Saturday, April 30, 2011

The Story of Nile's Birth

I started drafting the following a couple weeks after Nile was born. I have spent the past year deliberating on pressing "publish post". Well, here it is:

As promised, the story of Nile's birth.

Nile was born on her due date, March 23, bright and early at 6:30 a.m.

While I was pregnant, I decided that I wanted to give birth naturally, without drugs of any kind. Neil was really supportive of my decision. I heard about HypnoBirthing and decided that was the method I wanted to use to labor. I also wanted a doula for labor support. I had heard wonderful things about how the presence of a doula increases the positive outcome of natural childbirths, and I wanted that.

We found a HypnoBirthing instructor here in AZ and we took a class with her and another couple. It was a great experience and we hired her as our doula, too.  Because all hypnosis is self-hypnosis, HpynoBirthing teaches you relaxation techniques to manage pain. It is really great! It was nice having our doula there for the labor and delivery, and it helped me to feel like everything was under control.

We have the HypnoBirthing book and a couple cds that have relaxation prompts and imagery narrations that we listened to in preparation for Nile's birth. At first, I never knew how the "Rainbow Relaxation" imagery ended because I became so relaxed I fell asleep every time I listened to it. We put that and a few other HypnoBirthing tracks on an iPod, along with several hours of ocean wave sounds. I ended up looping the ocean waves and the Rainbow Relaxation during the labor. For a few hours it was Rainbow Relaxation over and over.

On Sunday, March 21, Neil and I went out to the desert to take maternity pictures. Good thing, since I went into labor the very next day.

I had been feeling fine most of the pregnancy, and hadn't gotten that feeling of "just get this baby out of me" like most people say they get during the last month -- I hadn't felt that way, that is, until the previous week. I was really feeling like I was getting all puffy (water retention), heavy and slow. I wanted to sit all the time. Even my face felt swollen. I had started to hope that Nile would be born on or near her due date!

My mom and I had an appointment to get pedicures at 11:00 a.m. on Monday, March 22. We went to do that and my feet and legs were swollen and gross. I do wonder now if the pedicure lady gave me some sort of reflexology pressure point techniques to induce labor. You never know!

After pedicures, I went to my sister-in-law Becky's house, where Neil was helping her with her computer. I laid down on the couch to rest and take a nap. I drifted in and out of consciousness. I started to not feel that great -- I kind of felt like I was coming down with something or was achey all over. I started to feel really mild pain in my lower back, like menstrual cramps. I didn't want to panic or rush things since Neil was still working on Becky's computer, but I went to tell him that I was tired and that I thought we should go. I felt almost on the verge of tears, you know how you feel when you are trying to hold it together but you really don't feel good and want to be alone? I wanted to go immediately, but I was embarrassed for Becky to suspect that I might be in the early stages of labor. Silly, I know. I obviously was feeling like maybe that's what was happening. I felt a little better once I got up to go talk to them, so I stalled for a little bit, but we finally went to leave.

As we were saying goodbye to Becky outside the house, we talked about getting together for lunch the next day, but we said we'd play it by ear; I think we both had a feeling our plans might change.

On our way back to the hotel, we stopped at an Arby's for lunch. We got some random things off of their dollar menu. We then realized we didn't have enough time to go back to the hotel and then make it to our Dr's appointment at 4:20 p.m. So after lunch we headed over to the Dr.'s.

I highly recommend our Dr. if you are in the Mesa, AZ, area: She delivered three babies (with another one on the way later this year) for two of my sisters-in-law and came highly recommended by them. Yes, that's us on her site, 4 weeks after Nile was born! If it gives you any idea of how tiny she is, I am 5'7", Neil is 5'5 1/2", and she is holding a newborn baby.

At the appointment, the Dr. said everything looked good, and that I was dilated to 1 1/2 cm. But she said that I could stay at 1 1/2 for two weeks or have the baby tomorrow, you can never tell. So we set up a follow-up appointment for Wed. March 24, the day after I was due.

I had specified in our birth plan that the Dr. not "sweep the membranes" (technical term; doing that during the exam is supposed to encourage the body into labor) so I hope she didn't, but you also never know ...

So we went back to the hotel and honestly the rest of the afternoon and evening was a blur, as I went straight to bed. I woke up on and off as the cramps seemed to increase in intensity. At some point, around 7:00 p.m.,  I realized that maybe this really was labor, so I asked Neil to start putting things in the car. He was gone for a loooong time, which made me really annoyed, as I had started to write down what time it was when I started to feel each cramp. It would subside, but then another one would come, at regular intervals. When they are 3-4 minutes apart, you are supposed to go to the hospital. They were first at 9, then 7, then 5 minutes apart. I put on some of the relaxation tracks, but I felt chaotic and unfocused without Neil in the room. He finally returned from packing the car and at some point texted our doula to give her the heads up.

