Bracing for the moment of truth in the delivery room
By JD Lasica
BabyCenter managing editor
Ireach the top of the landing at 12:57 a.m., after an especially long workday, and open our bedroom door. “How’d you like to have a baby today?” my wife says.
My heart flutters. Mary is six days past her due date, and friends and neighbors have been showering us with advice about how to induce labor. (I’ll cop to this: Last weekend I drove my more-than-ready wife over a dozen speed bumps in an effort to speed things up. Still, we have our standards, and we’ve resisted the old hike-her-up-on-the-washing-machine-during-spin-cycle routine.) I’ve heard so many old wives’ tales about how to pop this kid out of the oven that I nearly forgot the cardinal rule of childbirth: Babies arrive when they want to.
I reach for the phone. I’m ready to call the doctor, the hospital, 911, the National Guard — can you tell this is our first baby? — but Mary reminds me of what we learned during childbirth class: The hospital will send us packing if we show up too early. We time the contractions at ten minutes apart. Mary suggests we try to catch a few hours of sleep.
The call to the doctor
She wakes me from a fitful sleep at 4:47 a.m. A wave of guilt washes over me — Mary hasn’t slept at all, and the contractions seize her body every six minutes. We time two sets and call her obstetrician, who’s on call tonight. She tells us to head to the hospital. I’m happy to oblige — I’ve never seen my wife in such agony. Her moans are scaring our border collie. “I’m not even pushing and it’s killing me already,” she says. We hadn’t read about this: The baby is dropping so fast that a searing pain shoots through Mary’s rectum between contractions.
I drive to the hospital without causing too many multi-car pileups. We arrive at Alta Bates Hospital in Berkeley, California, at 5:27 a.m., and enter the main door. We’re whisked into triage, where a nurse applies a lubricant and attaches external fetal monitors to Mary’s belly. Mary’s water breaks and she’s dilated to 6 centimeters. The nurse nods approvingly and says, “Most first-time mothers don’t wait this long.” Mommy and baby check out fine, so we wobble into a nearby labor room, passing a crying newborn on the way. A beautiful sound.
A simple plan
Our birth plan is a simple one: “I want drugs,” Mary tells anyone who’ll listen. Dr. Eric Hunt, the anesthesiologist, administers an epidural — a mix of lidocaine and epinephrine — via an IV into the small of Mary’s back at 5:55 a.m.
Her heart rate is 85 (60 to 100 is considered normal), she’s now at 8 centimeters, and the baby has slipped down to the minus one position of engagement. Mary receives a second epidural of fentanyl and bupivacaine. She starts to feel its effects after seven minutes, and her pain begins to lift.
We begin to mellow out. We pass the time by listening to the thrum of our baby’s heartbeat on the monitor and looking out the window at pink clouds playing against a baby blue sky.
(A word of background: My wife and I are in our early 40s and got married 34 months ago. This is our first baby. At the amniocentesis, we learned it’s a boy. We have several friends who are trying to conceive, and we’re thrilled beyond words that Mary was able to get pregnant with just the use of a low-tech ovulation detector kit — and a little cooperation from me.)
At 6:54 a.m. Mary’s contractions are coming at 11/2 to 3 minutes apart. Remarkably, the pain has vanished. “This is a breeze,” she tells me, but it’s the epidural talking. “Just some pressure and a little cramping.” It’s as if she’s enjoying the contractions. My heart lifts, my frayed nerves start to heal. I put on an uptempo jazz CD by Diane Schuur. I fell in love with Mary at a Diane Schuur concert not far from here. The anesthesiologist leaves, and a nurse brings me a tray of waffles, cereal, and coffee. I eat at bedside.
The doctor is in
At 7:48 the attending physician, Dr. Katarina Lanner-Cusin, arrives and begins monitoring the contractions. Mary and I are mesmerized by the lines forming on the computer monitor: the contractions sketching a landscape of gently rolling hills. The epidural, not unexpectedly, has slowed down the contractions to every four minutes, so the doctor starts Mary on Pitocin to speed up the contractions.
At 8:27 a.m. I call Continental Airlines: My sister is already in the air, and she’s expecting me to pick her up at San Francisco Airport at 11. (“What if Mary goes into labor that morning?” my sister had asked. “Oh, please!” I said, my smug-male genes in full throttle.) A flight representative checks with a superior, then reports: “We’re not permitted to relay messages to passengers.” Appeals to our common bond as human beings get me nowhere.
