Wednesday, January 31, 2007

Adriana's birth story, part 3: Transfer for maternal exhaustion

Marsha said that they could hook me up to IV fluids to see if that would help with my energy level, since food and drink weren't staying down. I pushed the thought of the hospital to the back of my mind and agreed, all the while knowing that Brian was getting more and more worried. I don't know who went to set up the IV, but then Marsha was calling me over to the side of the tub, and I saw Pam with an IV pole in the doorway. As I moved toward Marsha, another contraction hit. I tried to stay calm, but throughout it all I could think was that I couldn't handle any more. I didn't have the strength. As it ended, I told her that I needed to go to the hospital for some pain relief.

I don't remember what Marsha said at the point, but whatever it was and whatever tone she took, she didn't make me feel guilty for my decision. In fact, once I made the decision, I felt relieved. I was finally going to be able to get some rest. I would go to the hospital, get the epidural, sleep for a while, and then have them turn off the epidural so I could get the baby out. It seemed simple and clear (although clearly naive), and I was more emotionally prepared to handle contractions while Brian loaded our things back into the car, and Marsha called the physician to let him know we would be going to the hospital.

Pam stayed behind to clean up the birth center, and we followed Marsha to the hospital. I concentrated on her taillights as we drove, because otherwise I concentrated on the clock and how long it seemed to be taking to get there (it was only about 20 minutes).

At the hospital they got us quickly into a room, and I was hooked up to IV fluids. I remember telling the nurse that I didn't like needles in the back of my hand, and asking several times how long it would take for the bag of fluids to be emptied so that I could receive the epidural, and then how long it would take for the anesthesiologist to get there. At that point I no longer cared about giving up a natural birth; I only wanted to rest and escape from the pain. A resident checked my cervix and said I was between six and seven centimeters.

The anesthesiologist arrived. He asked Brian and Marsha to sit down while he put in the epidural. Both protested, and while he still made Brian sit, he allowed me to lean forward into Marsha's arms as he put it in. I complained of pain in my neck just after it went in. Puzzled, he removed the epidural and was surprised that that seemed to help relieve the pain. He replaced it and the pain came back. It wasn't a severe pain, just a sort of sore, stiff feeling on the left side of my neck, and it eventually eased on its own.

I don't remember lying down in the bed or trying to sleep. It simply happened. The cramping pains that I had been feeling in my low back for more that 24 hours were gone and I could finally relax. Brian settled down in a fold out bed beside me, and Marsha dozed in a chair.

Sleep was easy, but it was easy to wake up, too, and I did wake up on and off as people came and went from the room. Various things happened throughout the night. I was given some Pitocin. I was alarmed when I realized that was happening, but Brian and Marsha reassured me, saying that they had explained it and it was necessary. Later we woke when the resident was explaining to us that they wanted to use an internal fetal monitor. I protested this, saying it wasn't something we had wanted. But the baby's heart rate had dropped significantly for four minutes, and they wanted to monitor her more closely. Feeling tired and stupid, and beginning to regret the decision to come to the hospital, I consented. It was for the baby. Anything for the baby.

At some point during the night, I asked Brian if he was okay. He had to remind me of this, but I do vaguely remember it. I remember chuckles from other people in the room, who were apparently amused by my concern for him. But I knew that it was probably distressing for him that we were so far from our planned birth, and it had to be hard for him to see me in the bed, hooked up to monitors and IVs and oxygen.

I woke up around six in the morning when the attending physician who backed up the midwives came in. I'd met him at some point during the night. He checked my cervix, and told me that I was at only an eight or a nine, after several hours of Pitocin, and encouraged me to consider a c-section. I looked to Brian and Marsha, but couldn't read their faces. I realized that a c-section might be necessary, but I wasn't ready to accept that yet. I told him so and asked to keep on trying. Maybe if I got back up on my hands and knees I could get the baby to turn. I don't think I really believed there was any chance of that. The baby was already at +1 station, I knew. It was probably too late. But I felt that I needed to try a little longer. The doctor agreed to let me, and said he would be back in an hour. Brian helped me get up onto my hands and knees.

Brian had helped me push the button to increase my epidural once around five that morning, but I was beginning to feel contractions again. They were long and hard, but with the epidural the pain wasn't severe and I could manage them. In fact, I found the sensation somewhat reassuring. Although it hadn't occurred to me at the time--probably because I was so relieved for the rest the epidural provided--it was rather eerie to know I was in labor but be completely unable to feel it. Feeling determined, I labored on my hands and knees for what seemed like a very short time, sometimes letting my head fall to the bed to help support my weight. Finally I couldn't hold myself up any longer, and I was so discouraged, thinking I'd only stayed up for five or ten minutes, but as I laid back down, Marsha told me I'd been that way for half an hour.

