Bart

7 pounds, 10 ounces, 21 inches long

December 2, 1997, 1:38 PM

Long Beach Memorial Medical Center, Long Beach, California

The story of this pregnancy starts before conception, because I plan ahead too much and my OB/GYN is too good. My regular family practitioner didn't do obstetrics, you see, so when my husband Rex and I started planning for our first child, I decided to shop for an obstetrician. I didn't need my annual Pap smear until May 1997, but I made an appointment for one with Dr. R. in February so I could check him out. The Pap was normal, but during the exam he found a lump in my neck which he suspected was a thyroid nodule. (Talk about a thorough gynecological exam!) He referred me to an endocrinologist. I wasn't too worried because I knew the majority of thyroid nodules are benign.

Unfortunately, the endocrinologist's biopsy showed that the lump was "suspicious" for cancer. Because I was pregnant, she sent the sample to UCLA for a second opinion, which eventually came back "highly suspicious". Uh-oh. Dr. T. (the endocrinologist) consulted with the West Coast guru endocrinologist who said it was no problem to perform a thyroidectomy on a pregnant patient in the 2^nd trimester. However, when she consulted with Dr. R. and the otolaryngologist who would be performing the surgery, Dr. Y, they felt better about holding off until the 32^nd week when the baby would be viable, in case something happened ("something" being preterm labor). That would be mid-September. Given that there would be so much delay anyway, that raised the question of whether to just postpone the surgery until after the baby was born in late November. It was kind of a win-win decision, since the odds of something bad happening (preterm labor vs. possible metastasis) were small in either case, but it's still an agonizing choice to make. Rex and I eventually decided to postpone surgery until after the baby was born. My rationale was that, if something bad happened to the baby because I had surgery, I could never forgive myself. Whereas, if something bad happened to me because I postponed the surgery, well, it was just lucky that Dr. R. found the lump in the first place. After all, what if I hadn't decided to "shop" for an OB? I wouldn't have had a Pap smear in 1997 at all (you can't get one when you're pregnant, I understand, and I spent most of 1997 in the family way), and the lump would have gone undetected until who-knows-when.

When I told Dr. R., he said that he might be able to induce labor at 38 weeks in order to get to the thyroidectomy that much sooner. I said sure, but I didn't think it would be necessary. My mom and my sister never made it to their due dates, so I figured the baby would come around 38 weeks anyway. And I was enjoying being pregnant. The pregnancy was very easy. Not much nausea, no vomiting at all, no other bad side effects to speak of, except for some sciatica for a few weeks at the beginning of the third trimester.

I did have a scare at about 26 weeks along. I stepped out of the shower and noticed there was a blood spot on my towel, exactly like when I have my period and forget to not wipe my crotch. Instant panic -- "I'm in premature labor! Something's wrong!" -- although when I checked, I couldn't find any more blood in my crotch, and I wasn't having any cramps or contractions or anything-- in fact, I felt terrific. You've probably guessed the next part: of course... I had just shaved my legs, and upon inspection, found a nasty nick in the back of my ankle, which I hadn't even felt. *Whew* -- talk about relief!

Another scare two weeks later -- I woke up one morning, peed, and went to feed the cat. Then I felt a trickle down my leg. Convinced I was leaking amniotic fluid, Rex and I rushed to the hospital. There wasn't any more after that initial trickle, though, and the ferning test was negative, so everything was OK. I didn't think it could be urine since I had just emptied and wiped, but I guess there was a little left in the pipeline. I was getting to the point where I often felt on the verge of leaking pee.

Since the other women in my family had always had their babies early, as I mentioned, Rex and I expected the baby before the November 29th due date. We got prepared well ahead of time and, at 38 weeks, we were ready for the baby. Ha ha. At my 38 1/2-week exam, my cervix was still closed. No induction then. At 39 1/2 weeks, I was at 1 centimeter, about 50% effaced but still pretty long in the cervix. No induction then either.

On Thanksgiving Day (39 weeks 5 days), I passed what I thought must be the mucus plug. I was surprised that it looked just like mucus with a tiny bit of blood. Like that stuff inside a hen's egg when you find a little bit of blood. On the Sunday of Thanksgiving weekend (40 weeks 1 day), then the mucus really started coming. All day, I passed gobs of brownish stuff. All that weekend I would have a few contractions in the morning before getting out of bed. They felt just like menstrual cramps. But they stopped when I got up.