We have dilation
The Pitocin is working. By 9:35 the contractions are coming 60 to 90 seconds apart. A half hour later, Mary is fully dilated to 10 centimeters and the baby has dropped to the plus-one position. We ask about the squat bar. The doctor says only 10 percent of the hospital’s patients use it, and women on an epidural can’t because the sedative causes a loss of sensation in the legs. At 10:18 the doctor says the magic words:
“It’s time to start pushing.”
It does not go as I expect.
I stroke the back of my wife’s head and say some comforting words as the RN, Elvira Nelson, urges my wife to push … take-a-deep-breath push … okay good now another one push. Mary is lying on her left side, her right leg propped up at a 45-degree angle by a student nurse. As labor coach, I remind Mary to breathe away the tension in her body when each series of contractions ends. It’s too soon to call the doctor, who’s eating a bagel in an office down the hall.
The contractions are spaced four minutes apart. When a new contraction hits, Mary takes a deep breath, grits her teeth, and pushes four times in succession as her face swells with deep purples and bright reds. The line graph on the monitor shoots up, creating a small mountain range of four little buttes, one for each push. “Come on, baby!” the student nurse urges. Between contractions, Mary inhales deeply through an oxygen mask. “It’s to help the baby,” nurse Nelson tells us.
Nelson wraps a plastic identification band around Mary’s wrist and my wrist and sets one aside for the baby. “Don’t take it off before you leave the hospital,” she warns us, “because if you’re holding the baby without a band, they’ll take him away from you.”
At 10:54 a.m. the nurse tells Mary to try pushing five times in a row instead of four. Mary does, and to my surprise she says, “This is cool. It’s not painful at all.” Nelson shines a spotlight into the birth canal and tugs my sleeve. “Look! You can see his brown hair.” But the baby is still far up the birth canal and doesn’t seem to be in any particular hurry. I put on a Tony Bennett CD. The first song is “Steppin’ Out With My Baby.” Maybe the little guy will take a hint.
Be the chicken
At 11:03, Dr. Lanner-Cusin swoops in for a few minutes and tells Mary to try pushing while flat on her back. I position myself farther down the bed. Every three to four minutes we try variations on the same theme: Mary announces a new contraction, we glance at the monitor to confirm this, I elevate her left leg, the student nurse lifts her right leg, and Mary bears down with all her soul, careful to hold her elbows — splayed like chicken wings — above the bed mattress. “Be the chicken!” our student nurse commands when my wife gives in to the exhaustion one time and lets her arms rest.
On the sunny side
Mary keeps pushing for the next 90 minutes. Somewhere in here I remember to call the airport and leave a page for my sister. She calls our room within minutes and grabs a taxi to the hospital. Dr. Lanner-Cusin, meantime, determines that the baby is occipital posterior. “Your baby’s a sunny-side up baby,” she says. “He’s facing up instead of down, which makes it harder and longer to push, but it’s common and completely normal.” She leaves, and the nurses take charge again.
Facing the inevitable
At 12:42 p.m., Mary has been in labor for 12 hours, and she’s been pushing for nearly 2½. “I want to try again,” she says, and does. But the result is the same. Nurse Nelson smiles and says, “That’s why they call it labor. And it hasn’t changed a whole lot in the last thousand years.”
We’re making little headway. The contractions are coming further apart. The pungent smells of labor fill the room. Dr. Lanner-Cusin returns, sizes up the situation, and says, “I think it’s time to consider the next step.” She says the baby is not in a position for a vacuum delivery — which we have fears about. Instead, she advises a cesarean delivery. Alta Bates has a very low c-section rate, even for women over 40, and we feel good about the level of professionalism we’ve seen.
Mary and I discuss the doctor’s recommendation. My chest tightens. I’m not sure I’m ready to see my wife under the knife. But Mary doesn’t hesitate. “I’m ready,” she says. I squeeze her hand. It’s her body, and I quickly assent. Just as we tell the doctor our decision, my sister arrives. Mary and I both need the hugs.
In the operating room
Everything speeds up now — I mean, really speeds up. An entirely new team of nurses enters the room and begins issuing directions. I put on a green smock, blue tissue-paper pants, a surgical mask, and a plastic surgical cap. At 1:02 p.m., Mary is wheeled off to surgery — c-sections take place in an antiseptic environment. I’m led to the recovery room to wait while they prepare her. While we’re apart, they prep her by increasing the anesthetic in the epidural and testing her reaction to an ice-cold liquid; she can feel it on her chest but not on her abdomen, which is what they’re after.