I knew nothing had happened. I knew that the doctor was going to come back and tell me I needed a c-section. I began to come to terms with the idea, and tried not to wonder what would have happened if I hadn't had the S&S, had gone to the birth center earlier in the day for some Ambien, hadn't decided to come to the hospital for an epidural, had fought against the Pitocin. I listened to the sound of my baby's heartbeat on the monitor, and told myself that all that mattered was a healthy baby. I thought about telling Brian that the doctor was going to tell me I needed a c-section, and that I understood and was okay with that, but when I looked at his exhausted face I couldn't do it. I lay there on the bed, feeling the contractions in my back in spite of the epidural, touching my belly with my hand in order to feel them there, and breathing slowly through each one.

A new nurse, Barbara, came on at seven, and I liked her immediately. A new anesthesiologist also came in briefly to introduce himself. The sky was beginning to get light as we waited for the doctor to return. Marsha sat beside me, with a hand on my belly and we agreed at one point that I was back to the run-on contractions--my belly never seemed to relax. I wondered what was going through Brian's mind. I knew he was scared and worried, but he wasn't showing it very much. I wished I could tell him something to make him feel better. I pressed the button to increase the epidural one more time as we waited for the doctor.

Just before eight, the resident came in. Although we knew the doctor would be there soon and would want to check me himself, the resident checked me. I was down to eight centimeters, she said, and the front of my cervix was swollen. A few minutes later, the attending physician entered the room, checked me, and repeated the resident's news.

"You need c-section," he said.

Whenever he spoke to me that night, and throughout my hospital stay, I had to concentrate hard to understand what he was saying through his heavy African accent, but those three words were very clear.

I looked at him, as he stood to my right, down near my knees. I glanced back up at Brian who was at my shoulder. Marsha was to my left, across from the doctor. I glanced at the clock and did the math: I had been laboring for 33 hours, if I included all those hours I didn't actually believe I was in labor. I turned back to the doctor, and told him that since the baby's heart rate was fine, I would rather just keep laboring.

Either the doctor or Marsha explained to me that I shouldn't keep going until the baby became distressed and the c-section became an emergency. It was Marsha who convinced me. When a midwife tells you it's time for a c-section, you know that you've gone as far as you can. I struggled not to cry (and completely failed at that) as I nodded my consent.

The doctor left the room, and preparations got underway. Barbara sat beside me on the bed and explained how the c-section would go, things I basically knew. I don't remember looking at Brian during this time, or anything he said to me, although I know we were both concerned about when he would be able to join me in the operating room. Barbara said that he could come along and wait just outside the room, and as soon as the doctors said it was all right, he could come in. Soon we headed off down the hall. Near the OR, Barbara handed Brian some scrubs. I was concerned about whether they would have booties that would fit over his shoes--that had been an issue when his mom had taken us to see an operation at her hospital, but here they fit with no problem. Barbara fitted a cap over my hair, and realized I was still wearing earrings. It hadn't occurred to me to take them off. Brian gave them to me for our first anniversary, and unless I want to wear something dangly for dress-up, I keep them in all the time. Barbara covered my ears with the net, but checked me for other jewelry and had me give my wedding rings to Brian to put in his pocket. I was touching my bare ring fingers with my thumbs as I was wheeled into the OR at 8:34.

Barbara introduced various people to me as they came in. The anesthesiologist was checking my IV, attaching those round EKG things to me, putting the oxygen meter back on my finger. I had a different kind of oxygen mask on now, one with tubes into my nose instead of something that fit over my mouth and nose. I kept talking to the anesthesiologist, because he was the only person in the room that had to stay right by me. I asked him about everything he was doing, and what other people in the room were doing. He patiently answered my questions, although I mostly tuned out his answers. I just had to keep talking to keep myself calm. I know that at one point I told him I was nervous about surgery. He assured me that it was a routine procedure and very safe. "Some women even choose to have c-sections," he told me. "Those women are crazy," I said to him, and went back to asking him questions about what was going on in the room, having realized that he and I had different perspectives on medicine and childbirth.

Brian was finally let into the room and came over to my side. I relaxed a bit with him there. I remember him commenting that he couldn't believe I was making jokes on the operating table, but neither of us remember what I was joking about. The last people to arrive were the pediatricians who would be taking care of the baby when she was born. I reminded Brian that he needed to go with the baby wherever she went, as it occurred to me that with a cesarean birth we wouldn't be allowed to wait until the cord stopped pulsing before we cut it, and Brian wouldn't be the one to cut it.