So much for my November baby, then-- Monday was December 1 (40 weeks 3 days). Another exam-- 2 centimeters, 60% effaced. Still no induction, but I got an appointment for Wednesday. Driving home from the exam, though, I started feeling contractions every so often. I stopped for groceries on the way home and bought out the store (does that count as nesting? We were still eating the carrots when the baby was 11 days old...). I had planned on holiday shopping in the afternoon but I stayed home instead to time the contractions. They were averaging 6-7 minutes apart. The book I had said that you shouldn't even bother to time them when they're 6-7 minutes apart, which was discouraging. (But Dr. R. said to go to the hospital if they're 5 minutes apart for an hour, and how are you supposed to know when they become 5 minutes apart if you aren't timing them when they're 6+ minutes apart? I think the book was wrong.) I called Rex to tell him, so he bought fried chicken on the way home from work.

I didn't want to eat much for dinner. We just putzed around and watched TV all evening, and the contractions stayed at 6-7 minutes apart. Finally at 11:00 PM I got hungry and ate two pieces of chicken. With such a hearty appetite, we figured that nothing was going to happen imminently, so we went to bed. Every 40 minutes or so a contraction would be strong enough to wake me up, but then I'd go back to sleep again. I actually got a pretty good night's sleep. We got up around 7:30 AM. I had a little soup for breakfast. The contractions were now 3-4 minutes apart. I was excited! They weren't really bad-- they were about like the menstrual cramps from a bad period. We waited until 8:30 to be sure they were staying at 3-4 minutes apart. Then Rex packed up the car while I put on my shoes (these two chores took about the same amount of time...) and we left for the hospital.

In the exam room, I was pronounced 4 centimeters with bulging membranes. Yay! The contractions were only just starting to be worse than my worst menstrual cramps. We went to the LDR (labor/delivery/recovery) room and met my labor nurse, Jane. The first thing I wanted to do was use the restroom in the LDR, but there was a smear of blood on the toilet seat. Jane called the janitor and had it cleaned, and I peed. I don't remember ever using it again after that (until after the baby was born). Then into the bed to be monitored for a while. One set of the bed controls didn't work... I was starting to wonder about this place!

Jane did her first exam pretty soon after I got to the room and I was then 5 cm. They talked to Dr. R. on the phone and he told them to go ahead and rupture my membranes. I was looking forward to a big gush, but I was disappointed. There was just the tiniest trickle when it was done, and then another trickle at the first contraction after that, and then I didn't notice any more fluid at all.

Jane put in an IV because I was positive for beta strep and needed antibiotics, but she couldn't find the antibiotics right away. I think they were finally put in about 11:00. Inserting the IV didn't hurt at all. Once it was in, Jane had Rex and I walk around a little. The contractions were now making me stop and concentrate on them. I would stand in a semi-squatting position (hands on my knees, butt swung out like I was about to sit down) and do pelvic thrusts. The instructor in our Prepared Childbirth class had recommended pelvic thrusts to ease the baby through the birth canal, but I was finding that they were great for pain relief. Rex was also terrific: he would massage my limbs (and back? don't remember) and he seemed to be able to read my mind as to what would feel good. We weren't doing any special breathing yet, just trying to stay relaxed. We walked down a hall and back to the room, got monitored for a little bit, then walked down a different hall. This hallway had a big poster with different laboring positions illustrated on it, and each sketch of the laboring woman was in black but the uterus was outlined in red. I had thought the poster was neat when we took the tour of the Birthcare Center a month before, but now that I was laboring, I couldn't look at it. The big red uteruses (uteri?) looked like CONTRACTIONS and I didn't want to see anything that made me think of contractions. (For that same reason I never looked at the monitor strip. Then when it was all over, the nurses whisked it away to pack it with the records [for liability purposes, damn lawyers], so I never did get to see it.)

Back in the room, I suddenly felt very nauseated and told Rex to bring me a barf bag. Good thing he was quick, too. No more than 15 seconds later, up came my soup. Jane asked if I wanted anything for the nausea. I thought that was a very silly question, because I somehow knew that as soon as my stomach was empty, the nausea would be gone. And it was, immediately. So I just shook my head no. But of course there's no way she could have known that. Anyway, looking back, that should have been my clue that I was entering transition. But neither Rex nor I thought of it, and if Jane did, she didn't say anything.

Now the contractions were getting harder and I just shuffled around the room, standing up (and semi-squatting and pelvic thrusting) to be monitored. I got really hot all of a sudden (another ignored transition clue!) and Rex switched from massages to applying a facecloth soaked in ice. It was really great the way he kept that cold cloth coming. We were using modified breathing (3:1) with the contractions now. Then, there was a contraction where the breaths came out as groans instead. Then, with hardly any break, another nasty one just like that. This was when I finally started thinking that that epidural would come in handy. Jane read my mind and asked if I wanted my epidural now, or if I wanted to be checked. It seemed like forever since I'd been checked, so I said "check me." Up onto the bed, and Jane's face looked quite surprised as she said, "There's just a lip." I was very happy, because I knew that it was almost time for the baby to come!

