Monday, January 17, 2011
A Father's Perspective - The Birth of Julius
Hi everybody, Janis here (Shaniqua's husband).
The nutshell story is that our son, Julius John Stipins, was born a week ago today. He is very healthy, Shaniqua is recovering well, and we're getting settled into a decent rhythm at home. It's perfectly fine to stop reading now. :-)
We have hesitated until now to send you all a birth story. For casual acquaintances and distant relatives, it's fine to send out a "Hey, it's a boy!" email, omitting the difficult and frightening parts. For our fellow travelers from the birth class, though, we didn't feel right giving you a sanitized version of the story. At the same time, we haven't been in a good enough place to feel like sharing the truth with anybody until now. So here it is, and hopefully it will be helpful in some way to some of you.
First of all: Shaniqua never went into labor naturally. We had considered and planned for many different eventualities, but this was not among them. I don't even remember it being mentioned in our class as a thing that happens, although possibly I wasn't paying attention. Our midwife, Maria Iorillo, says that she sees about two cases a year of a woman going until week 42 without going into labor. Shaniqua had plenty of Braxton-Hicks contractions, but still had not gone into labor by Dec 29, which was two weeks past our "due date". (A phrase worthy of irony-quotes, to be sure.)
Here is some information that we probably knew at some point, but did not have at the top of our heads when it became relevant:
- At least with our midwife, once the pregnancy extends to 41 weeks, it is recommended to get two non-invasive tests done at a hospital. The first is a non-stress test, which makes sure that the baby's heart rate is not crashing, and that he is moving often enough to indicate good health. The second is an amniotic fluid index, which makes sure that the baby has enough fluid around him in the uterus. These tests need to be repeated every few days starting with week 41. The idea is that the pregnancy can continue safely if the tests look good; otherwise induction is recommended. Our tests looked excellent on Dec 22, 24, and 27.
- We had established care at St Luke's and at UCSF. St Luke's is closer to us, and so we went there for the first two test dates. However, St Luke's will not induce labor past 41 weeks 4 days, so our test on Dec 27 was performed at UCSF, which is better equipped for neonatal intensive care.
Nobody likes a pregnancy to extend past 42 weeks, regardless of how good the test results look. If it is fair to call 40 weeks the "due date", it's probably fair to call 42 weeks the "induction date". This is a perfectly reasonable thing; it's just not something we were really conscious of until we zipped past week 41 with no labor.
Here is one of my opinions that I mentioned in class, but which bears repeating:
- If you accompany someone you care about into a hospital, prepare to be an advocate for that person. Question everything until you are satisfied that you understand what is happening, and do not feel obliged to accept someone's recommendations. Everyone who comes into your room has an agenda --- not a malicious one, but one which may not be aligned with your own goals. For a simple example, after each of the three testing sessions, we had to fend of a different well-meaning hospital employee hellbent on performing a cervical sweep. They each had to be turned down multiple times before finally accepting Shaniqua's decision. (Our midwife is not a fan of sweeps in most situations, including the situation we were in.)
Anyway, back to the birth story. With our midwife's guidance, we made the decision to check into UCSF for an induction on Dec 29. The appointment was made for 8pm, with the understanding that the first step of labor induction would be a drug called Cervidil, which is designed to ripen the cervix gradually, over a period of 12 hours or so. The idea was that Shaniqua would check into the hospital, they would give her this medication, she would get a good night's rest, and then on the morning of Dec 30 they could begin further induction if necessary (read: Pitocin).
That's not how it happened.
By the time Shaniqua had been checked in to the admittedly nice Labor Room 3, and her cervix had been roughly examined twice (and likely swept, in her estimation), and the Cervidil was inserted... it was 2am. OK, fine; she and I would get some sleep there, and we'd see what the morning would bring.
Forty-five minutes later, Shaniqua started having real, painful contractions. She had one real, painful contraction every 60 seconds from 3am until 11am, when the force of the contractions caused her body to eject the Cervidil. This is during the time that she had planned to be resting, based on what we had been told by the doctors. The doctors were surprised at how effective the Cervidil was, which was little comfort to Shaniqua.