As the operation began, Brian began speaking to me in a soothing voice. I shushed him and closed my eyes, no longer joking around to help myself relax. I felt pressure moving slowly across my abdomen, and then a few minutes later there was more pressure further up, almost to my ribs. For a moment it felt as though someone was sitting on my chest. I didn't realize it at the time, but in addition to being posterior, the baby had also decided not to tuck her chin to send a more manageable part of her head through the birth canal, but instead had stretched out her neck, putting her in a bad position for a normal birth.

I counted through my breaths to keep myself calm. Finally the anesthesiologist told Brian he could stand up and look over the drape, which he did. Someone announced that it was 9:10. As we I listened to the baby being suctioned, I asked Brian if the baby was really a girl. He said he couldn't see, but someone said yes, it was a baby girl. Finally there were cries from the baby, and I began to cry too. The baby was taken over to where the pediatricians were waiting, and Brian followed. I listened to her cry as I sobbed myself, so glad to have my baby born at last. I heard Brian asking about her size, and someone said she was probably about nine pounds. It took a few moments for me to realize that I could glance back over my right shoulder and see the baby. They were holding her up at the moment that I looked, and I was amazed. She was screaming and had a head of dark hair. "She has hair," I told the anesthesiologist, who was still seated at my left shoulder.

Soon I felt a horrible pain in my right shoulder, and told the anesthesiologist about it. I heard some comment about "referred pain," which I didn't quite understand, and then I told them that the pain was also in my left shoulder. The anesthesiologist quickly gave me something to stop the pain, but I remained tense as I waited for it to return. Someone announced that the baby weighed nine pounds and eleven ounces. "I knew I was going to have a big baby," I said to no one in particular.

The doctor continued to work on me, stitching me up, I assumed. Marsha told me later that after the long labor, my uterus had trouble clamping down after the baby was out. I apparently was losing more blood that I expected. It wasn't an emergency, but I was given a transfusion that night.

Brian was finally given the baby to bring over to me. Someone helped him bring her down so I could look into her eyes, and I reached out to touch her hair. Someone took the camera from Brian and photographed the three of us together like that. I don't remember the photo being taken, or Brian and the baby leaving to go to the nursery.

Tuesday, January 30, 2007

Adriana's birth story, part 2: The birth center

Contractions in the car were hard, but it became easier to manage them because I knew we were on our way. Somehow the fact that they were coming three minutes apart hadn't convinced me that I was really in labor. I breathed through one as we sat at the traffic light near the Washington Masonic Memorial, and then told Brian, "It just feels weird in my low back. We're going to get there, and Marsha's going to tell me I'm just constipated and to go home." But when we arrived at the birth center, Marsha called Pam and said, "They're here. I haven't checked her yet, but she looks like she's in labor. You should come." I told her I still wasn't sure. She had me undress and lie down on the big bed in the birthing suite, while she checked me. "You're five centimeters," she said, laughing. "Now do you believe you're in labor?" She called Pam back with an update, and Brian called our friend Marisa, who was planning on joining us at the birth center, to provide support to both Brian and me. We listened to the baby's heartbeat on the Doppler, and then Brian began to bring things in from the car, while Marsha set me up on the exercise ball to labor. After awhile I got back into the shower, since that had helped before.

When Marisa and Pam arrived I was back to laboring on the bed. It was mid-afternoon, and I was handling the contractions well. When Brian needed to get up, Pam took his place at my side, applying pressure to my back as contractions hit. The rest of the time, Brian knelt on a stool at my side, massaging my low back, while Marisa lay beside me on the bed, stroking my hand during contractions, so that I wouldn't hold tension there, and Pam stroked my calves and squeezed my feet. In between contractions, I was able to talk with them and enjoy their company. After some contractions, I felt strange for being the center of attention; it didn't quite make sense to have three people so focused on me. I mentioned this and everyone laughed at me. Periodically, Marsha or Pam would get out the Doppler to listen to the baby, who seemed to be doing well. They encouraged me to eat and drink, and I managed to drink a bottle of water, which Brian then refilled with some of my sports drink. I nibbled on a couple of pieces of dried fruit, but refused everything else Brian offered. I just didn't think I could handle it. Eventually I participated less in the conversation between contractions, letting my mind float as the soft voices surrounded me. Contractions came and went, as did nausea. I had been good about trying to stay hydrated, and Marisa would hand me my drink after each contraction, but once or twice I had to throw up. It didn't occur to me, though, how little I had been able to keep down since the night before.

