sexta-feira, 17 de maio de 2013

Baby Story (Labor and Delivery)

Baby Boy is sleeping next to me on a sofa cushion specially modified for his comfort (blankie, soft toys, drool-catcher, etc.). It is very likely that he will awaken before I have time to write the whole story of his birth, but, if I wait for the perfect moment, the writing will never happen. I have only been a mother now for a little over a month, but I have learned that perfect moments--if they ever existed--are now truly a thing of the past. [It has been well over a week since I wrote this introductory paragraph--baby is now in his 8th week outside the womb--but the rest still applies.]

This 'Baby Story' starts with the question of maternity leave--specifically, when I would take it. My due date was set for April 9th. Until what day could I safely count on making it to work? As a teacher, I wanted to prepare my students and my substitute for the smoothest transition possible. My work is challenging, and I believed (and still do believe) that my students deserved my efforts to keep them learning and engaged even though a baby was expected at any time.  I did not just want to be calling my principal one morning to say that the baby was on its way, and I wouldn't be coming in for a couple of months. However, I also did not want to be using weeks of my maternity leave at home twiddling my thumbs with very little to do... 

I bet on two and 1/2 weeks. I scheduled my last day as March 22nd. My school found and hired a substitute teacher, I gave encouraging pep-talks to my students trying to prepare them for the change, and I hurriedly de-cluttered my work space and prepared one full weeks worth of plans and copies so the substitute would have everything she needed to step in easily. And those last minute research papers that didn't get graded? No worries--those were thrown into my backpack and carried home, postponed for my days sitting around the house twiddling my thumbs. After all, first babies were often late. 

March 23rd. My husband and I woke up early on a beautiful, blue-sky morning. We picked up two friends/colleagues of mine who live close to us and drove them to my school's annual Sports Day. Then, my husband and I drove to look at some houses that were under-construction nearby. We had every intention of returning to the Sports Day event after we'd seen some plans and talked with on-site realtors--we weren't planning on buying a house yet, but both of our nesting instincts were in overdrive. 

As we were leaving the construction site, as my husband was still chatting with the last realtor, and as I was slowly making my way towards the car with an 'I'm finished with this air', it happened. They tell you in the books and on the websites that it is unlikely that your water will break out of the blue like it does in the movies--in my case, they lie. There I was standing on the side of the road, damp and confused and trying to discreetly get my husband's attention. Was it time? Was it really going to happen? Suddenly, I felt decidedly unprepared--after all, I was going to have two and 1/2 weeks to finish getting ready, right? 

Wrong. When my husband finally understood my predicament, he was wonderful. We called my doctor; I told her that 'maybe' my water had broken. She told me to stop by the hospital as she was there and that she would check. We did not pass go; we did not collect $200; we went straight to Perinatal. If we knew then what we know now, we would have taken our time. We would at least have stopped by the house for the hospital bag, but you can't blame a woman who's just been surprised by a gush of amniotic fluid for not being overly rational. In that moment, I just felt slightly lost and wanted some reassurance.

We arrived at the hospital just after 11:00 am. At the hospital, we found out many things: YES, my water had indeed broken; NO, not all labors proceed the same way; NO, my contractions were not behaving normally; and NO, I couldn't leave the hospital at that point, even just to pop out quickly to pick up a suitcase.

I need to mention at this point that my doctor was fabulous. 90% of the births that occur at Perinatal in Barra da Tijuca are cesarean births, and I've been told that most doctors in Rio's private hospitals encourage their patients who have chosen the less popular 'parto normal' to opt for the cesarean at the first sign of complication. During the entire 28 hours of my labor and delivery experience, my doctor never once suggested cutting me open, and, though we did end up needing some interventions that I hadn't anticipated, my husband and I were thoroughly informed about and consulted during the entire process. 

