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Week by Week

Charles and his dad

Born: October 24, 1996
Weight: 7 lb 1 oz
Length: 20"
Details:

My version: Scott's account

So here's the whole sequence of events from last Thursday.

We were supposed to check into the hospital at 7:30 in the morning to have labor induced. This is done with an increasing solution of pitocin, a synthetic version of the hormone that induces labor naturally. But there was a run on the hospital and we were told "wait a bit." We called pretty much every hour and were told the same thing. Some time before noon Kim called her doctor's office and let them know what was going on.

At 1 PM our doctor called us and said "Be there at 2 PM and we'll get this going." We found out later that as a scheduled induction, we were on the lowest priority, but the reason for scheduling induction was the gestational diabetes -- apparently that causes rapid breakdown of the placenta after the due date passes. Ours was the previous Friday (calculated from the ultrasound), so we were at the point where it should happen.

At 2 we checked in, they did the vitals and got us going. At 3 PM they actually started the pitocin drip, and I took a short nap (we'd been up all night walking, trying to get labor to start naturally).

At about 5 PM I woke up because there was a change in the tone of Kim's voice. Labor had become intense, the contractions painful -- something she experienced before with a short dose of pitocin while delivering Torrey. Contractions were every 3 minutes and it was no longer possible for her to talk during them.

We also noticed, about this time, that during these strong contractions, the fetal heart rate dropped from its normal 145-150 to 110-120. It had been resuming its initial position at the end of the contraction, but that started to diminish. By about 5:30 we noticed that the FHR was down to 120 most of the time and would dip to 100 or even into the 90s when Kim would contract.

At 5:45 they gave Kim an epidural at her request -- something not required with the other two deliveries. That would take about 15 minutes to take effect, she was told.

The fetal heart rate was now below 100 at rest and was dropping to the 60s during contractions. Dr. Grolle, the obstetrician, did an exam and broke Kim's water so that we could put in an internal scalp monitor (more reliable for the baby's heart rate). At the peak of contractions, the heart rate would stop altogether for up to 2 or 3 beats at a time (well, equivalent duration), then start back up.

It doesn't take Albert Schweitzer to figure out that this is not a good sign.

Dr. Grolle tried to open Kim's cervix (which was at 8 cm -- should be 10 cm for delivery) with his fingers, while we had her push -- probably still an hour too early to push. This caused the heart rate to drop even farther, into the 40s during contractions and back up to the 60s and 70s.

"We want your kid to go to college, right?" said Dr. Grolle. At that point things happened very fast. "Get the OR ready, we're going to crash," he told a nurse, who ran from the room. He apparently asked for another anesthesiologist and another surgeon, as well as the pediatrician, to come to the OR. They converted Kim's bed neatly into a gurney and we proceeded to run through the hospital pushing her on the bed.

I have never before been so scared in my life as I was at that moment.

"Crash, everybody," Dr. Grolle said as the staff started to wash up. "Nobody scrub -- just gowns and gloves, we're going in and taking this baby out *now*."

They took her off pitocin at 6 PM -- we know this from the strip on the FHR monitor. The good news is that at that point, almost immediately, Charles' heart rate climbed to the 140s.

I stood in the observation/scrub room next to the OR, watching this all through a small window. They intubated Kim and she was out in a few minutes. I didn't have time to say anything to her as they rushed her into the room. I don't know what I could have said that would have made a difference.

Standing alone in the scrub room, wondering how much I'd have to explain to the girls, wondering how many and which of my family would come out of the OR, was a moment I do not wish to repeat. I felt the fear reach up to take me.

And I chose not to let it.

At that moment, 5 or 6 pre-med students from De Anza (I didn't even know De Anza had a pre-med program) rushed in to the scrub room to watch the procedure. This was a *complete* miracle, because it allowed me to keep my attention on something other than how terrified I was.