Even though this is the non-sanitized version of our birth story, I am going to fast forward through the labor now, if for no other reason than that I lack the ability to communicate the profundity of what transpired in Labor Room 3 that night and day and night. Some day I will try to write it into a worthy story. For now, this is the email I sent to friends and relatives on 12/31/2010:
This is Janis writing from Shaniqua's email account, announcing that our son, Julius John Stipins, was born today at 7:42am at UCSF hospital. For those keeping records, he is 9lbs 8oz and 23" long. He's also very cute, due to looking a lot like his mom. :-)
We were planning a home birth, but Shaniqua still hadn't gone into labor two weeks after the due date. So we went in to the hospital on the evening of Dec 29, so that they could give Shaniqua something to induce labor. It worked surprisingly well, and by 3am Dec 30 Shaniqua was in labor. She labored for 28 hours, making incredible progress, and astonishing the doctors, the nurses, our midwife, her mom, and me.
Let me interject here that I am not claiming that any one way of giving birth is right, or wrong, or better than another. But I will tell you Shaniqua's way, which will surprise none of you who know her: she labored for 28 hours, on her own, refusing assistance from any doctors or nurses, and keeping her own counsel about every step she took with her baby. She made astonishing progress, the likes of which our doctors, nurses, and midwife had never seen, to say nothing of her awed husband. She breathed; she walked; she bounced on the fitness ball; she spent time in the tub. She did not take so much as a Tylenol for 23 hours, and then she only took something because she felt she needed to sleep for a bit. Still, as time went on, her vital signs got a little worse, and it became clear that it would be medically necessary to deliver by C-section, and she accepted that (probably because she knew she had done 120% of what any normal person could expect to do). Even so, 27 hours in, she still refused assistance in getting in or out of bed. In a nutshell, Shaniqua was able to bring Julius into the world exactly how she wanted to, if not how we originally planned. Having that kind of say was what we wanted out of a home birth in the first place, so it was a big success after all.
Anyway, the procedure went perfectly, and right now baby and mama are recovering together nicely in the hospital. I'm home, sending a few announcement emails before taking a shower, sleeping a bit, and heading back in.
If any of you feel compelled to offer congratulations, please give at least 99% of them just to Shaniqua. I'm looking forward to being one of two great parents that Julius has, but the successes up until today belong to her.
For this more specialized audience, I will give some of the technical details that I omitted from the included email:
- Shaniqua was 0cm dilated at 2am.
- She was 5cm dilated when her water broke at 1:30pm.
- She was 7cm dilated at 9pm, and did not dilate further than that, despite the addition of Pitocin from 1am-5am on 12/31.
Some more details:
- Shaniqua had severe preeclampsia and HELP syndrome.
- Her blood tests showed rapidly declining liver and kidney function, and her platelet count had dropped by 50% between checking in to the hospital and 9pm the next day.
- At 7:30pm her blood pressure was 190/105.
- At 7:35pm, her husband cleared all medical personnel out of the room so that she could work in peace with Maria and Nova.
- At 9pm, her blood pressure was 120/80.
For this more specialized audience, I will give some of the spiritual details that I omitted from the included email:
- Shaniqua told me, afterward, that she knew in her gut weeks ago that this baby would come via C-section. She feared for the child's loss of the oxytocin rush he was supposed to get as he passed through the birth canal, and she decided that she would labor naturally as long as humanly possible, so that her child would have the benefit of as much oxytocin as she could generate. I do not have sufficient words to comment further on this point.
- I personally had never witnessed nor imagined anything as powerful and profound as Shaniqua's labor. I worked with her through much of it, and advocated fiercely for her as well as I could so that the doctors would leave her to labor the way that she needed to; but the part that transformed me was between 10pm and 1am:
Shaniqua lay in the hospital bed, nonverbal, deep in her labor. She was having powerful contractions, strong enough to alter radically the shape of her belly, every few minutes. Shaniqua experienced these contractions as perfectly as any woman could hope to: she was fully present in each second of time, falling immediately into rest as each one passed, meeting the next one head on and riding it as it surged, moaning, breathing, shaping, visualizing, but never wasting one moment looking forward or backward, never stopping to reflect on the magnitude of the previous surge, never fearing the start of the next.