An interesting side note is that the week prior to this was Spring Break, and both our doula and Dr. had gone out of town! Our Dr. had not had a vacation with her family since before she started her private practice a few years ago, so although she promised she would deliver the baby since we'd come all the way from Argentina to do so, I had to try NOT to have the baby during Spring Break week! Kind of stressful. Especially because our time pre-baby was winding down but we didn't want to do anything that might cause me to go into labor ...

So we had made it this far and I think my body knew it was now "OK" to have the baby. And all systems were go.

Around 8:45 p.m. or so we carefully went out to the car and headed the 12 minutes to the hospital, a beautiful, state-of-the-art facility, which I also highly recommend if you are in the Mesa/Gilbert, AZ area. Along the way I ate a clementine orange, which I would see again later.

I had purchased a cute tank top, shorts and matching slippers from the Juniors section at Target. I had bought a Victoria's Secret bathrobe, and had envisioned myself donning this garb and walking around the halls and the peaceful hospital gardens while I labored. What I didn't realize is that the outfit was impractical: a hospital gown is infinitely more reasonable and is going to get messy anyway; and they sell you on the beautiful zen garden exclusively for use by the maternity ward, but you do NOT feel physically capable of walking to it when labor is in full swing and you can't barely get out of bed anyway.

But I'm skipping ahead.

At the hospital I felt OK enough to not be dropped off at the entrance, though the walk from the car to the maternity entrance was start and stop, with ginger steps.

The labor and delivery ward is high-security, so you actually have to show your pregnant belly at a closed-circuit camera to enter. We were let in and went through the whole "sitting in the waiting room for a bit till you get to talk to the triage nurse" that everyone complains about. They had warned us about this when we did a little birthing orientation class, so I didn't sweat it. They know if you need in NOW or not, and I was doing OK.

So when I was called in to talk to the pre-admittance lady, I kept it under control as she pulled out my file and asked me how long I had been having contractions. We were then good to go for a little inspection by the triage nurse. She did a quick exam and was surprised; she told me that I was "at a 6 with a bulging bag of waters, so once the water breaks, you will probably be at about a 5." WOW! That was encouraging to find out that after a couple hours of mild discomfort, I was already halfway there.

Needless to say, I was admitted.

I requested to be assigned a labor and delivery nurse who specializes in, or at least supports, natural childbirth. I was assigned Becky (not my sister-in-law), the kindest, gentlest, sweetest nurse you could ever wish for.

However, before I could focus on continuing labor, I had to get a Heparin, or "Hep-" lock, which is the start of an IV but without any tubing attached. A "just in case."

Since I desired a natural childbirth, I didn't want an IV line: Studies show that having an IV inserted is the first step to nurses or a Dr. convincing you to go with pitocin or other IV drugs, since the IV is already there. But my Dr.'s policy is to have an IV line; she won't attend a birth without one. Thus, we had compromised with the Hep-lock. I really was not happy about having to do it, but it turns out we were better safe than sorry: It took four different nurses to finally get it; eventually they had to call in an Emergency Room nurse from the IV team. They tried my wrist, my arm, my other wrist, and finally found success inserting the needle between my fingers! It was very uncomfortable as the contractions were coming and going. But I just made them try between contractions, waiting until a contraction subsided before they could try again. If, heaven forbid, I had not had the Hep-lock and had gone into an emergency situation, I don't want to know how many precious minutes would have been lost trying to get an IV line going.

So, Hep-lock taped to my hand, peace and quiet in the room, things started to get pretty intense from there. They kept the lights off, with only the soft glow of the bathroom light through the translucent door. I lay on one side or ther other, turning now and again, and had pillows tucked in all around my body.

I honestly have to say that labor is like REALLY intense menstrual cramps that come and go at regular intervals. The "discomfort" (HypnoBirthing discourages the use of words like "pain"; but let's face it, there I found myself, at the extreme limits of what I knew as "pain"!) was pretty exquisite.

My doula arrived and was a wonderful, calming presence. She was a wonderful complement to the nurses and to Neil. She rubbed my feet endlessly and talked me through some rough patches. At one point she went to lightly rub my hip, and the touch literally felt like she was going to crush my pelvis. My sensory perception was on overload. So she kept to my feet and calves. I had the Hypnobirthing track, "Rainbow Relaxation" playing, as well as ocean sounds, which were a recommendation from my natural-birthing, lactation consultant, RN friend Pamela. She had said that the waves mimicked the ebb and flow of the contractions. I kind of felt like they also went along with the controlled crashing of nature that was going on inside my body.