I think it was starting to get dark outside when I decided I wanted to try laboring in the jacuzzi. Pam or Marsha went to begin it filling for me. It seemed to take forever to fill, but finally it was ready. I let myself float around in it a bit. Brian put on trunks and got in the tub with me, holding me through contractions. Being weightless helped at first: the pain in my back wasn't so intense, and if I turned onto my hands and knees it seemed easier to breathe. Plus, when I was on my hands and knees, I could finally feel the contractions in my belly a bit. I'd been able to feel my belly tighten with my hand, but this was the first time I'd actually felt the tightening--low and strong across my abdomen. As we labored in the tub, the contractions intensified. I stretched out in Brian's arms, and felt the contractions lasting longer and coming on stronger. Soon it seemed that they never ended. Instead, the intensity just rose and fell in slow waves. I tried to control my breathing and moaned with each exhale, trying to keep the sounds low and deep. Brian sing-songed to me, telling me to relax, to breathe the baby out, to let the water relax me. My mind was divided at that point into a small part that was still very conscious of what was going on around me and intellectually aware of what it was I was supposed to do to relax, and the larger part that was consumed by contractions. The small, aware part was almost amused by Brian, but also very grateful, because his voice was calming, and the part of my mind that was consumed by contractions needed his calmness. Every now and then, when the seemingly unending contraction would peak again, I would lose control of my breathing and my low-pitched moans would become more shrill. I remember telling Brian that it wasn't fair, that the contractions weren't stopping, that I was afraid, that I hurt to much, that I couldn't do this. Then he would guide me through the pain with his soft voice, and the pain seemed more manageable as I could relax a little bit again. Pam came into the bathroom and during a low point in the contraction, she told me that I was having run-on contractions--one coming right on top of another.

I can't remember what made me decide to get out of the tub. At that point the run-on contractions had eased, and I was able to get at least a few seconds of rest in between each contraction. Brian and Pam wrapped me in a big towel and helped me dry off, as I began shaking uncontrollably with cold. We went back to the bedroom and Pam turned on the space heater to help me stay warm. It was dark outside, and through the blinds I could see the lights in the trees along the street outside. We checked again for the baby's heartbeat, and it was harder to find this time; it wasn't that there was anything wrong with the baby, just that it was getting harder to find a good place on my belly to listen. Pam said she and Marsha thought I might be going through transition, and Marsha offered to check me again.

I lay down on the bed, excited: if I was in transition, I was almost there; I was going to meet my baby soon; I had successfully labored. As a contraction eased, I relaxed so Marsha could check my cervix. I tried to read her face. She looked at me seriously and told me I was at six centimeters. My good mood plummeted. I wasn't in transition. I was still a centimeter away from transition. I had been at the birth center for almost five hours, and had only gained one centimeter. I moaned through another contraction, and then Marsha encouraged me to move around a bit. She wanted me squatting, or on the exercise ball, or walking around--something to help move the baby down. Exhausted and discouraged, I agreed. I tried the ball first, because my legs felt so tired. Brian put a pillow over the footboard of the bed for me to lean into and he continued to apply pressure to my back through contractions. I was getting 30 seconds of rest between each one, and those seconds were blissful; I was surprised when Brian told me how short the breaks were, since I was able to rest so much during them. I suppose in comparison to the run-on contractions, any amount of rest would have felt good. That also gave Pam more time between contractions to try to listen to the baby's heartbeat. I was restless, though. I couldn't just stay on the ball. We got up, and I walked up and down in the hallway with Brian. He would lean on a wall and support my weight when a contraction would hit. He kept trying to get me to eat something, and I agreed to try some lentil soup. Marisa heated the soup for me, while Brian helped me walk up and down stairs. That wasn't as difficult as I thought it would be, but I was still restless and discouraged, so it was hard for me to focus on doing one thing. We went back into the birthing suite and I ate a few bites of soup and drank some water. I got onto my hands and knees on the bed for awhile, but that position was getting more and more difficult to sustain. I threw up again, and then got back up to pace the hallway some more.

Regina, the midwife I had seen the day before, was at the birth center and came up to the suite. "Some people will do anything to get out of going for an ultrasound," she joked. It was nice to have another person there to talk with when I felt up to talking. Marisa had to leave at some point. Shortly after that, my water broke. I alternated between walking the hallway and lying on the bed. My throat was getting sore from moaning out contractions. I admitted to Pam that thoughts of an epidural were crossing my mind. She didn't make me feel guilty for that, but encouraged me to go on laboring. I think there was a decision around this time that the baby had definitely turned into a posterior position, which was why it was becoming more and more difficult to find the heartbeat.

I got sick again, and I could see concern in Marsha's face. She said she was worried about my energy level. She suggested a shot of Nubain, which wouldn't really help with the pain, but would help me get some sleep. But Nubain is a narcotic, and after experience with similar drugs for migraines when I was a teenager, I declined, explaining that I didn't react well to narcotics. Someone suggested I get back in the tub, and Pam began adding hot water to it. Brian didn't get in the tub with me this time, and I didn't ask him to. I could see worry in his eyes, worry that was probably reflected in my own, although I tried not to show it. I eased myself around in the water between contractions, trying different positions. I hoped that if I spent more time on my hands and knees that the baby would turn, and being in the water made it easier to support my body that way.

