One woman's path through doula training, childrearing, and a computer science Ph. D. program

Sunday, January 22, 2012

Sue's second baby

Sue and I go way back -- in fact, the first birth I ever attended was the birth of her first baby.  So when she was pregnant again, there was very little discussion about whether or not I would be at her birth. Even though I had moved two hours away from her house, it was just understood that I would be there, rain or shine, night or day.

And that is exactly how it was.

Past due part deux

Five days past her due date, Sue felt her first real labor contractions. She had had contractions for months, just like with her first baby, before real labor set in. Some contractions, like the Braxton-Hicks that plagued her throughout both pregnancies, did nothing, and others opened her cervix, a little at a time.

"Why doesn't my kid like to pee in nature?" Sue lamented one morning. "I have never heard of a toddler that doesn't want to use the great outdoors. I tucked him under my arm and wedged him above my huge belly and ran with him looking for a bathroom. Contractions the rest of the day."

Three days past her due date, her OB checked her cervix at her request. "She says I have a super thin and super favorable cervix and I will go into labor for reals next time I start contracting," Sue related. "She didn't give me a number for dilation but I could tell she could get her fingers further into my business."

Of course, I gave the best advice I could: "Are you thinking what I'm thinking?" I wrote on my antique cell phone. "That's right. Mad nookie all afternoon, and baby this evening." Of course, I was not even a little bit kidding. Sex is a great way to stimulate contractions for two reasons: orgasm has been known to set off contractions (because orgasm is a type of contraction); and semen contains the same chemicals as the stuff they use to induce labor, so just letting it hang out in the vagina will help ripen the cervix. Plus all those orgasmic hormones are the same ones that course through a mom's body when she is birthing a kid and breastfeeding. Sue replied that the timing would not work out -- it would complicate the pick-up from day care for her toddler, so she decided to wait.

But she did not have to wait long: just two days later, it happened. The familiar tightening of the belly, rhythmic, every few minutes. Just like last time! That evening, Sue made dinner for the last time for her family of three. Her toddler helped her put the finishing touches on the pie, and they waited together for it to bake.  I stopped by for a while, took a look around, and read a book with the toddler. Sue said, "You can probably just go home. It will be just like last time. You know, days of early labor. I'll call you if anything happens."

I went home, and straight to bed at the early hour of 9:30pm, snuggled up with my own toddler, who was about seven months older than Sue's.

It's code for "get me some caffeine."

No calls all night. At around 8, as my kid and I were getting up, I got a message from Joe. They were at the birth center (more like a maternity hospital, because they have anaesthesiologists on site, and a surgical room) checking on the labor because the contractions went on all night. Sue slept for two minutes at a time all night long.  And on that note, I was on my way -- despite Joe's warning: "We may be sent home again." To explain -- the birth center generally practices evidence-based care, and will send a mom home if she is not in active labor, so she can labor at home without the risk of unnecessary interventions. On the road, I got the confirmation (again from Joe) that they were staying.

As I rolled into town, I messaged Joe if they wanted anything from town: coffee, breakfast?

"Soy latte please," Joe wrote. "And Sue says she would kill a man for a coffee."

"Is 'coffee' code for peppermint soy latte?" I asked.

"It is," he replied.

I walked into our neighborhood coffee house and was greeted by Jill, who remembered me from my own infant-in-arms days, well before we moved two hours away. Because I was a regular, in the shop every day for something decaffeinated.

"Hey! What can I get ya?"

"Joe and Sue are havin' a baby, so I need to pick up a couple soy lattes for them," I said. "A medium soy latte for Joe."

"No, no," she interrupted, beaming. "Joe always gets a caramel soy latte."

"Oh? He did not say caramel," I pondered. "But let's go with the usual. And a soy latte with peppermint for Sue."

"That is so exciting! I saw Sue in here the other day and she told me she was past due but it's OK because she was past due with her first baby," said Jill, "and all I heard was past due... What if she had broken her water here?"

"Nah," I replied. "Only 25% of labors start with the water breaking." I do not know why I busted out the statistics.

"That's not what happens in movies! They always swoooosh, gush all over the floor, and then there is always yelling because there's only like ten minutes to get to the hospital before the baby plops out."

We laughed, and I left with the two lattes.


Arriving at the birth center around half-past 10am, I delivered the two lattes to Joe and Sue, who greeted them like undergraduates after an all-nighter.  I learned that they checked in at around 4cm. Yes, it is funny to talk about time in units of measurement -- but when birthin', does time really matter? Then again, do centimeters? What really matters is how the mom and her partner(s) and the baby are doing. And here, they were doing splendidly.

