there next to me that I didn’t sleep very well at all.)

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