birth story--- written as a letter to Deb, our bradley instructor

So… Here’s our birth story.

Liam Sebastian Fields was born at 5:07pm on 9/28 at St. Joseph’s East Women’s hospital. Virginia and I both think the labor and actual birth went about as well as possible, although there have been some post-birth complications that I will get to in a minute.
Before I get to the labor though, here’s a quick side note about our physician. We selected Dr. James before we had any intentions or real knowledge of natural birth, but stayed with her because at the time we felt comfortable with her. A couple weeks out from the labor though we started having second thoughts as we picked up on some things that caused concern. At Virginia’s 38 week exam, she stripped Virginia’s membranes during a vaginal exam and told her after the fact, which upset both of us greatly. She then offered to induce Virginia after telling her that she would be out of town on Liam’s due date. The same thing happened an exam week later on 9/27; Virginia was only 3cm dilated and she wanted to send her over to the hospital for “augmentation”, not inducement. Of course, we declined. Dr. James actually was out of town beginning 9/28 and Liam was delivered by Dr. Steele instead. We were very happy with Dr. Steele so it all worked out. Dr. Steele and every single one of the nurses was up to date on our birthing plan and we heard several people discussing it within the first 5 minutes of us arriving.
The evening of the 9/27, we went to the gym and walking the mile or so that she usually did every evening and had pineapple for dessert after dinner. She really wasn’t having consistent contractions through out the day (maybe one or two every hour if we were lucky). Virginia began feeling regular contractions around 2:45am on 9/28 (every 5 minutes) after she got up to go to the restroom. She monitored the contractions for the next 6 hours with a nifty iphone app (I was able to sleep until 5:45). Around 8:30 the contractions started to pick up steam (3-4 minutes apart—the drive to St. Joe East was 2 minutes) and we went to the hospital at 9am (after I finished baking chocolate chip-oatmeal-walnut cookies for the nursing staff). At check in she was 4 cm, 90% effaced and 0 station. After getting situated, the nurse wanted to keep Virginia on the fetal monitor for 30 minutes because her first blood pressure was a little high. They ran a pre-ecalampsia screen but every single BP after that was normal so we think it was a cuff placement issue. They did 20 on 40 off for 2 hours and then just kept the monitor off completely. Periodically though the nurse would just press the monitor to Virginia to check on the baby’s heart rate. They were never super rigid about checking though and were flexible if Virginia was in the middle of a lap around the floor. Until about 1pm or so, Virginia walked laps around the floor, tried some different positions in bed, and also used a yoga ball, provided by the hospital, to labor. She tried to squat during one contraction, but it didn’t work out too well. Which was disappointing because she has been training like crazy with squatting the past few months. On a similar note, Virginia wanted me to make an ipod play list of songs she thought would help her relax. This sounded good in theory, but she was done with the music by the 2nd song. She was all about the room being as dark as possible during a contraction, so every time one came I would kill the lights.
At 11:30am Dr. Steele examined Virginia, and she was 5 cm, 100% effaced, but I didn’t catch the station. Dr. Steele offered to break Virginia’s water, which we of course declined. She said that she would likely not be able to deliver the baby since it would be late in the evening before the baby would come since we were declining to have the water broken and another doctor on call would take over care. At 1:40 pm, Virginia’s water broke spontaneously during a particularly strong contraction. Our nurse Barb was actually holding the fetal monitor to Virginia at the time, so we got to hear a popping sound when it occurred. Shortly after the nurse examined Virginia and she was 7 cm. For the next 2 hours the contractions picked up intensity and took a lot more out of Virginia, but she was still very much in control. Around 3:40pm Dr. Steele checked her again and she was 8 cm. Sometime between 3:50 and 4pm, Virginia started transitioning. This was as intense as advertise. Virginia went from “ I’m not sure if I can do this,” to “I CAN’T DO THIS!” Each contraction was an ordeal but she got through them one at a time. Afterward, she said she was had complete knowledge that she was hysterical during these contractions, but there was no way to stop it. She was able to relax really well between contractions, and mentioned at one point that she wanted drugs during one of these down moments, but did not use our code word that we had discussed several times. Our nurse also picked up on what was happening and stayed by our side. She was so great and knew exactly the right thing to say and just how to say it, at least for Virginia.