Sue was standing and slow-dancing with herself during contractions, and Joe was browsing the web on his smartphone, coming over every few minutes to show off a hilarious photo -- like the one of the lemon giving birth to another lemon -- sending Sue into laugh-induced contractions. When she complained of sore feet, I asked the nurses for a labor ball. Sue sunk into the ball and moaned, "Oh yeah. That's the stuff."

Strangely, Sue had some back labor which was new to her, since her first baby did not give her such an affliction. Joe was delighted to push on her back, and was even more delighted to say obscene things about their position: her,  bending forward and him, standing behind her with his hands on her tailbone, his arms locked, his feet planted firmly into the floor, and his back against the wall.

"This position was more fun before," he remarked.

"You're telling me, kid!" Sue smirked.

Between contractions, we talked about toddlers, about mutual friends, about babies, and, of course, about labor. "I can tell this baby is bigger than the first one," Sue said. "I think this one is 9 1/2 pounds. The first one was almost 9."

"We will see!" I said.

At 5cm, or 2:20pm -- a full six hours since her 4cm cervical check -- and after a long shower, with the hot water pushing on her back (after this, the baby turned and there was no more back labor), Sue agreed to break her water. In her first birth, the AROM (artificial rupture of the membranes) sent her into full-blown labor and she had had her baby a mere five hours later. We expected similar results this time.

The OB reached the crochet-like hook inside and ruptured the membranes. "There is some meconium in the fluid," she said. "We will have to keep you on the monitor for a few more minutes."

The baby was watched for a while, but the nurses saw nothing strange; thus, Sue was released to get into the large bath tub provided she keep the wireless, waterproof monitors strapped to her belly by a wide green stretchy band. This time, there was no tub in the room, but there was one a few doors down. Sue got dressed -- the hospital gown which covered her front only, the band that covered her stomach, and a pair of gauze panties with a pad big enough to soak up a small aquarium.

We ventured into the hallway: Sue, then Joe with Sue's water bottle, and then me with the camera. A nurse from across the hall opened her eyes very wide at me and made a closing motion with her arms. I looked at Sue -- from behind, of course, and saw the problem (the behind) -- and immediately closed her gown and held it shut on our short walk down the hall.

In the warm water Sue relaxed immensely. The "ooh" and "ahh" moans were back. This time, I tried the count-up-to-ten, count-down-from-ten method that I had found to be working with my most recent clients. Her instructions were to stop me if she did not like it. She never stopped me. So I counted up to ten with each contraction, trying to match ten with the peak, and counted down as the contraction subsided.

The lights in the tub room were insanely bright. I asked the nurse if she had any of those battery-operated LED candles lying around, but she could not find them. So I did the next best thing: I taped blue washcloths over the lights with some fabric tape.
Mood lighting meets
modern engineering

Transition is when the baby falls out

An hour after getting into the tub, at 3:45pm, the telltale pressure at the top of each contraction. I called the nurse, who called the doctor, who called Sue to get her out of the water and back into the room for an exam. The nurse was the first to arrive, followed by Sue, who got on the bed and draped herself over the top of it, on all fours.

"Seven and a half," the nurse said. "Call the doctor," she shouted over her shoulder.

One more contraction, when Sue puffed like she was blowing out candles at her 3000th birthday.

"Where is the doctor?" the nurse snapped. "When I say 7 1/2 centimeters, you get the doctor," she complained with a huge fake smile and a glance at Sue and Joe to the other nurse, who had just walked in.

Sue growled.

"Hm, why don't you try just going with that feeling," said the nurse. "Just push through it."

Sue pushed.

The doctor walked in, introduced herself, and asked if she could do a little exam. Receiving the affirmative, she reached inside and whispered, "I can't find a cervix. The head is right there."

Sue whimpered.

"Why don't you get on your back," the doctor said. "It will be easier for you and the baby."

Sue turned over, graceful as any mammal with a baby hanging between their legs.

"Joe is going to count to ten, and you are going to push for the whole time," said the doctor. Joe counted; Sue pushed in silence. Then a deep breath, and more counting, more pushing, for the duration of the entire contraction. Above: Joe and Sue's heads; Joe's soft voice counting. Below: the baby's head, molded like a walnut. I snapped pictures of Joe supporting Sue. It was nearly 4pm.

But then something happened

The room filled with people: nurses for the doctor, nurses for the patient, doctor for the baby, nurses for the baby-doctor. Everyone was watching the baby's heart rate. The machine should have been beeping, but it was not. Maybe the lead was off. We had been having problems with the monitor finding the heart rate throughout the labor. The lead was off. Right?

"Let's get mom some oxygen," the doctor commanded. A plastic mask was handed to us and Joe and I placed it over Sue's face. "It's for the baby," the doctor said.

The baby-doctor, Dr. Moss, a wholly unremarkable middle-aged man in plain blue scrubs, looked concerned, with his hands folded in front of him, as he watched patiently for the baby to emerge. His two nurses were unwrapping things behind him on the baby warmer.