After some time spent monitoring my irregular contractions and checking my cervix, the doctor concluded that the birth would likely take awhile. We were admitted and sent to a very beautiful hospital room with a view of some nearby mountains--we received an upgrade to a suite somehow--and I spent the next several hours anticipating that my contractions would be getting worse at any time (I could barely feel anything initially) and getting my blood pressure monitored by a series of nurses. I also had a saline lock put into my arm. 


My contractions finally started to pick up around bedtime--just when having them was the least convenient. But, while they increased in strength, they continued to be irregular--not getting consistently closer together. Around midnight, after they'd attached me to a monitor to test the strength and frequency of my contractions and after checking my cervix again (little to no change), the doctor told us that she would see us again in the morning, but that, unless there was a dramatic change, we would probably need to intervene at that point to speed things up. My husband and I agreed.

It was a rough night--I got very little sleep as the contractions continually woke me--and I prayed that my body would get it together and do things 'normally'. Yet, in the morning when my contractions were monitored again, it was clear that for me and this baby 'normal' was outside our parameters. (I should mention at this time that baby's heart rate and activity were perfect throughout the whole ordeal.) 

Just before 9 am, they put in a pitocin drip, and around 10 am they suited us up for business. I was brought to the delivery room on a gurney, and my husband was properly sterilized. The pitocin wasn't helping very much at first, and our medical team continued to increase the dosage at intervals throughout the remainder of the morning and into the afternoon. We'd planned originally to try to manage the pain of the contractions naturally, but, when the pitocin finally kicked in (seemingly in one instant and then without relenting), I opted for an epidural. 

It took the anesthesiologist several attempts to get the needle in. That was probably the most difficult few moments of the whole labor for me: being told to lie very still when the contractions were continuous--my lower back felt like it was on fire--and knowing the possible consequences of moving at such a moment. But finally, the epidural was in, and I was thankful for it. 

My doctor told me that my dosage should be just enough to eliminate the back pain, but that I should still feel the contractions in my abdomen so that I'd know when to push when the time came. Unfortunately, some time later (I had no concept of time during this part of my labor)  the quick hand of an eager anesthesiologist (a second one as the first one had finished her shift) made that impossible by administering another shot of whatever it is that they give you when I mentioned to my doctor that I had felt a contraction in my back. At that point, with the second shot of painkiller, I lost feeling in my left leg. I had to sit/lie down for the rest of the delivery. I also couldn't feel my contractions for the pushing. (The feeling in my leg did come back by the time they brought me upstairs after the delivery--I was worried that it wouldn't at the time.) 

Fortunately, we started the pushing soon after this. The birthing room was suddenly filled with people at this point, all dressed in blue scrubs: my doctor, her cooperating doctor, a pediatrician, the anesthesiologist, and a handful of nurses. I kept one hand on my abdomen between contractions so that I could feel when to push. My husband stood reassuringly at my side--I'm pretty sure that his eyes were on me the whole time.

After a several minutes of pushing and because it didn't seem like we were making much headway (I've suddenly realized the appropriateness of the term headway), the pediatrician was laying across my stomach and pushing on the top of my uterus to prevent baby from moving back up between contractions. This was completely unexpected and uncomfortable. However, by that point, I was tired out, and, as bizarre and uncomfortable as it seemed to me, I just wanted my son to be born.

Finally, after what felt like an eternity, baby boy was born. He weighed 4.43 kilograms and was 53 centimeters long. The pediatrician congratulated me on giving birth to a one-month old. My obstetrician told me that my placenta was one of the largest, if not the largest, that she'd ever seen. All of that hardly mattered, when my son was put on my chest, and he looked at me through his sweet, confused eyes. 

My labor and delivery did not go as I'd imagined that they would (I didn't mention the episiotomy or the forceps--our uninvited party guests), and it all happened sooner than we were expecting (the very day after I stopped working and before the crib that we'd ordered had even arrived at our apartment). However, at the top of our birth plan we had stated that our primary goal was 'a safe and healthy delivery for baby and mother', and, in spite of the complications, that is what we received. 

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