Calling all hands--it's a staph meeting

After our long nap that Friday the 13th, I was relieved that no calamity had befallen us, but the day wasn't over yet. As I was nursing Jesse contentedly in my newly put-together, extremely comfortable rocker-glider, Dean bounded up the stairs and announced, with his usual humorous aplomb, that our baby had been recalled. We had been summoned back to the hospital for some antibiotics because one of the lab cultures had come back positive for a strain of unidentified bacteria, and because they weren't certain whether the bacteria had come from his skin (where it's--believe it or not--normally present) or from an internal infection. But his previous low-grade fever and high-ish white blood cell count meant that something was tasking his newborn system, and so he was re-admitted as a pediatric patient.

Before long, it became apparent that the bacteria was a staphylococcus, or staph, strain. What blew my mind was the number of times I was asked if I had tested positive for Group B Strep, which I hadn't. Last I checked, Strep and Staph were totally different strains of bacteria. I was also asked repeatedly if there had been anything unusual about my pregnancy. Well, aside from my tongue possibly being a map to buried treasure, no. I had to fight the urge to be smart-alecky ("At his second ultrasound, Jesse flipped us off..."), actually. I thought we'd be there for a while for them to draw new blood samples and be sent home with antibiotics, but then I found out we'd be there overnight for several courses of IV antibiotics.

I was devastated and nonplussed. We hadn't been told to pack for an overnight stay, for one--and this meant that I hadn't brought any of my postpartum supplies other than a change of pads, much less any food or drink. What was worse was that we were now in the pediatric unit, so I didn't have access to the mother-baby unit refreshment stand. I'd discover the following day that I was to be fed, being the breastfeeding mother of the patient, but in the meantime we were in for the most harrowing night I can ever remember. Dean went with the nurses while Jesse got his IV, and I meanwhile sat wringing my hands in Jesse's room, freaking out and thinking, "If I'd had him at home this never would have happened." When Dean brought Jesse back--his hand immobilized by the complicated heplock they had created--Dean said to me, "He is so brave, Helen." This struck me as a strange thing to hear Dean say, but then I realized that he was bonding with the baby too.

This being the same man who didn't speak to me for a half hour when I told him I was pregnant.

But the doctor--a very nice woman--came in and explained that we should have results of the additional tests by 3 p.m. the next day, and that they should reveal the course of treatment from that point forward. By this point, it was nearly 10 p.m. I thought I could tough it out, and Dean said he'd stay with us. Jesse cried through most of the night, and I found myself in meltdown mode shortly after 3 a.m., sobbing hysterically with my newborn, wanting nothing other than to go home. My milk was starting to come in; Dean was holding me and the night nurse was comforting me. I remember blubbering out all of my fears as I tried to nurse Jesse and he'd find no solace there because latching on was so difficult. Finally, Jesse and I fell asleep--with him in my lap in the hospital bed.

The following morning, a shift change brought us a new nurse that we didn't really see all that much of. Another doctor--different from the one we'd seen the previous night-- came in, did an exam, and explained brusquely that Jesse might be sick and might not be but we needed to err on the safe side, and left. We sat and waited, and sat and waited, and sat and waited. Jesse had two normal temperatures in a row. I got breakfast, and lunch, and was asked to place an order for dinner. That's when I started to get suspicious, and summoned the nurse to find out what was going on. It was now nearly 3. She explained that usually these infections meant a 48-hour stay in the hospital. I nearly lost it all over again. "I was told we'd have test results by this time!" I said, insistently. The nurse cocked her head. "Well, the doctor won't be back in until this evening."

ARGH! I nearly burst into tears again, but put my adamant hat on and told her what last night's doctor had said. The nurse said she'd try and find out the results of the additional testing and call today's doctor for more instructions.

An hour later she came back in and said we could go home; the tests showed he'd cleared whatever it was. Dean made the observation that I had been giving Jesse my antibodies since shortly after he was born, amniotic fluid in his tummy notwithstanding. (And I have the immune system of a tank, really. I don't get sick often, although I'm apt to get run-down often enough because I'm Type A that way.)