One more contraction, and Sue's baby boy slid out. Neither Joe nor I saw it because instantly, the cord was clamped in two places and cut in under three seconds. The baby flew in Dr. Moss' arms to the baby warmer, where six hands simultaneously rubbed a grey and floppy form of a plump infant. I put down my camera. For the first time in any of my births, I did not feel my eyes water. I felt bone dry as I came up to Sue and Joe.

"Good job," I cooed through my parched mouth. "Great job. That was so good." But nobody was paying attention. All eyes were on the baby warmer. Something white flashed in the doctor's hands -- something I have come to associate with the term "intubate" from watching TV shows like House.

There was a wet, muffled cough. Joe looked at me and whispered, "What's happening?"

"I don't know," I said.

I could see the baby's chest being massaged from both sides -- top and bottom, and his grey, limp ribcage was dancing on the warming bed. And when the ribcage danced, the grey arms bounced about on the bed as well. He looked like a lifelike doll, bouncing and dancing to some unheard music.

"He is doing fine," said the doctor. A suctioning sound came from the baby. Nobody believed him.

I looked at Sue. She was looking straight into Joe's face. The doctor was draining her placenta. Then we heard the baby's first cry, and we could all breathe again.

The nurse said, "Joe, you can go to the baby."

"I can?" he said, and, squeezing his wife's hand tenderly, and with a kiss on her head, he went to the warming bed.

The baby's head and chest had gotten pinker, but his arms and legs were still grey. Dr. Moss lifted an arm, and it snapped back into its curled place, jiggling a little.

"He is doing better, but I don't like to see babies so floppy," he said, explaining. "I want to take him to the nursery for some tests and to make sure he gets better." He used small words.

Dr. Moss was making preparations to carry the baby to the nursery. An astute nurse asked -- and for this, I thanked her silently -- "Can the mom see the baby first?"

"Oh, yes, of course," he answered and held the baby out to Sue. This gesture reminded me of The Lion King, when Rafiki the monkey presented Simba to the animals in the kingdom. Held up for the subjects, high above them and far from them, to be seen, but not touched. I watched from behind and snapped a photo: an anxious, worried, pained mother longing for her child; and the wrinkled, chubby back of a limp, pinkish grey baby.
Rafiki presenting Simba to the animal kingdom.
(c) The Walt Disney Company, 1994--1995

"Do you have any questions for me?" asked Dr. Moss.

"No," Sue said.

I looked at Sue. "Do you want to ask when you can hold the baby?"

"Yes," Sue said.

"It's hard to say," Dr. Moss said to Sue. "After we draw some blood, and run some tests. I would like to say 45 minutes. But it may take longer."


And with this, Dr. Moss ran away with a tightly-swaddled baby. Joe went with him, and I stayed with Sue.
A blur of Dr. Moss taking away the new baby

There was so much cognitive dissonance for me. On the one hand, every doctor and nurse were saying things like "He's doing so well," but on the other, nobody could touch the baby. And he was grey and floppy. If he were doing so well, he would be on his mama's chest, just like last time. And Joe would be cutting the cord, just like last time. What did it mean? Was the baby okay, or wasn't he?

The nurse said the baby likely inhaled some meconium. I looked at the remains of the umbilical cord. It was blue, not stained by meconium the way the cords get after they had been bathing in meconium for hours. So the meconium could not have happened too long ago. What did it all mean? And why was everyone using small words and saying he was so well, when he clearly unwell?

Physical repair

Sue's doctor was threading a curved needle and began to make the repairs. "Second degree?" I asked.

"Yes," she replied.

"Ah, like last time," Sue said.

"Yes, and it looks like you tore in the same place," her doctor said. "I can see the scar right here."

It was clear that Sue was in a significant amount of discomfort. Her doctor worried: "Would you like some more numbing?"

"It's not you," Sue replied. "It's just everything. I'm very sore. Ow! OK, that one was you."

We tried to have a sense of humor, but it was so grim in the room. The doctor finished her repair, and left. Sue turned to the side, away from me, and shut her eyes. I thought she was trying to sleep after her long ordeal: twenty-six long hours of early labor, and an hour and a half of the real deal. And then this.

I touched her thigh. "Do you mind if I go to the nursery and try to get some pictures of the baby? I have my phone. Call if you want me to come back."

Sue nodded, eyes shut. I went out.


The nursery was a single room, attached to a the single operating room. Outside the nursery door, I saw through the mostly-closed blinds that inside, there were just two warming beds. Only one was occupied, with Joe and Sue's baby. Joe was rocking in the chair nearby and two nurses and Dr. Moss were doing something to the baby. A third nurse was at the computer, typing furiously.

