A HARD DAY’S NIGHT
THURSDAY
Beatrice’s medically derived due date has just come and gone. She, and the baby, are in good health by all measures, but she is miserable. The ladies behind the food line at the cafeteria we frequent have been commenting on how big she is. Today at her checkup her midwife expresses some concern.
SUNDAY
Beatrice’s midwife makes a home visit. We recall that Rainer, at 8 lb 10 oz, had a hard time getting his shoulders out two years ago. The midwife will make an appointment for Beatrice to see an Ob/Gyn as soon as possible, to see what an ultrasound can tell us.
MONDAY
4:15 PM
Beatrice arrives at the doctor’s office to find a full waiting room with overflow in the hallway.
5:30 PM
I notice Beatrice’s car in the doctor’s parking lot as I pass by on my way home after work. I stop and find Beatrice still waiting in a half full waiting room. We call her mother and tell her she might need to stay with Rainer a while more. I walk out to bring back some snacks. On the way back I feel an uncharacteristic sense of dread.
10:40 PM
Our turn at last. We are the last patients in the office, and as cranky as we are, we are lucky the doctor has not been called away to attend a birth in all the time we have been waiting.
The ultrasound is done and the computer calculations predict a baby somewhere between 8 lbs 6 oz and 8 lbs 14 oz – somewhere either just below, or slightly larger than her brother was. More critically, the ultrasound shows that the baby’s abdomen, an indicator for shoulder size, has grown to be as big around as her head. Most successful vaginal births take place before this happens.
11:45 PM
After a conference call between us, the midwife, and the doctor, we officially transfer care to the doctor and commit to a hospital birth. The idea of repeating the home birth scenario of two years before is difficult to let go of.
The doctor’s opinion is that since we already suspect a problem there is no good reason to let the baby continue to grow. He recommends inducing labor as soon as he can arrange a slot at the hospital.
I say we should wait at least another 24 hours to see if natural labor commences before asking the doctor to make the arrangements. Beatrice, not immediately ready to commit, concurs.
We go home, I pick up some sandwiches on the way.
TUESDAY
8:00 AM – 2:00 PM
Beatrice spends the day calling people with similar or relevant experiences. By early afternoon she has left a message with the doctor to set things up as soon as he can.
5:00 PM
The doctor has not picked up his non-emergency messages. We don’t know when an induction might be scheduled.
11:40 PM
The doctor phones us at home. The appointment is for 8 AM on Thursday.
WEDNESDAY
10:00 AM
We arrive at the hospital admitting desk to do as much of the paperwork as possible before tomorrow morning. They tell us to be there at 6 AM the next day.
THURSDAY (15 July 1999)
5:30 AM
We slip out of the house without waking Rainer. His grandmother will be sleeping beside him when he wakes up.
6:00 AM
We arrive in Labor/Delivery room 5 and spread out our stuff. Beatrice gets hooked up to the monitors and they start an IV port, though nothing is dripped in for now.
11:00 AM
The chart recorder runs out of paper. Beatrice takes off all the monitors. No one notices either of these occurrences. Beatrice takes a nap.
1:45 PM
The doctor shows up. It’s been a busy day.
Earlier we were surprised and pleased to learn that we would not start off with (and may not even need to finish with) Pitocin, but will be using a relatively new and reportedly gentler drug administered as a vaginally suppository. He inserts the pill and tells us that things will start happening in about 35 minutes.
JUST BEFORE DARK
Beatrice is nearly fully dilated. The induced contractions have been much shorter than they would be if they had started naturally, but happen much more frequently. They have been coming at almost exactly 1-1/2 minute intervals for several hours.
I walk to the nurse’s station to tell them that she has gooshed. We think her water has broken. While I am there I hear things like ” …. number four wants an epidural ….” So far Beatrice has had nothing. I notice the nurses make comments about her “excellent control” as they enter notes on the monitor screen.
The baby’s head is at station minus two or minus one.
A LITTLE WHILE LATER
The doctor arrives. Beatrice is fully dilated but her membrane is still intact in spite of the leaking waters.
She begins to push. She gets off the bed to pee. We hear a splash. Definite breakage. The doctor is called.