I went into what some call "Labor Land." Time was completely warped, and passed by quickly. It is hard to explain, but I felt really sleepy and kind of out of it. I think it could be because all the blood was rushing to the parts of my body that were working hard, and not to my brain. Or, nature's natural process was kicking in and my body's own birth-relieving hormones were being produced. At any rate, it is quite a blessing, to feel drowsy and to lose one's concept of time, during a time like this.

I felt like if I weren't so uncomfortable, I'd like to go to sleep. A contraction would come on, but I knew that I could ride it out; I envisioned myself riding it like a wave in the 'ocean sounds' I was listening to (never mind that I am afraid of surfing!). It didn't feel like it lasted very long, and then there would be a long pause between contractions, where I could recover and regroup. Toward the end, Neil, my doula and the nurse were discussing how the contractions were only 30 seconds to a minute apart -- that sounded crazy, because I would have told you that it felt like a good five-minute break between contractions. It's amazing how a reprieve from extreme pain, now matter how small, can be enjoyed fraction of a second by fraction of a second, just feeling grateful for even the most abbreviated moments of relief. At the same time, every time I looked at the clock, another 45 minutes or an hour had flown by. Very wild time distortion.

My back really hurt. It seemed like the contractions started deeply and ferociously in my lower back, roared up through my mid-section, and then slowly went back down my torso with huge claws scraping the whole way down. If you can envision that happening over and over every few minutes, you can imagine what labor is like. Or at least back labor -- I found out later that I was apparently experiencing back labor, as Nile came out face up, so they told me I had been in back labor. But during labor I thought "wow, this is pretty painful on my lower back, but it couldn't possibly be back labor because that is supposed to be excruciatingly painful." I still think I must've had a mild case, but I guess it's all a matter of perspective. I tried laboring on my elbows and knees, but it didn't help the discomfort at all, so I went back to laying on one side or the other.

A big part of HypnoBirthing is imagery, so I continually envisioned the baby descending through the birth path.

I had a baby heart rate monitor attached to my stomach, and I thought for sure that the heart rate would increase during the intensity of the contractions, but it never did. It had a regular rhythm and no increase in rate; it was somewhat soothing. I had heard you could turn the sound on or off periodically, but I wanted it kept on, because it provided a consistent sound anchor for my labor.

I also found myself counting things, mostly the number of lines on the plastic intercom built in to my hospital bed side rail. There were 13 of them. Somehow focusing on the counting helped to distract me, if only a little.

I told my doula and nurse how my back hurt, so someone got me a warm washcloth. I was laying on my side and they pressed it against my lower back. At the moment the heat seeped into my back, I felt a soft POP! feeling and then the flood of fluid as my water broke. I felt like I peed my pants with a pitcher of water. I exclaimed "Oh! I think my water just broke!" and that was fine with everyone in the room.

It was more of a problem getting a change of linens, and that is probably the one complaint I have -- you pay enough to stay in a hospital room, and then they told me they were having trouble finding more sheets, absorbent bed pads, and pillowcases. I'm sorry, but there were built-in cupboards around my bed which should have been fully stocked upon my arrival. That is the piece of advice I would give to anyone going in to have a baby -- insist that you have an endless supply of linens on hand, as soon as you get in your room.

I got up to go to the bathroom and change my drenched, clammy, clinging gown (and I had to wait till they found a new one) and then I had to come back to a cold, wet, soaked bed. I asked them to change it before I got back in, but that took time. If you ask him, Neil is still upset about that and that he didn't realize my need at the time. At any rate, as labor progressed, more fluid gushed out with each contraction, so I understand where they might want to hold back on doling out the linens, but as I said, ten thousand dollars should pay for extra linens on hand and laundry service.

I tried to take a hot shower, but the water temperature was fluctuating wildly (and my skin was hyper-sensitive anyway) and, sitting in a shower chair, the water only hit me on my back or on my front, not both, so I was freezing cold and very uncomfortable, so that attempt was short-lived.

They also sell you on a fancy Japanese soaking tub at the hospital. But labor and delivery nurse Becky didn't really encourage me to use it. After delivery she actually admitted that she thinks it's unhygienic. "Sure it gets cleaned between uses, but by regular janitors ..."

At one point as I labored I felt like things were so intense, I didn't know if I could continue naturally. I said this to my doula and Neil, partially hoping they would tell me "OK, let's get the drugs," but mostly hoping they would encourage me to keep going. To my slight dismay, they were like, "OK, whatever you think is best for you." We came this far for them to say that?!