I brought them up to speed on what was happening to that point -- the FHR readings, the unsuccessful attempt at pushing, and the "don't bother to scrub" admonition. I then proceeded to describe to them what the doctor was doing. I'd had the benefit of having watched an entire C-section on The Learning Channel some two months before, so I knew what was going on -- when he went through the fascia, when he was moving the uterus, and the like. And being able to describe it to the students was my way of taking responsibility for at least part of what was going on, and kept me from breaking down at all.

I wasn't expecting the speed of the procedure. Again, from the FHR monitor: the first scalpel touched Kim at 6:20, and Charles was crying at 6:25. Nobody in the hospital could remember a faster section. I put on gown, hat, and mask and went in to check on what was going on. The baby was doing well under the pediatrician's care, had already had the cord cut and was getting swabbed under the warmer.

While there, I took a quick look at Dr. Grolle, who should have been closing up at that time. "I've got a couple of bleeders here," I heard him say to the other surgeon. We found out later that through some piece of bad luck, Kim had two larger blood vessels running through her uterus at the point where it was most effective to remove Charles. These took some doing to get them to close up, and in the process Kim lost a lot of blood. Not enough to require a transfusion, but we would find out later (through Saturday's first miracle) that she lost 2L in the procedure.

At this point, I went with Charles -- there was really nothing I could do for Kim at that point other than stay out of the doctors' way and let them do what they could. I'm a little confused on exactly what came next here -- I spent most of the time with Charles, but there was one point at which I checked in on Kim and was told "She's fine," while Dr. Grolle was in the process of sewing up one of the final few layers.

Found out that Charles' blood gases and cord gases were 100% at birth, so he'd never had any hypoxia. The cord was very tight around his neck, though; apparently what happened was that as he was squeezed by the contractions and forced farther down into the pelvis, the cord would tighten up. Babies have up to 50% of their blood in the placenta, and if the cord shuts off and they were to retain the 150 bpm heart rate, "they'd blow their brains out" in Dr. Grolle's words. So the slowdown in FHR is to avoid pressure aneurysms. Neat. It appears to work. On the other hand, the cord was in such a configuration that if they had tried to deliver him vaginally, you would be reading a very different story now.

Once Kim was declared fine, I called my girls and let them know. Bo was great when I explained that Mom had to have an operation to get the baby out. "An operation?" she said. "I saw that on TV!" "Yes, that's exactly what she had." Torrey was near tears on the phone -- "I'm okay, just a little excited," she said. Called my parents next.

Around 7:30 I went in search of Kim, found that she was in the recovery room and was out of the anaesthesia by then. Still groggy, though. I sat with her and let her know what had gone on, the time I'd spent with Charles, the rest of it. About 8 PM I wheeled Charles into the recovery room so that she could see him and hold him -- she hadn't had that chance yet. So I missed getting to tell the doctors "It's a..." as I'd done with the first two, but in exchange I got to be the one to hand Kim her son for the first time.

The med students wandered through the recovery room a little later; we invited them over to see Charles, and I gave them a killer acknowledgment, about how their professionalism allowed me to concentrate on what was going on in the room instead of what was going on in my head, and about what great doctors they were going to be. They bounced out of the room about six inches off the ground, all of them. I liked that, but they really saved me from a few pretty miserable minutes with myself.

I, in turn, got an awe-inspiring acknowledgment from Kim's nurse, Meg, about how unbelievable it was the way that I was always in the right place, out of the way when I needed to be and helping to push or roll or carry something when there was something to be pushed or rolled or carried, and how I just held it all together in the face of some pretty frightening stuff.

Friday and Saturday were pretty exciting too. It was the Hallowe'en Carnival again at school, and I was again the head of the committee and the ringmaster/M.C. for the show. I've tried a couple of times to convey to Kim the amount of love and concern there is for her at the school, but I'm not sure she got it. What really did it was when her friends volunteered to give blood if she needed it (she didn't), so that we'd know where it came from.