The nurse ran down our discharge instructions and then went on to add a bit of unsolicited advice. "And don't put your baby in the bed with you!" she said, firmly. Did we look suspiciously like co-sleepers to her? Or was she concerned about the fact that when she'd come in this morning, Jesse had been asleep in my lap? "They can suffocate," she continued, "and when you go into a deep sleep, you can roll over on top of the baby."

Yeah, like I roll over on top of my husband on a regular basis, right? I co-slept with my first son without ever having heard of attachment parenting (or co-sleeping, for that matter. It just made sense, and made him a better sleeper; he slept through the night at 6 weeks and slept in his bassinet or crib from that point onward, with the occasional exception for rough nights.

So we just smiled and nodded and took our little boy home--for good, this time.

The first few nights

When we moved to the mother-baby unit after Jesse's birth, I discovered that I had a psychotic bed. As I'd lie in it, various compartments would inflate and deflate, and I joked that it was alive and breathing. Dean immediately conked out on the couch, and I set up my computer to start sending out notifications to folks while getting the hang of breastfeeding and swaddling. It quickly became apparent that Jesse didn't like the hospital bassinet, and I didn't either -- they were clearly set up for standing up care by nurses rather than bedside care by moms, and I had to get out of the psychotic bed to lift him out of the bassinet, then clamber back into the psychotic bed, which would then heave and sigh and readjust to the change in weight. Jesse took to breastfeeding pretty easily, all things considered, but showed (and still shows) a strong preference for my left side.

I couldn't sleep, though. I had an incredible amount of adrenaline coursing through my system. So I watched the baby, transfixed, in awe. In fact, at 1:30 or so I sent my first tweets out, and one of the comments I made was "And I just cannot get over how beautiful this baby is. Seriously." Seriously.

But about 4 a.m., something weird happened. Jesse started making choking and retching noises and I freaked out. The nurse happened to walk in before I could hit the page nurse button, and she picked him up and started vigorously burping him, explaining that he was now clearing amniotic fluid from his tummy and it would need to be burped out. The stuff that he kicked out was a foul-smelling mix of colostrum and amniotic fluid. This continued for the next two hours, before he started a whining scream that carried down the hall. The nurse rushed in again, took his vitals, and discovered that he was running a mild fever. Off he was whisked to the nursery for monitoring, and there he treated everyone to a grand show of projectile vomiting amniotic fluid.

I was half panicked, but so exhausted that I collapsed into a fitful sleep for an hour or so, punctuated by my iPhone alarm to get Dean up so I could send him to get Elder Son off to school. At that time, we asked if we could see Jesse before Dean left, but apparently Jesse was getting labwork done and a checkup by the pediatrician. The nurses were more nonplussed that I was up and walking around the floor so easily. I was more nonplussed that we couldn't see our baby.

An hour later, I was summoned in to feed Jesse. He had stabilized considerably since the vomiting thing, and if he could feed without any reflux this time around they'd be satisfied that he was ok in spite of the mild fever. They offered me a chair in a room for privacy, and I realized, horrified, that I was in the circumcision room--with two immobilization stations that made me weep that I'd put my first son through this procedure. It struck me also that the chair I was in was the antithesis of a comfortable breastfeeding chair, and the boppy they gave me did nothing to improve my own comfort level. But Jesse did fine, and so he came back with me to my room.

When the lab results came back, he showed a higher than normal white blood cell count, and between that and the mild fever, the pediatrician was a little concerned. But he seemed to be "over the hump," as he put it, and when Dean got back we spent the day cuddling Jesse. But I wanted to leave. I'd passed through my postpartum checkups with flying colors, refusing Percocet for the cramps (though I did take a couple of Motrin) and peeing just fine. In fact, I was amazed at how little pain I was in, having had a second degree tear--with Elder Son, I'd had a second degree episiotomy, and had a hell of a time with basic elimination functions.

And the second 24 hours passed without much of a glitch aside from the fact that Jesse went on a crying jag about 3 a.m. And nothing I could do would appease him. I just wanted to go home, to take Jesse home, and realized, somewhat blankly, that I really could have, and should have, done all of this at home. My midwife had even suggested it to me at one point, and I was reluctant, thinking of the risk factors I had. But really, looking back on it, I was so aware of my body and my baby that I'd have known if any of those risks were coming into play.

