The Story of Asa's Birth

by Liz

My son Asa was due November 24, the Saturday after Thanksgiving, and I really wasn't expecting labor until at least a week later, in the tradition of first babies being late. However, I woke up at 7 on the morning of Sunday, November 18 with contractions. According to the handy labor timer my doula, Tracy Hartley, had given me for my Visor, the contractions were coming between 8 and 12 minutes apart. I bustled around in between, getting breakfast and putting the last few things in our hospital bags. I woke up Sven mid-morning, telling him I didn't think he was going to get to the hardware store that day as he had planned. I also called Tracy to tell her my situation.

The Harry Potter movie had opened the Friday previously and I had made plans to see it the day before Thanksgiving with my parents. Sven had teased me that I would certainly give birth before the movie opened, since I was so interested in seeing it. I told Tracy that my impulse was to head out to the movies, and to my surprise she said, "Go ahead!" So I called my parents and after they had a good laugh, they promised to meet us at the theater in Glendale for a matinee.

I went on having contractions through the afternoon, although they slowed down considerably during the movie and dinner afterward. However, things started to speed up a little later that night. By 12:30 a.m., the contractions were much more painful and 5 minutes apart. At my request, Sven called Tracy to come provide support.

Tracy arrived at 1:40, and soon after, I threw up, a sign of progress in labor. She and Sven supported me through the contractions, Tracy using the hypnobirthing relaxation techniques we'd practiced. By 2:30, the contractions were strong and 3 minutes apart. We headed for the hospital.

In triage at Kaiser, the first doctor who checked me, Dr. Lewis, said I was fully effaced and at eight centimeters. (I was a little surprised to learn that the dilation check is done by feel, but I suppose it's hard to get a ruler in there.) She wanted a second opinion from someone with smaller hands, though. The second doctor, Dr. Lau, said nope, three centimeters. That was much more realistic, I thought. Dr. Lewis checked the baby with a portable ultrasound and reported that he was very low -- at 0 station -- with plenty of fluid. She guessed his weight at 6 pounds 11 ounces. Soon after that, I was admitted to the Birthing Center, and Tracy and I went walking up and down the halls on the advice of the hospital staff. I paused to lean up against the wall and breathed through each contraction. We came back to the room periodically for my contractions and the baby's heartbeat to be monitored.

The nursing care I got at Kaiser through what turned out to be a long labor was mostly good but occasionally indifferent and, a few times, pesky. I had one of those pesky nurses that morning in the Birthing Center. I sometimes have trouble getting blood drawn because I tense up, my blood pressure drops and the poor medical staffer sits there with the needle in my vein and nothing coming out. This happened when the nurse tried to draw my blood that Monday morning between walks. She came back a little later and Tracy helped me relax while she did the draw from my hand rather than my arm -- but then she put a heplock in my hand without asking me. This is one of the things Tracy and Sven knew I explicitly did not want unless it was necessary. When I realized what was happening, I blew a minor fuse and insisted she remove it. She asked me several times if I wanted it removed, and reminded me that it would make emergency procedures easier if it was already in. "I do not want a heplock," I said clearly, and she didn't ask again. Fortunately, this nurse went off shift soon after.

Walking, monitoring, walking, monitoring. Our family friend Karen arrived at 7:30, and my father came soon after. My mother had an important meeting that morning but was planning to come after that. Karen took a chair by the monitor and was entertained by the rise and fall of the pressure track that followed my contractions.

The midwife on duty that day checked me at 10:30 and I was still at three centimeters. Things had slowed down. Tracy tried some acupressure on my ankles, which had no immediate effect (although usually this tactic has a delayed effect). At 12:30, the midwife suggested I go home. You're too happy, she observed, and it was true that I was not in much pain and was enjoying hanging out with Sven, Tracy, and our guests. I felt a little desperate about my recalcitrant cervix, and I said I'd try some more walking and some nipple stimulation. With a burst of energy, accompanied by Tracy, I climbed the stairs from the second floor Birthing Center to the seventh floor, then walked down to the basement, and then climbed back to the seventh floor. Very soon after we returned to the room, my mother arrived. Sven and I took a shower and did some nipple stimulation. However, by then I had reconciled myself to my stalled out situation and we left the hospital for home around 4 p.m. to get some sleep.

I didn't have long to wait for things to pick up again. After a brief nap, I was awakened around 7 p.m. with strong, painful contractions. Sven offered a shoulder to lean on, and a bucket for me to throw up in. We called Tracy to come back around 8:30 p.m. By 10, the contractions were three minutes apart and lasting two minutes. I was in the labor zone and my memories of this time are hazy, but Tracy's notes tell me that the contractions were coming further apart an hour later, and that I dozed between contractions from 11 to midnight. Then I woke up and said I wanted to go to the hospital. We were back in triage at 1:40 a.m.