If someone has never seen a loved one suffer, I don’t think it’s possible to prepare yourself for hard it is to see your wife in such anguish. At one point the nurse did pull me to the side to let me know this is very normal, but if I thought Virginia should consider intervention I should talk it over with her (Virginia). She also told me she would not ever offer it to Virginia and she never mentioned it to me again. Quick side note. When processing in they insisted we sign the epidural consent form just in case, but assured us they would not ever push it on us, and they stayed true to their word.
At 4:30pm Virginia was 10 cm and ready to push! Just before she started pushing I could hear Dr. Steele reviewing the birth plan with her team and making sure everyone was aware, which was very reassuring to me. Virginia was in a much better mental state now and even conversational with the staff in between contractions. I didn’t count but I would guess took about 10 contractions with pushing to get him out. She pushed for 37 minutes. Once he crowned, he came out very quickly. Virginia doesn’t remember the ring of fire happening (they added lots of topical lidocaine) and didn’t really think the pushing was painful. She was surprised that she felt like her ears were going to pop every time she pushed. She did have some second stage tearing that required stitching, which was pretty uncomfortable even with some lidocaine injections.
Liam was put skin to skin immediately after birth but soon it was apparent he was having some respiratory distress- lots of grunting that didn’t improve with the suction bulb. They took him off to the side (I went with him) and suctioned 12 ml out, but he still wasn’t breathing well and was grunting with each breath. They tried skin to skin for a few more minutes to see if that would calm him down and allow him to feed, but it was very apparent this tactic wasn’t working. They took him down to the nursery (I went with him) and after seeing his O2 saturation was too low, they started him on oxygen. He coughed up more mucousy fluid, but was still laboring to breathe. The pediatrician came by and recommended that the neonatalist take control. Dr. Jundy ordered up x-rays and blood work, and they admitted him to the NICU. X-rays showed a lot of fluid in both lungs and a pneumothorax in his lower right lung. They determined that he aspirated fluid while being born. They put him on some various medications that Virginia can elaborate more on and put a breathing hood over his face for over night O2 treatment. The next morning after new x-rays, the pheumothorax had resolved on its own, but they were now treating him for aspiration pneumonia. His breathing rate was still very high and his O2 saturation would drop whenever he was distressed from over stimulation. They did remove the hood though and are delivering oxygen through his nose now. Because he is on restricted stimuli so keep is breathing rate down, I have yet to hold him and that is one of the worst part. We are both aching to cuddle him.
This morning (9/30) he looked much improved. He seems much more comfortable and less distressed. His breathing rate is still too high though and x-rays have not yet shown noticeable improvement. He has a good appetite and his body functions are starting to normalize. Virginia was able to pump 10 ml of colostrum after birth, which they gave him, and has been pumping regularly since with mixed results- we have been using pictures and one of his blankets to help her. Whatever she is getting though, they are giving to him. Virginia will be discharged today, but unfortunately the earliest Liam could possibly go home is Sunday, but at least we’re close to the hospital. We will be going to the hospital every 3 hours to visit and delivery whatever Virginia has been able to pump.
Even though this post birth isn’t what we hoped for, we do feel the best course of action has been taken. The NICU nurses along with the neonatalists Dr. Jundy and Dr. Ang have been great. We also feel the labor floor nurses were also great, especially Barb. Everyone was very cognizant and respectful of our birth plan although things got derailed post birth. Virginia labored at the hospital for 8 hours and we felt the facility was a reasonably quiet, private, and suitable place to labor. Also, there’s no way a successful, textbook natural birth would have been possible without the 12 week Bradley course and supplemental guidance from related materials. Deb, the accounts you gave of your real world experience as a natural birther and doulah were absolutely invaluable to us. The Bradley material although, good and informative, really hit home with us when you would relate it back to your experiences. For that we truly thank you for sharing and helping to make Liam’s natural birth possible.

10/1/10 update: chest xray is better, breathing rate is down but not quiet where is needs to be, we get to hold the baby this afternoon!, planned discharge from NICU still on Sunday hopefully.