In spite of the dramatic rupture of the membrane, the baby’s head has not moved passed station zero. The doctor has been in surgery and has been called away from writing orders for a patient who is very sick. He tells the nurse to call him when and if the baby gets to station plus two, but otherwise to wait for him to come back, which he will do as soon as he can.
THE NEXT TWO HOURS
It seems likely that Beatrice is in “back labor.” Most babies face the tailbone during birth. This one is looking up or to the side. The consequence of this is even more back pain for the mother.
Three of us: the nurse, the midwife, and I, encourage and comfort Beatrice as she continues pushing. There are breaks in her control. She will later explain that the back pain was continuous so she did not get that very important break between the mercilessly frequent contractions.
The delivery table is set up with an array of instruments. The newborn staff has got the infant warmer bed ready and is wandering in and out to get a read on timing. The previously invisible spot lamp has been rotated down from its ceiling panel, but is not lit.
9:30 PM
Things have gotten bad. When Beatrice asks how far she has progressed no one will tell her. Only offering general encouragement. “You’re doing fine, just a little more, you’re almost there”
She’s heard it before and is expecting a number. She knows. Everyone knows that nothing has happened in over an hour of pushing. The nurse and the midwife, by training and personality determined to encourage, cannot quickly change their tune, nor would anything be served by their doing so. I am at a loss.
Beatrice is now curled up in a sort of squat. She cannot speak, only move her mouth. She has told us that she knows everyone is lying, and she knows that the head has not moved, and she can tell that it is not going to move.
She has begged for pain relief. She has told us all that she needs, wants, and expects a C-section so to get started with it. She does not move or speak, only breathes. If I touch her it makes it worse.
Mother and baby’s vital signs are both strong. Three of us stand around Beatrice rather uselessly for another ten minutes.
9:40 PM
The doctor arrives. He asks for an update. The nurse gives an encouraging but vague reply. The doctor checks for himself: no progress since he was last here, maybe the baby has even slid back a bit. He goes into the hallway to talk to the nurse.
The doctor returns and in a remarkably concise way outlines our options and the attendant risks. There is only one option. The doctor looks around the room. I let him know that he need not expect any second guessing from me. “I concur” I say clearly.
Consent forms are brought. A saline IV is started. The nurse-anesthetist is called at home. “This is the person you want to put in the needle for the spinal.” The doctor tells Beatrice when she realizes that this implies a delay. The doctor offers her something to “take the edge off” that can be administered through her IV, but it will definitely affect the baby to the extent that it will need to be antidoted immediately after birth. The nurse looks worried. The midwife gets in Beatrice’s ear and says “don’t”. The doctor says the orders are there if she changes her mind, he’s done it before. He is not pushing, just offering her a way to stay in control.
The doctor looks at the clock and speaks to various people. I hear the words “cut time” and “ten-thirty.” The doctor leaves to go get a hamburger. He has been in the hospital as long as we have, and has probably eaten less. It does not occur to me to begrudge the man a chance to balance his blood sugar before cutting open my wife.
10:00 PM
The nurse-anesthetist arrives. He explains what he is going to do and why. There are options, but there is clearly a best course. He tells me that I must wait here until I am called although the midwife may come with them to the OR. I reflexively challenge him on that point, then decide not to pick that battle. I would be a distraction to him, even if I said nothing.
Beatrice is wheeled out. I am left in an empty room with the space where the bed was outlined by sticky tape from the drop clothes that had been there moments before.
I pace. I stand. I breathe. Finally I sink into a squat with my back against the door jam and stare down the hall.
THE NEXT TWENTY MINUTES
Beatrice waits in the OR in same state as when she left the room. They will not start the anesthesia until someone in the operating team confirms, by sight, that the doctor is in the building.
Beatrice passes the time explaining to those around her what she thinks of this policy and what they should do about it.
The doctor’s car is spotted through a window as it returns to the parking lot. A chain is formed. Someone waits at the door, someone else down the hall, and further down to watch the elevator. The elevator doors open and a wave of nods starts the anesthesia.
10:25 PM
I am gowned, capped, and masked.