Meanwhile, Maria sat by the bed in a glider chair, her hands folded over her belly, sleeping between surges, and waking to coach Shaniqua through each. I can see the scene still, with Maria's face lit by the glow of the computer monitors in the dark room, an expression of perfect calm and understanding as she watched over Shaniqua, guiding her through the creation of our family.
I watched from a few feet away, attempting to rest on a couch, but unable to let my consciousness slip from the scene before me. Here were two archetypes of womanhood, walking the boundary between life and death, night and day, one life and two. One of the women had never made this journey before, but went on fearless and confident and undaunted, trusting herself never to misstep; the other had guided many along similar paths, knew exactly what guidance to offer and when, and knew also that success or failure, life or death, was ultimately beyond her control. Together they worked, while I watched; and I like to think that I learned something about life and death and womanhood from being there.
- Our birth story definitely has a touch of bad-to-worse, at least when you consider that our original goal was to have a vaginal birth at home. Had Shaniqua broken down and cried; had she bemoaned her fate; had she indulged even once in the slightest form of self-pity or fear or frustration, I would not have thought one iota less of her as a person. But she did none of those things. She spent every bit of her energy on laboring with her child, letting nothing distract her, nothing dissuade her from reaching the finish line on her own. Her determination and focus inspired me through the whole experience, and saved me from falling into negativity and fear of my own. I was in awe of her, and I remain so.
OK, end birth story.
I'm running out of energy here --- my fault for writing so much --- so let me just give a brief outline of what happened from the birth until today.
- C-section babies don't get the amniotic fluid squeezed out of them by passing through the birth canal. This means that when Julius was measured at 9 lbs 8 oz, he was weighted down by at least three bellyfuls of fluid that he vomited up the first night. This was not "spitting up", he covered Shaniqua's chest with fluid each time. He also blew out four diapers with meconium in the first 24 hours. Together with the fact that Shaniqua and Julius were plumped up with three boluses of saline from the labor, the kid dropped 9.8% of his weight by the next morning.
- Despite the fact that this weight loss was entirely understandable, the hospital has a policy of watching closely any baby that loses 10% of his birth weight. We got watched carefully. Whee.
- Breast milk comes in later after a C-section than it does after a vaginal delivery.
- Kid was "underweight". Mom was waiting for breast milk. Not a good situation.
- We met some very kind people in the hospital, but also some very clueless and frustrating ones. Shaniqua was in the middle of processing a tiny fraction of what she had gone through during the labor, when a 26-year-old OB doc fresh out of med school comes in to do rounds. She'd never met Shaniqua before, but when Shaniqua made the mistake of crying in front of this doc, next thing we know... social worker knocking on the door! Whee.
- Think very carefully about whether having her mom around for the labor is what you want to do. I spent a nontrivial fraction of my energy during the labor in a battle of wills with my mother in law, who was convinced I was killing her daughter by preventing unwanted medical interventions. In the grand scheme of things, it wasn't an important conflict; but some moms don't really want to see their daughters go through this kind of experience.
- We finally got out of the hospital on the night of Tuesday, Jan 4. We only managed this by feeding the kid some formula to boost his weight enough for the hospital to let us go. Feeding formula to the kid was an extremely emotionally charged decision.
- Sleep is very, very important. Not just a little important. Postpartum stress/exhaustion/emotions can look a lot like postpartum depression or psychosis after severe sleep deprivation. Moms: please eat and sleep as well as you can, for everybody's sake. Dads: same advice.
- After meeting with Maria on Wednesday, we got on a schedule intended to help Shaniqua's milk come in, while getting the kid's weight back up a bit. It worked on both counts: Julius gained back 15 oz in less than 48 hours (!), and as of today Shaniqua is starting on-demand breastfeeding, which was her original intent.
Anyway, I'm gonna go ahead and stop now. :-) Please forgive my meandering attempt to capture some of our birth experience to share with you all.