After 20 minutes — it seems much longer — the student nurse enters and beckons me into the delivery room. Four doctors and nurses in scrubs surround Mary, who’s flat on the operating table. The moment I shuffle in, Dr. Lanner-Cusin begins an incision. A foot-tall curtain blocks Mary’s view of the procedure, but I can see them slice just below her bikini line, exposing her intestines. I lean down, kiss her forehead, and say, “I’m here for you, honey.” She forces a weak smile. She’s conscious, but heavily medicated and doesn’t feel a thing.
Moments later, I look up — and am stunned. The doctor is already pulling out the baby. First the head, then a huge mass of quivering red flesh. A full-throated cry pierces the room. Our son! It’s a tight squeeze through the incision, and the doctor twists his body and forcibly yanks his head, stretching his neck, to get one shoulder out, then the second, and finally the rest of his body.
At this point I had imagined myself weeping, overcome with emotion; instead, I’m gripped by awe and wonder. A nurse holds him up for my wife to see, wraps him in a blanket, and pats him down. Someone calls out, “Time of birth, 1:41.” The nurse calls to me from over her shoulder: “Want to see your son, Dad?”
Cutting the cord
I leave my wife’s side and wander 20 feet to the testing station. Joan Werner, RN, manager of the neonatal transport program, gives our baby an Apgar testto measure respiration, pulse, activity level, response to stimulation, and appearance. He scores 9 on the 10-point scale. (“Nobody scores a 10,” Werner says, though other hospitals do award a 10.) We’re very lucky.
I begin videotaping this writhing, screaming, big baby. (See his first minute of life in a RealVideo clip.) From head to toe his color is a deep clay red, not the mottled gray I’d seen in the birth video (via vaginal delivery). His head is slightly elongated, almost cone-shaped, from 150 minutes of being squeezed in the birth canal. I’m amazed at everything about this baby: his vigorous kicking and powerful wail, his trembling lower lip and sunken chin, his fine, downy hair, his spidery fingers, the white tips of his long fingernails.
Werner hands me a pair of surgical scissors and points to a spot on the umbilical cord. I had told her I wanted to participate in this small ritual. I snip once, twice, three, and four times before the thick, rubbery tissue cuts completely.
Tests — and hugs
Werner performs a second series of tests on him when he’s five minutes old, and he scores perfectly on these as well. His color is already changing to a lighter, mottled pink-and-white hue, including two perfectly rosy cheeks. “Want to hold your baby?” the nurse asks, and hands him to me. I hug him tightly, beside myself with joy.
I carry him to Mary, who kisses him but is too weak to hold him. The anesthesiologist takes our camcorder and captures the moment. Then I carry our baby to the recovery room. Mary follows on a gurney and is moved to a bed. A nurse checks her blood pressure, pulse, temperature, lochia, uterus, and abdominal dressing. She’s still reeling from the operation and the sedatives, and she can’t breastfeed yet.
The baby undergoes tests to assess his vital signs and to measure his heart rate (147) and respiration rate (48), both within normal range. His temperature is a bit low, 97.9, so they keep him in the warming unit for a few minutes. The nurse dabs erythromycin ointment in his eyes to prevent infection, then gives him an injection of vitamin K in his leg to promote normal blood clotting ability. An assistant makes two copies of his footprint with a powder; one for us and one for the hospital. He lays him on his back to take three mug shots. Then a nurse bathes him in a little wash bin.
The end of our day — and a new beginning
All of the tests take about an hour. The family comes in — my sister and Mary’s parents — and everyone takes turns holding the baby. Then I wheel the baby’s bassinet to a private room in the Family Care Center, or maternity ward, where we’ll spend the next three days.
In this hospital they perform 600 deliveries a month, and each one has a unique birth story. We’ve named our son Robert James. Robert means bright and shining, and already he’s the light of our lives. We’ve both wanted a child for years, and we’re still amazed that we’ve been blessed with this young and vibrant life to care for. To see him squirming in my arms, to look into his dark cobalt eyes and see the light there — to peer into his soul — makes my heart flutter. No longer can I think of myself only in the old way: husband, companion, brother, son. Now I am a father.
I can already tell. This changes everything.