I enter an incredibly cramped OR and am shown a stool at Beatrice’s right shoulder. I have to move aside tubes and wires to sit down. Beatrice is shaking, hard – a common side effect of the anesthetic we are told. We talk a bit. Beatrice apologizes to the team for her comments of a few minutes ago. They assure her he didn’t say anything out line.
I lower my head to the corner of the table and breathe deeply. I have not eaten since noon. The room is warm. The concept of what is about to happen takes a very personal turn. They want to know if I am OK. I say I will try to fall to the right, since there are fewer wires in that direction. Someone grabs me by the back of the gown – good thing it doesn’t snap in front I think. I squat in a corner of the room with my head between my knees and finish off the orange juice and graham crackers that someone put in my hands. I’m OK and sit back on the stool, but I won’t look in the mirror they set up so Beatrice could watch. I hear the doctor announce “Cutting.”
SOME TIME PASSES
The doctor takes two phone calls, via the nurses, while he is working. The first about a patient he was just inside of, and the second from a team awaiting his arrival to work on another patient.
11:04 PM
The doctor makes some exclamatory noises. “Big” I hear, then a strong cry. I surprise myself and let out a loud whoop, but still don’t think about looking up. “Look!”, Beatrice tells me. I ask if it’s all the way out. Yes it is. I look up in time to see a baby passed back to the receiving table. I get up to assume my duty. The child is not to leave my sight until it is back with Beatrice.
When I get to the baby station she is on the scale and I see a four digit number beginning with “5”. I know this is the weight in grams and I am stunned. Before I can do the mental calculations the nurse presses a button and the display changes – eleven pounds six point seven ounces. I shake my head as the number is announced. “So much for ultrasound calculations” I say loudly. “Hey, I said it was just an estimate” the doctor replies. Eleven pounds six. This explains why the baby never engaged in the first place. It explains a lot of things, but it doesn’t explain why she didn’t decide to come out a month ago.
I look on as the nurses clean her up. She has her eyes open and watches me. I make a few fumbling attempts at conversation with my new daughter. They hand her to me and motion for me to bring her to Beatrice. I turn around to carry her back to that end of the room. I am on the “live” side of the sterile curtain.
I don’t mean to but I look at the action, at the surgeon’s work. Don’t ever do this unless you really mean to.
I hold the baby for Beatrice to see. The phone rings. Somehow Beatrice’s sister has managed to get patched through to the OR. I shout that we will call her back. The midwife takes the call.
I take the baby back to the newborn staff and we wheel her out of the room. I leave Beatrice behind with the midwife. They are still putting her back together.
While the doctor finishes up, Beatrice vomits and the anesthetic begins to wear thin – she can feel tugging that she couldn’t before. They give her a few minutes of unconsciousness before closing and moving her.
MIDNIGHT
The nursery staff lets me know that Beatrice arrived in a recovery room not too long ago. She will need to be there for at least an hour before they move us to our new room and I can bring the baby to nurse.
The baby has had a vitamin K shot, goop in her eyes, a couple of heel pricks, and a bath. She has watched everything around her the whole time and is starting to root around looking to suck. If her glucose drops too low they will give her formula. We don’t want that to happen.
I pass the time holding the baby and eating a grilled cheese sandwich.
FRIDAY
SOME TIME AFTER 2 AM
We are located in a new room. The couch is made up. The baby has nursed. The Demerol is pumping nicely. We get what sleep we can amidst the hospital routine.
MID-MORNING
Beatrice calls her mother at our house. Her mother arrives with Rainer. I take Rainer home. Beatrice’s mother stays. If the new mother is not capable of getting up, they will take the baby to the nursery unless someone else stays. We work out a tag team strategy.
SUNDAY EVENING
The recovery portion of the experience has been in stark contrast to the labor and delivery. On this floor the nurses have to raid neighboring rooms to get toilet paper at night. Orders to clean Beatrice’s incision were overlooked. She was told that a fresh pair of mesh underwear was not available, but it would be OK to rinse out and re-use the pair she had. Beatrice has been making a mental list. I encourage her to write it down so we can send a letter.
Rest will be more forthcoming at home. Beatrice’s mother comes from the hospital to watch Rainer at home. I drive to the hospital. We pack and leave. We stop to fill the prescriptions. We finally get through the front door and are all together in the house for the first time.