So that was my weekend.

Kim's version: Kim's account

Charles's Birth -- Kim's Account

It is a tale of stop and go labor two weeks before actual delivery. Induction, (overdue and gestational diabetes..) an epidural I thought I'd never ask for and an emergency life-saving C-section at the end. Interested? Read on...

First of all, I'd like to say that my son is beautiful, perfect, currently nine days old and thriving. Secondly, I'd like to say that you moms out there that willingly opt for more than one C-section are true heroes--after two unmedicated natural births, with accompanying stitches and healing-- healing up after this C-section thing is hell. Never again for me! But then this was my surprise bonus child after all.

Over a week before my due date I started a mild labor on a Sunday night, contractions stronger than B-H, every 5-7 minutes that I was unable to sleep through. Monday morning we took the girls to my friends and waited a bit more. After 11, the contractions slowed down. We did errands. We went to the park and walked and walked. It only made me tired, since my hips and ligaments were all loose and 'ready'. Tuesday I had my regular OB appt. Still 1 cm like before, and only somewhat effaced. Darn. the doctor said if we went to the next week's appt we would do an induction, scheduled for Thursday, Oct 24. My due date was 10-18 and normally both the Dr. and I would wait longer but I had GD and they don't like to wait for the placenta to break down. My elder daughter was 3 days overdue, #2 was ten days early. I didn't know WHAT to expect.

A week later, there I was back being checked again, still at 1-1.5 cm and 30% effaced. I thought I would go mad if one more person asked me if I was *still here*. Arrgh. Wednesday night 10/23 stronger than B-H contractions started in late afternoon. At 5, I told me husband to finish up at work, come home for dinner as I thought it was real this time for sure. The doctor on call told me to check into the hospital. Finally! By 8 my friends arrived to take the girls (big sisters aged 5 and 8) to their much anticipated sleepover. While we waited for them to arrive Scott and I actually watched the baby drop two inches into my pelvis! Hooray! I thought! But of course, this only made my labor stop again. At the hospital, I was 2 cm and 50% effaced. A few hours walking around did not make for much difference, so I reluctantly bade the nurses goodby until morning as I was scheduled for induction at 7:30. I was confident I'd be having the bay the next day one way or the other.

The next morning, I called the hospital than had been so quiet the night before to find out there was an ongoing population explosion and they didn't have a bed for me! Aaauggh! This was the worst. I tried not to cry. I called again at 10 and noon. Every pregnant lady in the bay area was there giving birth, it seemed. And the full moon still 3-4 days away! At 1 pm my Dr called me, he'd pulled some strings and called in some favors and told me to be there at 2.

By 3 I was IV'ed (it took 3 tries- ouch!) and monitored and they started the pitocin drip at a low dose. We noticed once as the baby's heartrate, usually at 140-145 would race during a contraction, dropping back to baseline, suddenly dropped past 120 to 100 or so. "What was THAT?" we asked. The nurse said it was possible the baby's cord had gotten squeezed, possibly even by his own hand. He went back to normal and the nurse and Scott and I agreed to keep an eye out for anything similar. The pitocin started working and I started having "good" contractions pretty soon. They turned up the juice and they started getting harder and harder. I'd had pitocin briefly during my first birth and thought it had been much harder then. The medical staff will assure you that it is a synthetic hormone just like the one you produce yourself-- and while this might be true, the drip I think puts more in you faster than you do normally. At 4:30 I was in agony. I'd had the girls with no medication and I have a very high tolerance for pain but I didn't know how I was going to survive this one. My Dr. checked me, I was only at 4 cm, and every time (every 1.5 minutes) I'd have a contraction I was shaking like I would fall apart. They offered me an epidural and much to my surprise I agreed to it. I really didn't think I'd be together enough to push the baby out if I had to go much longer as I was. I felt bad. The nurse came in with a shot of Demerol as the anaesthiologist was 15 minutes away and they said it would take 15 minutes to take hold. The nurse said it would be out of my system in a hour, by the time the baby was born but I refused it anyway (thank goodness)