After a fairly short time in the tub, Pam and Marsha joined us in the bathroom. There was talk of a hospital transfer, so I could get an epidural and a bit of rest. The idea certainly appealed to me at this point. I was exhausted and wanted to sleep almost more than I wanted to meet my baby. But I was still worried about going to the hospital, and I felt self-conscious about giving up on my natural birth. In my mind I saw the sheet of statistics from the birth center, with the number one reason for transfer to the hospital: maternal exhaustion. I saw myself getting closer and closer to being a part of that category.

Monday, January 29, 2007

Adriana's birth story: Laboring at home

As brevity is apparently not my strong suit, I'll be posting this in several pieces.

On January 9th, I went for my 41-week appointment with the midwife. We had a non-stress test, where the midwife, Regina, strapped an external fetal monitor around my belly. That tracked the baby's heart rate on a strip of paper, and I pressed a button every time I felt the baby move, which made a made a mark on the paper to show whether the baby's heart rate increased in response to movements. After about 20 minutes, we could see that the baby was indeed "reactive" and doing fine, but I got a referral for an ultrasound on Friday to check to make sure I still had adequate amniotic fluid. During the test we talked about inducing labor. The practice would only allow me to go two weeks past my due date before referring me to their back-up physician for induction and a hospital birth.

I didn't want a hospital birth, but I had spent the day before thinking a lot about the possibility. I knew that when I went through the doors of the hospital to give birth, I was putting myself at higher risk for interventions that I didn't want--Pitocin, episiotomy, c-section. Those interventions wouldn't be the end of the world, I knew, but I hated the idea of giving up our plans for a peaceful birth at the center with few or no interventions. I talked with a friend about my worries, and she pointed out that just because I was more likely to face those things in a hospital setting, I wasn't necessarily going to experience them, as I had educated myself and was making an effort not to have to go through them. Somehow, those words helped. I went to yoga that night to help me relax and by the time of my visit I was feeling better. I hadn't exactly come to terms with the idea of a hospital induction, but I felt calmer about it.

We looked at the calendar with Regina and decided that the induction would probably have to be scheduled for the 15th or 16th, depending on whether the hospital would do a scheduled induction on the Monday holiday. I crossed my fingers that I would have until at least the 16th, and Regina said she would talk with the other midwives about letting me go that long--42 weeks and 2 days--but that she thought it would be fine. I could tell she didn't like the idea of the hospital induction either. We discussed more "natural" methods of induction as well, such as castor oil, evening primrose oil, and "stretch and sweep." Regina offered to do the stretch and sweep during that office visit, and I agreed. I didn't think it would actually work, but I figured it was worth a try. Regina said that it seemed most effective when done repeatedly, so I could come back in Friday after my ultrasound for a second try.

I expected the S&S to hurt, but it wasn't too bad. It was difficult at first for Regina to reach my cervix. The baby's head was low, and my cervix was still back behind it. I was about 50% effaced, and when Regina said that laughed to myself. At my 36-week visit, I had been 50% effaced, and Brian and I had become certain that meant the baby wouldn't be late after all. Regina also said I was only one centimeter dilated, but that was enough. She used a finger to pull the edge of the cervix back and try to separate the bag of waters from the cervix. I felt a bit of cramping in my low back, but not the kind of pain I had expected.

We headed home, stopping at Whole Foods on the way for a bottle of evening primrose oil capsules and some Ben & Jerry's. (What? Cookie dough ice cream totally helps induce labor. I'm sure I read that somewhere.) After dinner, I took two capsules and ate some ice cream. The cramping I had felt during the exam was mild, feeling mostly like PMS, but I had felt that way a lot over the past couple of weeks. By the time we went to bed around 11 that night, the feeling was getting stronger. I lay in bed trying to sleep as the cramping came and went. Eventually I felt a wave of nausea and got up to be sick.

I spent the next few hours back and forth between bed and the bathroom. I went downstairs and got out a bottle of the sports drink I had bought to take to the birth center for during labor. Water tasted funny and I thought I would have a better chance of keeping that down than actual fruit juice. I drank a few ounces and went back to bed, but soon needed to throw up again. I finally woke up Brian to tell him that I was sick. He got up with me for a little while and sat in the bathroom with me while I tried to throw up. We went back to bed so we could try to sleep, but my cramps kept coming. I started to wonder if this was labor, but the pain was all in my low back. Nevertheless, I started looking at the clock: five minutes between, then 30, then twelve. There was no regularity. Brian slept, and when I had a 30-minute break, I think I was able to doze too. When the cramps were particularly strong I would wake Brian and he would press on my back while I took long, slow, deep breaths.