After all those painful contractions, I was at 4 centimeters, 90% effaced, with the baby at -1. Less effaced, and the baby had moved up. That was a low moment. The doctor said I could walk, or I could be admitted. We had lots of bags so I asked to be admitted before I went back to walking, so we'd have a place to put all our stuff. By 3 a.m. I was settled into a Birthing Center room, but I didn't stay long. At 3:30, a nurse from Labor & Delivery came in and informed us that my blood pressure was high and that if it didn't go down, I'd be considered "high risk" and have to move to Labor & Delivery. High blood pressure in pregnancy or labor is a condition known as pre-eclampsia. There is a small but significant risk of seizures and other complications, so hospital staff take it very seriously.

An hour later, with contractions coming between four and five minutes apart, my blood pressure was still high. This was my other low moment. I wasn't about to refuse treatment for pre-eclampsia, but I wasn't thrilled about leaving the spacious Birthing Center room and physically moving onto another bed. I was so, so tired. "I want to keep the bed," I moaned. The Birthing Center beds were extremely adjustable and had a removable lower half for delivery. Nobody argued; someone put an oxygen mask onto my face and they moved me, bed and all, to L & D at 4:30.

At this point, I recall that there was a separation in my mind between the various medical tasks going on around me and being done to me, and my internal world after being up for two nights. Out in the medical world, I was put on an IV and had my blood drawn. In my internal world, as I told Tracy, I was tired, and I was tired of labor. Tracy recommended that I ask for an epidural, which would allow me to get some rest and possibly have a salutary effect on my blood pressure. I asked for pain relief, but unfortunately the anesthesiologist reported that I had low platelets in the previous day's lab results, which would mean difficulty clotting and preclude an epidural. After a short wait, that morning's blood work showed the same. No epidural for me.

Around this time, 5:30 a.m., I was started on magnesium sulfate to prevent a seizure. I could get morphine for pain relief too, I was told. However, the magnesium sulfate is supposed to act as a muscle relaxant, and that's exactly what it did for me, without additional side effects that I could notice. Mercifully, the many medical staff refrained from telling me what side effects I might have experienced, with the exception of warning me that it might burn a bit as the "bolus," the first, more concentrated bit, went into my vein. (It didn't.)

Soon after that, I was checked again. Fully effaced, seven centimeters, and the baby was back to 0 station. Progress at last! As an alternative to putting me on pitocin to speed things up, a doctor ruptured membranes. The fluid, fortunately, was clear.

More medical stuff: time for a catheter. I was asked if I wanted my morphine now, but I was feeling relaxed enough from the magnesium that I turned it down. The contractions were 3-4 minutes apart, but finally I was getting a little rest, despite the automatic blood pressure cuff that took a reading every 30 minutes.

Through the morning, as my family trickled in, my blood pressure slowly dropped and my cervix slowly dilated. I was at 8-1/2 centimeters at 8:45. A doctor cleared me to have the oxygen mask removed at 9, as the monitors showed the baby doing fine. My brother and sister-in-law arrivd at 10:45. Dr. Lau (she of the smaller hands from my first triage) reported 9 or 9-1/2 centimeters and the baby at +1 at noon. My mother arrived at 12:15, and I recall her standing in the corner of the small room to my right while Tracy stood by the bed at my left. "Are you worried?" I asked her. All the tubes and monitors around and on me, a marked contrast to the scene she found in the Birthing Center the previous day, can't have inspired her to be calm. I explained a little about the medical situation, and Tracy reassured her that first, the risk of eclampsia was small, but second, that it was a good thing it was being taken seriously. She stayed in the room with me until Dr. Lewis stopped by to say that she was on duty and would attend in the delivery room.

When Dr. Lewis checked me at 1:15 p.m., I was completely effaced, completely dilated, and the baby was at +2. She did something to take care of a remaining lip on the cervix. Still, I didn't feel the urge to push. As I had been through the whole labor, I was coherent, but there was a fuzzy barrier between me and the world from the magnesium, sleep deprivation and being in the labor zone. (Another factor was my blurry vision because I'm extremely nearsighted and I was spending most of my time without my glasses on.)