The baby's heartrate had plunged a few more times by now and we were expecting him to be born with the cord around his neck, and they coached me on how to stop at the crucial moment so they could untangle it. So I *really* wanted to be completely with it at the dramatic conclusion. They gave me an epidural about the same time they broke my water to insert an internal monitor to better track the heartrate thing, which was starting to worry everyone. The epidural, I have to say, was set so mild that it only took the edge off the contractions, much like a natural birth would feel like, not a lot of fun, but endurable. I could feel everything and felt I could make it all the way, which they didn't think would take too long, I had gone fron 4 to 6 in 15 minutes and my Dr, who had thought he'd be going home and leaving me to his associate (he looked pretty beat, poor guy, he'd been delivering babies all day and night after all...) said he was staying for the grand finale. By the time I made it to 8 (about 15 more minutes and the epi just taking hold) the heartrate problem was getting BAD. the Dr. tried holding my cervix open and had me try to push which was tricky as I felt I didn't have anything to push against. It was sort of working (I was trying SOOO hard) but the baby's heart finally dropped to 40- 50 beats.

Now things got very dramatic. We/they agreed to an emergency C-section, I was told they'd be putting me completely under with a general as the epidural was set so low there wouldn't be time to numb me. I was very terrified for the baby. We crashed across the hall, the Dr hollering for everyone to throw on a gown and not to take time to scrub. Scott, unscrubbed, was relegated to a viewing window and they started getting me ready. This was the most scared I have ever been. Mostly for the baby, a great deal for Scott, alone and concerned in the next room, and a bit for myself, still un-numb, I could feel as they shaved and slathered betadine on the incision site. Would they remember to put me out before they cut me open?

I guess they remembered because they next thing I knew I was waking up in a different room. It had taken 5 minutes from first incision to the birth of Charles, who was apgar of 6 at first, the cord had been so tightly wrapped around his neck he was blue. He quickly went to a score of 9. At 7 pounds 1 oz he was pronounced perfect and he and Dad went off to wash and fix him up. As they took him from the room, Scott could hear that they were working excitely on me, I was bleeding quite badly, it seemed. I had told Scott ahead of time to stay with the baby after birth, so he didn't stay as they starte the one hour job of sewing everything back together. I guess the bleeding was quite bad, I learned afterward I had lost 2 liters. Woof.

When I woke up, it seemed like it took several minutes to learn I had had a boy, he was perfect, and Dad was off calling some proud relatives. When they brought the baby to me I was amazed at just how beautiful he was. A healty crop of reddish blond hair adorned his head and his features were/are exquisite. Very much worth it, but I've gotta admit, healing up after a C-section is no piece of cake. Thursday night they had me on morphine-- which if you've never had it, maybe it works, but it makes you feel terrible. I had a button I could press every 5 minutes that would put some into my IV, but by Friday morning I wasn't pressing it anymore. I started taking Vicodin and Advil which worked better and stopped me feeling nauseated. Charles nursed a little Thursday night and by Friday morning was a real pro. I stayed in the hospital until Saturday evening (just 2 days!) Tuesday they took out the surgical staples at my OB's office.

Currently at nine days after the fact I still cannot roll over in bed, which makes sleeping at night problematical- I sleep for the most part upright on the couch. Charles, of course, sleeps more during the day, 2-3 hours at a stretch, waking at night every 1.5 to 2 hours or so (I think--I'm so sleepy I don't pay lots of attention.) I'm looking forward to driving some time next week, taking hot baths again (not sure when I can do this!) and being able to hop to my feet without feeling like my guts are going to rip open and spill out.

Charles is a real sweetheart, doesn't cry much and loves looking at people and moving his face around. His sisters, father and I are completely besotted.

More pictures when I get WinFTP at work...

--Scott