I do not know what I was imagining a nursery to look like. Maybe like nurseries in the older movies, with a row of beds and a baby in each bed, and a large window to see in. This was a far cry from that image, and there was significantly less cooing over new babies.

A nurse approached the door and I asked her if I could go in.

"Are you family?" she asked.

"No, I am a friend," I replied. "I am Joe's friend. He is inside on the rocking chair."

"I will ask," she said, and disappeared inside. I stood back and read some things posted on the bulletin board while I waited. There was an article about a woman that had a c-section, and someone had left a surgical sponge inside her abdomen. The sponge caused several of her organs to fuse, and the court granted her over $500k in medical expenses, and the nurses were held responsible because they should have counted the sponges. They said they did, and it should be the doctor's fault because he was in charge.

The nurse returned and said that I could not come in because they were going to clear the room for a chest x-ray, to check whether there was any infection in the lungs from inhaling meconium. I thanked her (for what?) and headed back to Sue's room.

In the small waiting area, I met a white-haired woman wearing nice exercise clothes. I had seen her waiting, talking on the phone, and reading books on those couches several times in the hours since I arrived. I asked: "Having a baby?"

"Well, I hope so. We have been here all morning and things are happening very slowly. How about you?"

"My friend had a baby boy recently."

"Oh, how lovely! There was a baby boy born at 3, is that your friend's?"

"No, hers was at 4."

"Oh, two baby boys! How nice. Is he with your friend now?"

"No, he's in the nursery."

Her eyes lit up. "There is a nursery? Where you can see the babies?"

"Um." I did not know how to answer that question. I could have said, "It's where the sick babies go." Although not untrue and not really revealing anything about Sue's baby's condition, I did not know if it would be the wrong thing to say. Instead I said, "No, you can't see in, and there is just the one baby inside."

Sue's nurse came out of her room. Seeing me she said, "Can you do me a favor? Do you know where the baby blankets are?"

I confessed I did not. She explained where to find them, and that underneath the warm baby blankets are the warm adult blankets. Sue was cold. I rushed off.

In the room I found a frightened Sue. She had not been sleeping -- she had been terrified. I put the toasty blanket on her and sat by her head.

"I thought you were sleeping," I said. The room was dark, and the rain spattered on the window and the small balcony outside. Sue's room was silent and lonely.

"No," she replied. After a pause: "Everything hurts." And: "I want my baby."

"I know. Joe is with him. I was watching him watching your baby."

Emotional repair

Hours passed without any of us really understanding what was happening. The turning point was when the nurse suggested a trip to the nursery. This motivated Sue so much that she immediately forgot about her body's aches; with her nurse's help she got up, got dressed, and was wheeled in the chair to the nursery.

Joe was standing up over the warming bed with a finger in the baby's mouth. The baby was sucking beautifully. Joe said: "My finger is all pruny. This has been going on for hours. My feet are sore." We laughed. Finally, we laughed.

The baby was connected to a heart monitor, oxygen saturation sensor, breathing monitor, and an IV in his ankle, and the nurse was trying desperately to draw blood from any of the baby's four limbs, with little success. She had been trying for quite some time. With each needle-stick, the baby would cry briefly, and continue sucking.

"Do we have any sugar-water?" another nurse asked. "If you put some on your finger for him to suck, it's a natural pain reliever for the baby."

"How about we use breast milk?" I suggested, always the advocate.

"I'm not sure there is any in there," Sue said.

"That is a great idea," the nurses said, and gaily approached Sue. "Try it!" Sue tried expressing a little milk onto Joe's pinky and out came a copious amount of colostrum. And as soon as Joe put the finger into the baby's mouth, his eyes opened and he visibly salivated.

"He likes it!" everyone exclaimed.

Sue finally got to hold her baby, still connected to all of his tubes and monitors, at 7:30 -- over 3 1/2 hours after his birth. She held him and nursed him, though he was already drifting into a solid sleep. But in his sleep he would wake, nurse, and fall asleep again, snuggled skin-to-skin with his mama.


Every birth is different. How true this is.

Sue's goals for this labor were to complain less and to push faster, and she succeeded in both. She complained very little -- only in transition did a little complaint escape her lips (and who wouldn't, a little?) -- and she pushed for just fifteen minutes. One could say it was a better birth in this way.

But after the baby's birth, when things took a turn for the unknown, when the baby did not go directly on mama's chest but was instead whisked away, and nobody understood what was happening -- oh! how different it was than the first, picture-perfect natural birth.

You will hear, "What matters is a healthy mama and a healthy baby." While this is true, it is an understatement to the emotional roller coaster which is made more prominent by the mother's extreme hormone shifts after the birth of a baby. In the end, this story had a happy ending, though certainly not without serious worry.

What really happened? I guess this is something for Joe and Sue to figure out with their doctor. My part is to support them throughout birth, and my support will continue until they have closure.
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