At a little after 2, yet another doctor informed me that my contractions had spaced out to 5-6 minutes. My whole labor was two standard deviations on the slow side of average, he said. He recommended pitocin to make sure the contractions came frequently and strongly enough to push the baby out in the allotted two hours. When he promised that they would start at the very lowest dose and increase it only slowly as necessary, I agreed. (Later, Sven remarked that he had appreciated how this doctor had phrased my situation. "Two standard deviations is still on the normal curve," Sven said, as opposed to being a complete outlier.)

I don't remember ever really feeling an urge to push, but I did a practice push with Tracy, Sven and my brother Greg in the room around 2:20. I did a little more pushing with a nurse in the room 30 minutes later, and then they moved me to the delivery room as Tracy and Sven and the medical personnel suited up. It seemed odd to suddenly have to change rooms in the middle of everything, but the delivery room was certainly more spacious. A nurse removed the bottom of the famous Birthing Center bed and some medical person instructed me in how to grab my thighs as I pushed. I was still pretty spaced out, and I was glad when Tracy and a nurse took over supporting my legs. Sven was standing by my head. Tracy had warned me that some nurses liked to loudly count to ten to help the laboring woman time her pushes, and indeed as I pushed there was some nurse, loudly counting. Sven was by my ear, also counting but on a slightly different tempo. Between contractions, I said that Sven should please be the only one counting, and the nurse mercifully shut up.

I pushed for only twenty minutes. Asa was born at 3:30 p.m., 6 pounds 5 ounces and 19-1/2 inches. Dr. Lewis had lubricated me with mineral oil as the baby's head came down, and I had some minor, superficial tearing. I learned later that Sven cut the cord.

Someone said, "It's a boy!" and someone else asked if he had a name yet. "Asa," I said. "It's an old Hebrew word -- it means 'healer.'" I got a murmur of approval from the room full of healers.

A picture from the delivery room.

I had said in my birth plan that I wanted to warm Asa on my chest after he was born, and to my faint surprise that was what happened. He was alert and calm. It had been so long, I wasn't sure whether anyone in the room even knew I had a birth plan. When I wrote it, I assumed that I'd get a chance to try to nurse right then, but Asa was whisked away for all the measuring and cleaning that happens to newborns. I asked Sven to follow him so there would be a familiar voice nearby. The placenta came out fairly soon after. We had wanted to take the placenta home but we forgot to bring a container. One of the medical staff produced one and we were in business. While Asa was measured and weighed and washed and so on, Dr. Lewis stitched me up.

We were moved to the recovery room, where fortunately I was the only patient because my parents and my brother and sister-in-law came in with Sven to admire our lovely baby. Many commented on how cute he was, and my mother noted that he was cuter than either I or my brother were at birth. Then everyone left to get some rest, and to let me get some rest. I didn't get a chance to try nursing until 6:30 that evening.

I spent the next two nights at Kaiser, the first one in L & D recovery (as I was still on magnesium sulfate until late the following morning) and the second in Family Centered Care in a private room. Asa roomed in with me the whole time, although I wasn't up to doing any diaper changing until the second night. There wasn't space for Sven to sleep, which was just as well. He slept at home both nights and reported that he'd finally gotten a good sleep Wednesday night. I was released to go home on Thanksgiving Day, an auspicious time to bring home a new baby as my parents dropped by that night with a big care package of Thanksgiving leftovers.

It wasn't the birth I expected -- but I can't say that I had a lot of expectations, so I wasn't disappointed. I was grateful to be spared back labor, and hours of pushing. I was also glad to avoid further complications like a caesarian, mostly because of the longer recovery time. Tracy and one or two nurses remarked that it had been a good labor. As far as I can figure, Tracy was referring to the fact that I held it together for the whole two days and was always thinking clearly enough to participate in the process, including all the medical decisions. I spoke up when I didn't like what was going on, like the surprise heplock and the loud nurse counting in the delivery room, and I cooperated as well as I could with procedures that were uncomfortable to me, like the many blood draws. (Tracy helped me relax for a couple of them.) Sven thought the nurses were referring to the speed with which I pushed Asa out when they complimented the labor. Overall the medical care I received was very good, and I don't recall ever being treated like an object rather than a person. I had done a few things to encourage that -- at Tracy's suggestion, we brought a big care package of mostly healthy food for the nursing staff to which I stapled my Birth Plan, and I labored in my own clothes, a big t-shirt. Still, when I did start to lose it, like when I was moved from the Birthing Center to Labor & Delivery, I was treated very kindly and with respect.

We had our ups and downs nursing over the next few days, in the hospital and once we got home, but things straightened out after we saw a lactation nurse on Monday. We're tired now, almost five weeks later, but what else did we expect? Asa is a beautiful baby and we're proud to be his parents.

A picture of Liz and Asa in bed.

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