Around four o'clock, I started to think about calling a midwife. I wondered who was on call; we had forgotten to pick up the January call schedule. Not that it mattered--I like all the midwives, and if I needed someone, it wasn't as though I had a choice of who I got. At 4:45, after getting sick one more time, I woke Brian and told him I was going to call.

When the answering service picked up, I said that I needed to speak with a midwife. "Are you in labor?" the woman asked. I told her that I didn't know. I was starting to think that I might be, but I still hadn't felt any pain in my belly, just the normal tightening of Braxton-Hicks contractions that I had been feeling for several weeks. Within 15 minutes, one of the midwives, Marsha, returned my call. I described what was going on. She asked whether my belly was tightening and whether there was any regularity to the cramps or the Braxton-Hicks contractions. I told her there wasn't, but she told me that it could still be labor. She wanted me to try to drink a little something and get some rest. I hung up the phone and went back to what I'd spent the rest of the night doing.

I did manage to get some sleep here and there. Brian applied pressure to my back and kept encouraging me to eat or drink something. The sun came up, and I know Brian was on the phone with Marsha again at some point, while I rested in bed, breathing through what I still thought were cramps, although Brian and Marsha had decided it was labor. At one point I decided a hot shower would help me relax. I was having trouble standing and breathing when the cramps would hit, so I pulled a towel into the shower and knelt on it, letting the hot water hit my low back. Finally, I found some relief.

While I was in the shower, Marsha suggested to Brian that we come into the birth center. She could give me some Ambien to help me rest up so that I would have energy for labor. But after my shower I was able to relax and doze a bit more, so we decided to stay at home. We called our birth assistant, Pam, to tell her what was going on. Brian described everything to her, and then I spoke to her, telling her that I didn't really think I was in labor, as the pain was all in my back. She suggested getting onto my hands and knees to try to ease the pain of the cramps, and to lean over pillows in that position to get some rest in between. I did what I could to relax, and eased myself through contractions with deep breaths, beginning to vocalize with low moans when I exhaled.

Finally, conceding that this might be labor and that I was too uncomfortable to stay home any longer, I told Brian to call Marsha and tell her we would be coming in. Brian began throwing the last minute items into our bags, and to move things to the car, while I breathed through contractions on my own the best I could.

I hadn't realized how much being calm and breathing carefully helped manage the pain until one hit me really hard. I didn't realize that Brian had taken a bag out to the car, and I called out for him. When he didn't respond I called again and began to panic. The pain grew worse and my breathing became more erratic. I called for him over and over until he was there, apologizing, trying to calm me down. "Where are you? Why didn't you come?" I asked him, when the pain finally subsided. He explained, and then began timing his trips outside so that he was always back for contractions, sprinting to the car with my duffel bag, returning to help me with a contraction, then sprinting back out to put my exercise ball in the back of the car. At last he helped me out to the car and we were on our way.

Monday, January 15, 2007


Adriana Ruth
January 11, 2007
9:10 AM
9 pounds, 11 ounces
22 inches

mom and baby

i thank You God for most this amazing
day:for the leaping greenly spirits of trees
and a blue true dream of sky;and for everything
which is natural which is infinite which is yes

(i who have died am alive again today,
and this is the sun's birthday;this is the birth
day of life and of love and wings:and of the gay
great happening illimitably earth)

how should tasting touching hearing seeing
breathing any--lifted from the no
of all nothing--human merely being
doubt unimaginable You?

(now the ears of my ears awake and
now the eyes of my eyes are opened)

-e.e. cummings

Tuesday, January 09, 2007

Book review: Pregnancy books

I had been reading online articles for months when I got pregnant, but I am a reader and a researcher and once I really was pregnant, I started building something of a library of pregnancy books. I never picked up a copy of What to Expect When You're Expecting, as I was told that a lot of the book would just terrify me. Instead I asked friends for recommendations and ended up with a half dozen books to occupy me over the past nine months (and one week!).

Your Pregnancy Week by Week (5th Edition)
Glade B Curtis, and Judith Schuler

This was one of the first pregnancy books I bought. A friend had it during her pregnancy a few years ago, and I began calling it "the fruit book" at that time, because when I would call her to ask how she was doing, she would always tell me "This week the baby is the size of a grape" (or a strawberry, or a plum, or a peach), because each week the book gives you something to compare the size of your baby to. My favorite thing about this book is explained in its title: "week by week." This book gives you something new to read with each week of your pregnancy. Most other books only give you an update every month, which I found frustrating, especially early in pregnancy, when I knew things were changing constantly. Not that reading about it really makes a difference--I was still anxious no matter how much I read--but at least it gave me something to do.

