The post-partum suites

The mood in the delivery room is of subdued euphoria. The attending doctor congratulates us on our baby and our choice of delivery method. Cracking a smile, the once aloof resident begins to chat with us, a little nervously, as if she were relieved to have passed some difficult exam. One nurse exclaims "your pelvis rocks!", pointing out that if anyone had known in advance that this first time mom was set to deliver 10 pounds of boy child sunny side up after 30 hours of active labor, a Cesarean would have been ordered immediately. One by one, people trickle out. Soon only Catalina, Francisco, Baby Zoogle and myself remain. I crawl into the birthing bed next to my wife, cradling Piro in one hand, supported by both our bodies. We both drift off.

After about two hours, during which time Piro is reweighed and measured, anti-bacterial goop is smeared in his eyes, and vitamin K is injected in his bottom (a procedure he disapproves of vehemently), abuelo takes off and the Nuclear Family is led to the post-partum suite, a skeletal affair with bare walls, hard linoleum, and no reading lights. Mom gets a bohemuth hospital bed, adjustable in 27 different ways, all of them uncomfortable. Dad gets a crocodile-green vinyl chair that folds out into a bed whose contours are inverse to his own. Bambino gets a clinical plexiglass bassinet on a rolling set of drawers.

It's been almost 48 hours since we last did any serious sleeping, but adrenalin is a wonderful thing, and we fritter away a few hours cooing and clucking over baby, rehashing his entrance into the world. Probably a bad choice: a constant stream of nurses, doctors, and lactation consultants ensures that even if Piro cooperated, we wouldn't get more than three hours sleep at a stretch.

The rest is a blur: I remember a washing, a lot of temperatures being taken, a herd of kind hospital types verifying that things looked good and that so and so would be in later to do X, but no one came in more than twice, and everyone wore the same kind of institutional clothes, and I probably got some of that goop they lubed up Piro with in my own eyes, cause I wasn't seeing so clearly, and I certainly wasn't remembering so good, and then it was Friday mid-morning and we asked if we could go and they said yes, soon as Piro get's the go-ahead. That came at 2p.m. from a certain Dr. Pye, who took a dim view of our request to postpone injections for a bit but seemed otherwise totally amicable and gave Piro a clean bill of health.

At 3:00 we left the hospital. You have to bring your car seat up to the check out station (I guess they like to verify that you have one, and know how to use it.) We did not know how to use ours, of course. The baggage guy just laughed, and laughed harder when he learned we didn't have name for our little hairless tree frog. 'You did know you were having a baby, didn't you?' he joked as he showed us how to buckle Piro in place. He wheeled Catalina to the car, I carried a profoundly zonked out Piro in the car seat, Francisco drove, and we got home at 3:30p.m. exactly 36 hours after Piro entered the world.

Endgame

The midwife is late. At 9:00 a nurse we've seen only once before tells us that she'll do the check, since Shannon is occupied with a birth in another suite. Euphoria! Full dilation. The only thing between here and a baby is the Push, a phase, we are informed, that typically takes first time moms between 1 and 2 hours.

A sweet tempered young woman in a blue scrub is assigned to help us push. Catalina's epidural is reduced by half so she can feel the relevant muscles, a sort of chin-up bar is rigged to the bottom of her bed, and the young woman shows her various canonical positions, most of which involve hanging from or pulling on the bar, knees wide apart. Exhaustion is palpable, but the news of the Last Phase seems heartening, and Catalina dutifully begins to squeeze and grunt with her contractions (which she can now feel, but only lightly.)

At the beginning of the push, Piro is positioned at +1, meaning the crown of his head is 1cm below the line of the pelvis. This is considered a favorable position in which to begin pushing; at +4, the baby 'crowns', and full emergence follows shortly. Shannon tells us that the rate at which the baby descends is variable, even unimportant: what is important is that the mother 'show progress'. Her check at 10p.m. reveals that Piro is still at +1. Disappointed, exhausted, and still barely in touch with her contractions, Catalina struggles to stay awake. The nurses all concur that the push phase should be characterized by an overwhelming desire to 'get that baby out'; the only major desire Catalina has at the moment is to sleep. She struggles on, but when the next check at 11p.m. reveals the same level of descent, the room is swept with a now somber realization that the plan needs changing.