But I have to thank my doula, because at that moment I think she went out to get Becky, to ask her to check me. Becky came in the room and said brightly but gently, "OK, let's see how you're doing." This was probably around 4:00 in the morning. She checked me and I was at an 8. Only 2 cm. to go! This was extremely encouraging, and gave me total newfound determination to keep going.

I don't know if it was shortly before or after that, but I suddenly felt waves of nausea. Remember that clementine orange I ate in the car? It came up into a plastic enema pan, undigested, in little chewed up wedges. They said that was a sign of the "transition" phase, supposedly the most intense time during labor, when the most cervical changes happen during the shortest amount of time. This also signals that the baby is almost here!

During labor, the nurses had kept me apprised of my Dr's whereabouts. She came to the hospital not long after I was admitted, maybe around 10:30 p.m., and had slept in another room. At some point shortly after the return of the clementine, my Dr. made her first appearance in my room, coming in to encourage me further. She leaned down and told me I was doing great, that "you've got this!" that I could do it naturally and it wouldn't be much longer. Well, she's the Dr.! So I was completely confident at that point.

I actually asked Becky how much longer she thought it would be. She said that based on what she'd seen from other women at my stage and progressing as I was, she predicted that Nile would be born after 6:00 a.m., maybe half-past. That was more than two hours away! I had a long haul ahead of me, though the thought of "only" two more hours was encouraging.

I started to feel like I had to go to the bathroom, so I went and sat on the toilet for a bit, where I nearly fell asleep except for the raging contractions periodically racking my body. Nothing happened on the toilet (hey, we're talking childbirth here, I think we've already crossed the line of TMI) but apparently if you feel like you have to "go" that is a sign that the end is near, as the baby is pressing on the same nerves that give you the "No. 2" signal. Becky said it was great if I could just sit on the toilet, because it would help the cervix to open and the baby to descend, so I visualized both of those things happening every time I got up to sit on the toilet, which I did a few times.

My Dr. had come in that one time to keep me going, but now I could hear muffled talking and laughter coming from down the hall. I felt a little bit irritated by that (pretty much anything irritates you when you're in labor) but Becky said it was my Dr., that she was up and talking to the nurses. "She always keeps them in stitches, we love her!" she added. That was a nice thought, and I was a little less annoyed, especially knowing that she was up and ready for action now.

Becky checked me maybe a couple more times, as she said I was at a 9 1/2 and then 9 3/4. How she can tell the miniscule difference, I don't know. By this point of course the baby's head was pretty far descended and she could feel it, but she said there was a little lip of cervix that was resisting. So she finally said, "let's do a test and see if you can push to melt away this little ridge". So I did, and it went away, and I was at a 10.

Things all started to speed up at that point, but the weird thing was, I was really real, fully conscious, feeling, hearing, sounds, sensations, and it was not softened by any drug or birthing fantasy that I may have imagined during my pregnancy. This was REAL and it was happening now.

In an authoritative, calm but urgent tone, Becky sent someone to get my Dr. and said "we're ready to push". My diminutive Dr. entered the room, and despite her petite size, her reputation as the boss of the delivery room held true. She owned that place. People were going here, doing that, prepping this, and she was in charge, in her enormous gown over her scrubs.

A tall wheeled tray table that had sat quietly against a wall was pulled out, the disposable sheet that was over it was removed, to reveal rows of benignly gleaming silver instruments.

It was time to push.

I didn't really feel the "urge to push" that all the books and HypnoBirthing materials had talked about. But if they said I was at a 10 and ready to push, well golly, I was going to push with all my might.

So push I did, starting at 6:00 a.m. I thought the baby would come right out, with how hard I was pushing. As instructed, I waited for each contraction and then pushed with it. My doula was counting for me, the classic "1-2-3 ... 10". But then I kind of lost my rhythm and with such intense sensations I couldn't really tell when I was having a contraction or not, so I pushed intermittently.

I remembered the advice of my ocean-waves friend Pamela, who has had two babies: push from the top of your stomach (like you're a belly dancer rolling your stomach), not from your nether regions (like you're going to the bathroom).

A side note here along the same lines: I had a fear that I would do something unpleasant (inadvertently go No. 2) during the pushing stage of delivery. Even though everyone says you won't care at that point, I still didn't want it to happen. And I felt like I WOULD care at that point. But it didn't happen (I even asked Neil, to be sure). So if any of you out there share the same fear, know that it probably(?) won't happen; maybe the pushing from the top of your stomach helps?