My least favorite thing about this book is that it takes a very medical view of pregnancy and childbirth. Perhaps I shouldn't have been surprised by that. After all, the cover does bill it as "the only best-selling guide written by a doctor." But other books I've read (including the Mayo Clinic guide listed below) take a more balanced view of out-of-hospital births. Is home birth safe? the authors ask in a text box on the subject. "By any doctor's standards, the answer is a resounding "No!" I am planning birth center birth, attending by a midwife, rather than a home birth, but I was still put off by this. The authors don't offer specific citations for the studies they mention that found home births risky. They also point out that risk of serious complications increases when a woman suffers from gestational diabetes or high blood pressure. They do not, in this section, mention that these women are at higher risk of complications in any birth setting, nor do they discuss whether home birth or birth center midwives will refer their clients to back-up physicians because of these higher risks. I do hope that in a future edition of the book, the authors will consider other research, including a 2005 study of low-risk women with planned home births, that found that the women had fewer interventions than similar women birthing in hospital settings and experienced similar outcomes.

Maybe it's strange of me to spend so much time thinking about half a page in a book, but this particular half page really stood out to me. Still, I found the book helpful overall, and I have recommended it to other pregnant women.

The Pregnancy Book
William Sears and Martha Sears

I confess that I have drunk the Dr. Sears Kool-Aid. And while I haven't yet had my baby, so I can't attest to his parenting advice, I have enjoyed the Kool-Aid so far. The Sears' philosophy of attachment parenting appeals to me, and I found their pregnancy book offered a more balanced perspective on pregnancy and birth options. I did not feel that they were pushing readers toward natural childbirth or judging those who opt for other alternatives. This book does only offer monthly snapshots, which I found frustrating at times. I do think it has a good index and makes a good reference book, though, so that even if you're experiencing something that's not discussed in your current month, it is easy to find what you're looking for.

This is another book that cites studies without actually citing the studies. The authors offer some numbers from studies to offer support for some of their claims, but they don't tell me where to go find the studies to read them for myself. As someone who really likes research and numbers, it hurts my heart to not have access to some of the details of the statistics they are quoting. I mean, at least give me the z-scores or something.

The Girlfriends' Guide to Pregnancy
Vicki Iovine

This book was perhaps the least practical, in most senses, of all the books I read, but I did find it helpful. It's not helpful if you are having some concerns about something medical going on. It's great, though, if you want to laugh about pregnancy and hear some practical advice about what other women have experienced. And I didn't have the issue with wanting something more of a bibliography, because it's not the kind of book to offer up many studies to begin with.

The Expectant Father
Armin A. Brott and Jennifer Ash

I bought this book for Brian after reading some reviews on Amazon. He had been asking our midwife about books on becoming a father. He apparently meant actual parenting books, but I was unclear on what he was talking about at the time. Both of us did end up reading and liking this book. It doesn't go into a lot of detail on more medical aspects of pregnancy, but that was fine. They begin each chapter (one for each month) with lists of what your partner is experiencing physically and emotionally, a section on what's happening with the baby, and then a discussion on what's going on for the father. I found the sections on what the partner (that's me!) is experience to be fairly accurate, and what it listed for what the father was experiencing seemed reasonable to me. But the book also included more practical advice that isn't in the books targeted to women, such as a discussion of different types of life insurance and some information on various college savings accounts. I suppose these sections are in this book because it is aimed at men, and these are traditionally things that men deal with. Plus, it could give expectant fathers something to do while their partners gestate (that's a fancy word for nap and eat). But in our house I'm the one that generally handles that, so I found the information helpful in getting me thinking about what we needed to do (once I got over my momentary outrage that these people seemed to think it was my husband's responsiblity to deal with these things). And it got my mind of the gestating for a while.

As for the book's balance between "medical" and "alternative" practices during pregnancy and childbirth, I felt the authors did a fairly good job. Their discussion of issues such as out-of-hospital birth and natural childbirth methods didn't strike me as at all judgemental. It's also not a book that's heavy on the statistics and research, so I don't think it would help anyone make a decision about this sort of thing, but it does offer a way to start thinking about what you want to do.

Complete Book of Pregnancy and Baby's First Year
Mayo Clinic

A friend sent me a link to a State Farm website where you could send in your name and address and get a free copy of this book (unfortunately, I have lost the link), so I think it was totally worth what I paid for it. And I think if I'd paid actual money for it, it would have been worth it too. I would weigh this heavy book on my kitchen scale, but that only goes up to five pounds, and I think this book is heavier than that. When the book arrived, I did start to read it through, but I found some sections too difficult to read--in the early days of pregnancy, I really was not emotionally prepared to read about birth defects and chromosomal abnormalities. But it was my reference book for any concerns I had about medical aspects of pregnancy, and when we were weighing whether to go ahead with theAFP (triple screen), this book had the best discussion of what the test would actually be able to tell us.