The midwife theorizes that we're seeing the same pattern of interlarded strong and weak contractions that characterized her earlier active labor, and that the present set of weak contractions are probably inadequate to advance the baby. Why the contractions are weak is anyone's guess, but at this point the uterus is probably exhausted, and slowing down to rest. Under normal circumstances, we might be able to wait for it to recuperate and pick up, but with membranes ruptured for over 30 hours, waiting is not a luxury we have. Everyone concurs that it time for Pitocin.

Catalina starts on a low dose, and her epidural is reduced still further to augment feeling in the muscles. Now she has real pain, and we're back in the cycle of seeing her fight tooth and nail for every advance. Two hours of grueling squeeze are followed by another check: we've gained a centimeter at most. Catalina looks savaged.

They call in a doctor, a tight-lipped, waifish woman with an arrogant demeanor. Without saying much, she performs a manual check, confirming that Piro is facing occiput posterior, i.e. with the back of the head against the spine of the mother. This explains both the intense pain and the slowness of the labor. She also confirms that the amniotic fluid contains myconium, i.e. a baby bowel movement, which could be a sign of fetal distress. She spends five minutes attempting to rotate the baby by hand before leaving to discuss the issue with the attending physician.

He arrives, similarly arrogant, a tall, well-build man in his late forties. He describes the situation as follows: Catalina is effectively done (her uterus is exhausted, to say nothing of her spirits), time is short, and the labor is not progressing. Moreover, her uterus feels warm, and he's fairly certain she has an infection. Two options: one, cut in from above, two, pull out from below. Given the near certainty of infection, a C-section might have serious implications for any future child bearing plans. As for the 'below' options, there are two: the pump, or forceps. The baby is slightly deflexed, however, meaning his head is tilted back, augmenting the tightness of the fit and reducing the probabilities that the suction cup would fit well. It would probably slip off and end in failure. Moreover, trying both suction and forceps in succession radically increases the odds of cerebral hemorage, so if one fails, it's on to a C-section. His recommendation is the forceps.

The final scene: a mob around the bed, the doctor, his two residents, two principal and about ten auxiliary nurses, the midwife, the doula, my own lankey self. 'All the pushing you did before was practice', the doctor says, 'this is for real. It's got to work.' The doctor cranks the epidural. 'Pitocin is our friend', he intones, and cranks that too. All the heavy drugs we thought to avoid coursing full blast through the system. A contraction materializes on the monitor, Catalina takes a large breath, and then she's pushing with everything she's got, eye-popping, tendon-straining, braining-clouding pushing, for the count of ten, then another breath, and the whole thing over again, and one more time again. Three sets of crowd-cheering, beeper-studded, life-and-death push on one end and pull on the other. And then a pause: the doctor does the check. 'Excellent. Good descent. Let's do it again.' And so we do, once more, twice more, ultimately about eight or nine cycles of three 10 second pushes per contraction, and on the tenth, I see a huge distorted clown face, eyes skewed above a massive nose emerging through green-yellow-black-red slime, a mouth twisted purple, Picasso-like away from the rest, a hairy cone above this, below, fin-like hands and feet, the huge filanges of a primordial creature, grotesquely oversized limbs, and gnarled chord curling away in the bowels of my woman. Piro, welcome to the world.

Piro pending!

My hospital tote consists of a toothbrush, a pair of sweats, A People's History of the United States, the bible, Where Angels Fear to Tread, several math papers, and a laptop. Catalina's has one pea green homemade birthing gown, seven books of modern lyric poetry, enough snacks for the Grand Poobah's army, a camera, her entire CD collection, one pair of thick andalusian wool socks, and toothpaste.

It is Wednesday evening, one week to the day beyond Piro's due date, and we have been in Magee's LDR (Labor and Delivery Room) #14 for almost 24 hours. Per standard pokey-baby protocol, we went in for our 'non-stress' test yesterday afternoon, ostensibly to verify that Piro's extended stay in the womb had no overtone of duress, but in fact to expedite his emergence via a mysterious process called 'membrane stripping', officially minimally interventionist, in practice an obscure species of pokeage that produced overwhelming evidence of amniotic sack leakage. And unfortunately, once the waters break, the risk of infection skyrockets and doctors want Baby out asap. The official recommendation was to check in right then and get on with parturition, but the ever pliant midwives arranged a grace period of four hours to collect materials, eat, and take a shower. I taught my class, Catalina took a nap: five hours later, Francisco screeches to a halt in the Magee emergency entrance, and Cata and I pad to triage, fresh faced, jovial, hauling our backpacks like a couple of cubscouts out on their first overnight camping trip.