I didn't scream hysterically, curse, or wail in agony. I did not feel uncontrollable pain and above all, it was a natural process, so I knew I wasn't going to die. Movies and TV shows completely and inaccurately dramatize the labor process.

I asked the Dr. if there was a more efficient way of pushing; I would do anything they suggested. I was in the classic on-your-back, legs-spread position, but HypnoBirthing had suggested other positions, and I had thought maybe squatting could work. There was no squatting to be had; for one, the Dr. would not be able to see anything, but mostly I didn't really see myself trying to get into that position at this point.

At any rate, with each push, everyone was exclaiming that they were starting to be able to see the head! They said they could see a quarter-size part of the head. Then a half-dollar. I was pushing so hard I couldn't believe that was all they could see! Even the Dr. and the nurses said, "Wow, she's strong!" in reference to my PUSHing. I was really giving it all my might. I didn't care -- at this point, nothing really felt better or worse than anything else and I just wanted it to be OVER. My doula had promised me that I would feel better IMMEDIATELY after the baby came out, and if that didn't prove to be true, I could "punch [her] in the mouth". I didn't want to do that, but the thought of immediate relief glimmered irresistibly within my reach.

As I was pushing, I noticed out of the corner of my eye that Becky was writing with erasable marker on the translucent bathroom door:  "Happy Birthday, Nile!" followed by


This was really happening!

Finally they saw more of the head with each contraction, and I think someone may have said that it would only be a couple more pushes, then one more push, and then SUDDENLY, exactly 30 minutes after I began pushing,

She was here!

At 6:30 a.m. on her due date, March 23, 2010.

And I IMMEDIATELY felt better. I mean, better than better; I felt like I had gone from feeling horrible,  to feeling like I just woke up feeling great on the best day of my life. Neil still teases me because the instant the baby came out, I exclaimed "I feel so much better already!" It was incredible. I didn't even know what else to do or say. I just kind of watched, because the baby wasn't really making much noise. As soon as she came out the Dr. went into routine mode, suctioning her nose (which was something in our birth plan we had specifically stated we did not want -- too rough of a first greeting in the world). Ah well.

Then the baby let out this low "aghhhhh aghhhhh" sort of complaint of a wail. But it was a low, hoarse sound, not a piercing baby cry. The Dr. was holding her up, and she or someone else said, "we want her to make a good, strong crying sound" but I think her voice was naturally low and hoarse, because she did continue to cry, but in the same "aggghhhh" way. [A year later I can say that her cry has always been that way, to this day.] So I guess she checked out, and her APGAR was good.

I'm not sure if it was before or after that, the Dr. proceeded to clamp the cord for Neil to cut. Another thing we had specified in our birth plan: Please wait for the cord to stop pulsating before cutting it. This can be several minutes or longer. The Dr. said, "Oh, it had already stopped." I am actually pointing to it in surprise in a picture that was snapped, but it was already done before I could say anything.

When they handed her to me, I held her on my left side, looking into her eyes for the first time. They were like little slits, almost swollen shut, but she had them opened and was looking at me with these eyes that were dark blue, but light enough to convince me that I didn't think they would be brown. I was very happy with that.

Neil says I kissed her and said I love you, which I don't quite remember. They then took her over to be warmed up, weighed, and cleaned up.

During this time, the Dr. gave me some stitches. I did allow her to give me some local anesthesia for that! We had a conversation, and my doula asked me about the tiny (but stretched) laparoscopy scar she'd seen on my side from an appendectomy years ago. As I talked, I kept an eye on what was happening in the corner, making sure Neil was with the baby the whole time. It was really weird, and maybe no one will understand this, but I felt so strange, I was transformed into a mother in name only; I didn't feel a surge in pride or love. As the time passes, I see that it is something that grows and grows to infinite proportions. But at that moment in the hospital, making small talk with my Dr. and doula while I was given stitches, I really felt detached, literally and figuratively. It has taken time, but luckily not very much time, to feel completely attached to her, and [saying this now, a year later] I now feel incredibly attached to her and am totally a mother now. I have a complete bond with her.

We then got several pictures with the nurses and our doula, and I could tell the Dr. wanted me to try feeding her, which she then asked me to do. I did and she latched right on, to my surprise and relief.

Moral of the story: If you want a natural birth, I recommend HypnoBirthing as a method toward that end. I don't think you can go into labor without some way to get through it, whether it be HypnoBirthing, Lamaze, an epidural, or whatever works for you. Also, if you don't feel like mom material or transformed at the moment of childbirth, don't worry, it will likely grow on you, and it is the most wonderful feeling.