It was about 12:30 PM and Dr. R hadn't been in yet... he had two other women laboring that same morning (one of them an induction). When Jane called to tell him to come for a delivery, he thought it was one of the other ones, since they had both started earlier than I had!

I think the contractions were less painful immediately after that. They were turning into pushing contractions. These contractions were really quite different. They didn't hurt at all, they just came with the urge to push. And in between I was able to get really, really comfortable. All my limbs would completely relax and it was incredibly blissful. I've heard people say that it took them a while to get the hang of pushing, and I would say that, at least partly, it's more a matter of taking a while for the contractions to fully change to pushing contractions. With each one the urge to push was better defined, and between each one I could relax more deeply.

I panted through the pushing contractions until Dr. R. arrived. Nurses for the baby, other assistants, and some students also showed up. (Jane asked me if it was OK for the students to be there, and I said sure.) They broke down the bed, Dr. R. assumed his position and I scooted my butt to the end of the bed to push in earnest. Everyone gathered around and chanted "Push! Push! Push!" Rex held my left hand and someone else held my right. At first I wasn't holding my breath long enough-- I really did need to hold my breath completely, since it was almost all a diaphragm push (although all the muscles I had were getting into it). Jane also had to help me keep going through the entire contraction. I would do three pushes and then stop, since that's what we practiced in the prepared childbirth class, not realizing that I still had some good contraction time after the third push. Jane was terrific at explaining how to do this stuff.

We had learned about perineal massage in the prepared childbirth class and I'd been doing it every night (well, almost every night... well, every other night for sure). I don't know whether it really stretched the perineum or not. It did make me realize that I have a very inelastic band of tissue around it. I would describe it as like that plastic twine that the Sunday paper comes tied up in. So I wasn't too surprised when, after eight or ten pushing contractions, Dr. R. said "I'm going to have to cut you." I could feel the pricks from the lidocaine injections.

Somewhere in there I squeezed some poop out. A nurse commented that that meant I was pushing right. I didn't feel it come out but I felt someone wiping me.

Then I had a push in which I felt a burning pain at my urethra. I was alarmed until I realized what it was -- the crowning "ring of fire" I've heard about, but with the lidocaine numbing most of the region, I only felt a "point of fire." Someone announced that the head was born! Then with a squishy slop, the rest of Bart entered the world.

Dr. R. asked me to put my hands up by my stomach. Having no idea why, I held them out palms down... then he handed me my baby! It was so incredible to hold him. "He's so big!" I said. I couldn't believe that he had come out of me. He was very calm and alert, looking around with shiny, puzzled eyes. Dr. R. guessed that he was 7 and a half pounds -- after Bart was weighed in at 7 pounds, 10 ounces, he joked that he should have clipped the cord closer. Rex had not planned on cutting the cord, but Dr. R. said, "Father, cut the cord!" so he did (being careful not to cut Dr. R.'s fingers off). Bart's apgars were 9 and 9. He also had a port-wine stain birthmark on his thigh.

I had no interest in pushing any more, even though Dr. R. said, "You're going to have to give up that placenta." But nothing was happening in that department, even when I did a half-hearted push, so he stitched me up while we chatted about a mutual acquaintance. I felt the last couple of stitches but they didn't hurt. Then I pushed, and he pulled, and out came the placenta. I caught just a glimpse of it and it looked a little torn.

Jane asked if I wanted to breastfeed before Bart had to go off to the nursery, so we did. I don't really remember how it went.

The saga continued on December 24 when I returned to the hospital for my thyroid lumpectomy. Unfortunately, that confirmed the diagnosis of cancer. The tumor had spread out to the surrounding muscle and was wrapped around the recurrent laryngeal nerve (which serves the vocal cord) and Dr. Y. had to "peel it off" the nerve as she described it. She removed the entire right side of the thyroid, and the left had to come out too. But she didn't do the left at that time, because she wanted to make sure there was no damage to the nerve that would harm my voice. My voice was fine, though, so I returned to the hospital on January 7 for a third time to have the left side removed. That surgery went well too, and an MRI showed no lymph node involvement. So Bart and I are happy and enjoying breastfeeding (once past the miserable learning period) until I need to have radioactive iodine treatments in February.

Having a terrific partner with you at birth is as good as any medication! Thanks, Rex, for all your support, before, during, and after. We love our little Bart.