Husband-Coached Childbirth
Robert A. Bradley

Bradley's book isn't a traditional pregnancy book as the ones above are, but it's on my shelf and I thought I would include it here, since I washed down my Dr. SearsKool-Aid with a glass of Dr. Bradley's Kool -Aid. Not having been through birth yet, I can't attest to his method of childbirth, although I can say that I feel more confident going into this because of reading his book and taking his class. Bradley was one of the first doctors to advocate for the presence of fathers in the delivery room, something that I take for granted at this point. His book isn't really balanced. While he does recognize that some women really need an epidural or other interventions during birth, his goal is to have women get through birth drug-free. The book offers helpful tips for parents-to-be on exercises to help prepare the body for labor and details at what to expect during labor.

I would also like to note here that the workbook that you are given when you sign up for a Bradley course could use some serious editing. The typos in there made me twitch.

Thursday, January 04, 2007

Lions and tigers and bears

I have a confession to make: as cute as Tai Shan is, I prefer the tigers to the pandas at the National Zoo. I worried that admitting something less than absolute devotion to Butterstick would mean that I could no longer be a Washingtonian, but then I remembered that I live in Virginia anyhow.

I've made it my goal to get out of the house every day. If I sit at home, I just worry too much about when the baby's going to come. So we made it outdoors for walks on both Saturday and Sunday, but I fell down on meeting the goal on Monday and Tuesday. Yesterday I overcompensated by spending three hours walking around the zoo. I must say that a weekday in early January (especially one that is 60 degrees and mostly sunny) is a much better day to be at the zoo than Memorial Day, which was the last time I went. That day it was completely crowded and miserably hot. Yesterday it was fairly empty, so I had lots of chats with the docents, and it was so nice that I could have even walked around with no coat. I kept the coat on, because it is longer than my maternity sweaters, which I am apparently outgrowing, as they keep riding up and exposing my belly.

The tigers were my favorite part of the trip. Yes, Tai Shan is adorable, but he just sits in the tree or lies around eating bamboo. Cute, but not quite the same as the tiger cubs. The cubs were too new to be on exhibit back in May, so this was the first time I got to see them. They are no longer the cute, squishy, kissable little kitty cats that I saw pictures of over the summer. Now they mostly look like smaller versions of their parents. Still, they are fun to watch play, especially when they are pouncing on their mom.

tiger cub

tiger cub

mom and baby tiger

Oh, and there are also gorillas and sloth bears and lions. And a lot of other critters that I didn't get photos of, because three hours on my feet got to be a bit much. I needed to concentrate on keeping myself moving, not taking pictures.


sloth bear


Tuesday, January 02, 2007


We've been spotting what Brian was sure was a hawk of some sort, and thought might be a bald eagle, out our windows over the past couple of weeks. We've taken a couple of walks around the neighborhood and down near Four Mile Run in hopes of getting a better glimpse, but we never found anything.

But this morning some loud noise from just outside our windows got Brian's attention. The hawk (not an eagle) was in our magnolia tree. He got a great view through our upstairs window, and then when the bird moved to the next magnolia over to eat its prey, he went outside to take some more pictures.

hawk perched in magnolia tree with prey

hawk perched in magnolia tree


On Sunday as we walked through Four Mile Run park looking into the bare trees for signs of an eagle nesting, we spotted a heron by the water. I didn't have the camera out and wasn't moving very quickly, so thought I had missed it, so I was pleasantly surprised to see this picture when I was downloading Brian's hawk images.

heron taking flight

Mason Neck

Back in June, Brian and I ventured out to Mason Neck State Park for a nature walk. It was a beautiful, warm day, and the some of the wetlands we walked through on the Bay View trail were fascinating. Everything was so lush and bright.

Bay View trail wetlands in June

We went back this past Saturday after I read that this was a good time of year to see bald eagles in the area. It seemed like a good chance to play with my spiffy new camera. (I was also hoping that a good walk would encourage Sticky to enter the world.) We went in the late afternoon, mostly because we were lazy about getting out of the house, but we rationalized that sunset would probably be a good time to check out some birds. I was amazed at how the wetlands had changed in six months.

Bay View trail wetlands in December

It was a good walk, albeit a bit chilly, and it was fun to experiment with the optical zoom on the camera. I also need to play with all the different shooting modes on my camera. I have a feeling I can do a lot more to adjust the lighting on some shots.


pine cones

red leaves


We saw a few herons, although I was never quick enough with my camera to really catch one. And at the end of the walk we did finally glimpse an eagle, perched high in the trees at some distance from us.

Eagle silhouette