Oh benighted optimism! Almost immediately, we faced bad karma and hard choices. The processing wench apprises us we are being admitted for 'induction', one of those taboo words that crunchy moms rail against the world over. No sooner are we in triage than the midwife asks us if we want to puncture a few remaining amniotic pockets, in the reasonable hope that doing so might stimulate contractions and delay the dread moment when we administer Pitocin. But neither pokings nor Pitocin were part of the original plan: immediately, I feel trapped in the dread tentacles of Institutional Medicine. The midwife assures us there is nothing she can 'force' us to do, and that if we wish to go home, she won't call the police. But she also makes it clear that any attempt to delay Pitocin beyond the 24 hour mark would be considered dangerously renegade. We hedge. While hedging, nature lets loose the contractions: we enter LDR #14 at midnight with a sense of having narrowly avoided some perilous pitfall.

By morning, however, everything stalls. Back to square one. For better or worse, we decide to proceed with the membrane puncture. At 11:30a.m., blood and liquid pour forth. The midwife is delighted, I am horrified, Catalina is obliviously but soon descends into the most excruciating contractions. She labors like mad until 4p.m. By then, she is begging for mercy. The midwife checks her: 6-7 centimeters. She has progressed a little over 1 cm in 16 hours of labor. The spirit cracks. By 5p.m., she's on an epidural.

And now of course the whole avalanche begins to come tumbling down around us. Her temperature is a little high. If she gets an infection, even Pitocin might not work and she'll be reduced to a C-section, so the midwife suggests a propholactic dose of antibiotics. Contractions continue through the epidural, but by 6p.m. she's still not pushing, and the question becomes how far she has progressed. Either we check her and increase the risk of infection (moot if she takes the antibiotics) or don't check her and risk losing another hour or two to an already devastating physical trial. So perhaps we should start her on a low dose of Pitocin anyway, though it really only makes sense to do with an internal fetal monitor (another crunchy mom bugaboo.)

We seem to be lucky. The midwife confirms that she at 9+ centimeters, and totally effaced. So the contractions are working, suggesting that she probably doesn't have an infection, or at least one serious enough to sabotage the function of the uterus. Thus no Pitocin for the moment, and we'll wait and see on the antibiotics (temperatures sometimes spike with epidurals.) Now its just a long slog, hoping that the cervix disappears, the temperature stays constant, the contractions continue, and baby doesn't get stressed out, and the body begins to push. The midwife will return in at 8:30 to check on things.

Where's Piro?

Roughly eight months ago, medical science announced with somber certainty that Cocodrilo Jr. (otherwise known as Vampiro, the blood sucker, or just Piro, if we're feeling lazy) was due to begin his reign of terror on August 20, 2008. That was yesterday, and so far, neither scale nor claw. We're outraged (and a little nervous.)

There are doubtless any number of compelling reasons to take due dates with a grain of salt. One of the things that amazed me when Catalina reported the pregnancy was that embro-dating is an approximate science. Indeed, the age of the child dates from the last day of the mother's last period, since it's anyone's guess exactly when within the window of the subsequent period the fertilized egg actually made it to the uterus. So, if I understand the theory correctly, the actual, biological age of an embryo dated 'X weeks' can vary by up to a couple of weeks. In our case, belly size and a few ultrasounds suggested that Piro was on the older end of the scale, which we interpreted to mean that he should be coming out early.

So much for back of the envelope calculations.

As a mathematician, I am sympathetic to the presence of statistical noise. (Whether or not my sympathies extend to baby noise remains to be seen.) And on a purely rational level I totally understand the fact that Piro is happy in his intra-uterine lair and reluctant to leap into a world where, e.g., I have been assiduously practicing diminished sevenths on my guitar. Our anxiety comes from the fact that current medical standards insist that children not born by 42 weeks be induced, a process that generally entails the administration of Oxytocin, a concommitant strengthening of the contractions, and, ultimately, the administration of an epidural. In other words, if Piro doesn't get off his duff and take the plunge, our natural childbirth plans are most likely out the window. Add to this the lingering fear that he really is a large boy (witness attached belly shots) and that this macrocephaloid monster won't make it through the pelvis, and you've got a nice recipe for lingering, low-level anxiety.

Fortunately, the natural induction regime is a lot of fun. Spicy food and aggressive love are what the mid-wife suggested, and we've been going hard in both categories. Mexican chile soup on Tuesday, hot Indian chicken curry on Wednesday, blazing black beans McCanCan tonight. Let us hope the recipes work soon, however: next on the agenda is Castor oil, followed by various sorts of clinical penetrations that sound about as much fun as the rack.