The Delivery

At around 8:30 on Thursday, March 20th, Emily lost her mucous plug. This is sometimes, but not always, an indicator for pregnancy. (My apologies if this is TMI.) About twenty minutes later, her water broke. There was no gush, and instead it trickled throughout the night. We couldn’t reach our doctor (there were phone problems) and so, after consulting with the hospital, we were urged to come in. This is partially because Emily carries Strep B, which isn’t a big deal (around 30% of pregnant women have it), but for which IV antibiotics are urged. She had one small contraction before we left and one contraction in the car.

We reached the hospital around 11:30 pm and were checked into room 444. The intake took a while. It seemed like a fairly quiet night, and our nurse was professional if not necessarily friendly.

One of our practice’s doctors actually came in around midnight to check on Emily and to apologize for the phone situation. Initially he planned to give her a gel to encourage dilation, but after checking her he realized this wasn’t necessary. At this point she was around 60% effaced and dilated to 1 cm.

During the night Emily’s contractions continued, rising in intensity. On the monitor, I could see that the baby’s heart sometimes raced to above 200, but no one really explained this to us. I did ask and learned that this was high, but as long as it didn’t continue it was not a major concern. In retrospect, Emily’s pregnancy was moving rapidly at this point. She very calmly handled the contractions with breathing.

By morning she was around 6 cm dilated, which is pretty far along and the hope was that she might have the baby by noon or not long after. In reality, the contractions ebbed and flowed, and stagnated for a while. There was some debate over whether she was 7 or 8 cm dilated, but then later I heard 6.5. Early in the afternoon our doctor prescribed petosin. This increased the strength of the contractions, and Emily began to feel them more strongly. Emily elected to get the epidural, which was a big help in giving her a rest before pushing began.

Part of this period was a bit scary. A couple of times the baby’s heart rate dipped, and the medical staff moved her around to change the baby’s position. At one point they put a monitor on the baby’s head and there were five or six nurses there.

Around 3:30 in the afternoon, Emily was encouraged to begin pushing. The nurse who helped us, Carol, held one leg while I held the other. Emily would breath for a 10 count with each contraction, and repeated this three times with each contraction.

I don’t remember the exact timeframe, but the baby slowly advanced through the canal, and his head sat close to the exit for perhaps the last hour or so of pushing. This was all a bit surreal. There were several stretches where the nurse left for short blocks of time and I was with Emily alone. During these times, she sometimes rested, but other times we continued with just the two of us.

Near the end, the nurse told Emily to stop pushing, as she went to find the doctor. They detached the bottom portion of the bed and brought a sterilized set of instruments for the doctor. The doctor warned us that after an extended period of pushing, the baby might not be very awake or interactive.

When the baby did come, the doctor quickly cut the cord and moved him to the station near the bed. The nurses then removed the baby from the room to another area. At this point, I was a bit confused. The baby had “terminal maconium,” which meant he had pooped. This means they must suction the baby and can raise concerns.

In the nursing station with little Samuel, I was fairly frustrated with how things worked. I watched a series of tests which did not seem especially scientific or helpful. Nurses interacted with him briefly, but for most of the time it was me by his side. Initially there was some concern about how interaction level, but actually he seemed very alert to me and the pictures bear this out. His apgars were relatively good and his vitals were fine.

I wish I had pushed them to get him back to his mother. They were very slow. When he pooped later, this further delayed things, as they gave him a bath, etc.

I have been thinking about this experience a lot because I am struggling with how our medical system works. It seems pretty clear to me that each of the following is true:

-Being at a hospital was very helpful, especially in monitoring the heart rate and assessing when the baby was in distress. I value technology and as a historian appreciate what it has done for us.
-The labor itself may have been influenced by staff changes (for instance, the shift in personnel at 7 pm). Being there over a holiday seemed to mean that we got less follow-up care after the delivery.

-A lot more information would have been nice, and ideally we would have had a doulah or midwife. It was very strange to me that we had essentially one nurse over the three days who spent a substantial block of time with us, and this was only during the active phase of the delivery. The doctor also was only there for an hour or perhaps two hours.

-Most of the work seemed to document rather than assist. In other words, the nurse spent a substantial amount of time inputing interventions. On the other hand, we had minimal help with nursing for the crucial first few hours, and only sporadic help from nursing consultants.
Some of our basic efforts to be involved were pushed off. My doctor said it “wasn’t necessary” to be at the circumcision, after I asked to be there. We were delayed on taking the baby well after he had been stabilized. Our request for no bottle/no pacifier was ignored (or at least a pacifier was given to him). Because we declined these measures, there was essentially nothing the nurses could do for us (their work doesn’t seem to include holding babies or interacting with them).

-Several days after the fact, most of these aren’t a big deal. However, it amazes me that one of life’s most intimate acts is so defined by a bureaucracy. I also was disappointed in the lack of information at every stage. Despite the repeated warnings I received that you can have “too much information,” I’m glad we took the classes, read the books, and watched the DVDs. It is also amazing to me that that the only person I saw several days in a row was a church member who worked at the hospital (and was an incredible help).

We are very glad to have Samuel with us, and some of this is just frustration over a process where we don’t (can’t?) have a lot of control. Nonetheless, it is also a reflection on a system that is excellent at diagnosis and emergency intervention, but isn’t particularly good at providing health.