But I don't have regrets, either. It took the experience to teach me that I could do this, and that I could help others do this.

At any rate, we were discharged late Friday morning. I couldn't wait to get my little boy home, to introduce him to his big brother, and to enjoy getting some rest in a bed that didn't sigh every five minutes. After having a light lunch, I took Jesse upstairs, and we both slept-comfortably-for the first time in his life.

Jesse's birth story, part 3

Back onto the ball I went at 8, and immediately, it seemed, I went into hard labor. I started hee-hee-hooing in time with my bounces, and got Dean into a pattern where he'd steady my back and massage the small of my back during the contraction and then move his hands up toward the center of my back during the time between contractions. This system worked really well and soon I could just say "Hands Up" as the contraction would fade and "Hands Down" as the next one would start. Faster and faster they came, and Dean would remind me: "Baby down, Mama open."

Contrast this with the epidural model where you can't leave the bed and your partner has to tell you when the next contraction is happening when the needle rises on the monitor. We'd have been there all night and probably wound up having a c-section.

It was clear that I was in labor now, though, and the bouncing no longer seemed silly. In fact, during the interludes of "rest" where I'd have to get on the monitor for 20 minutes, I was aching to get back on the ball. It was more comfortable to bounce through the damned things--and bouncing has a rhythm that you can really flow with. My next round on the monitor was at 8:30, and I found I hated being in bed and got back on the ball as quickly as possible.

At nine, I was bouncing, and trying to breathe, and howling as I did so. It was an uncanny ululation as I allowed the baby down and felt myself opening, finally. I clumsily banged the call nurse button and told her what I'd just felt. "I need to push!" I said, I think with a scream. Keep in mind I'd just hit 5 cm. at 7:45.

She hurriedly got me into bed, hooked me up to the monitors, and checked me. "She's at 8, and look at those contractions!" she hollered, galvanizing several other nurses into action and sending one off to get the doctor. I realized I was in transition and glanced at the monitor; the contractions were literally happening on top of one another, cresting like great waves pounding into one another before washing ashore in violent cascades. I think I finally understood what it meant to be in both agony and ecstasy at the same time, and stared down in bewilderment as they removed the bottom of the bed and Lisa began to manage my breathing using a counting technique that forced me to refocus my attention away from the wild banshee I was becoming as I continued to howl.

"Helen, you still have just a little bit of cervix left," she said. It was happening that fast. "Breathe with me, now." Five hees. Hooooooo. Four hees. Hoooooo. Five. Hooooooo. Lisa was holding one leg, Dean was holding the other. Three hees. Hooooooo. Five hees. Hoooooo. Two. Hooooooo. The doctor was at the foot of the bed. The other nurses were frantically getting everything ready, I was suddenly aware that It Was About To Happen.

(It was right around this time that my midwife found out I'd been admitted. She called and was told I was about to deliver. She commented back on my Facebook update: 'Why do my best patients always give birth on days I have my pager off?")

At 9:30, I got the ok to push. "Already?!" I said. I heard Lisa tell Dean to support my head as I did--and then, I pushed. With each contraction, I'd push three times; with each push, I'd visualize where he was. The baby crowned on the third contraction, and Dean looked down as we moved into the fourth to see his skull molding to emerge. "You'll feel some burning," said one of the nurses, and -- I felt his head move through me, and screamed again.

"Don't scream," said Lisa, and I nearly laughed. "Pant like you've never panted before." The baby was being suctioned, and I felt goosebumps as I fought the urge to push him the rest of the way out before the doctor had a chance to move his shoulders safely.

"Ok, push again," and out he came. Phflump into the doctor's waiting hands, and then--that first cry. They placed him on my abdomen to dry him and suction him, and I sat there breathless and awestruck, stuttering the only thing I could think to say as I wrapped my arms around him: He's beautiful. I was blinking rapidly, trying to get a sense of what had just happened as he was carried over to the examining table. He had a lot of fluid even after the first round of suctioning, and so I sent Dean over to watch as they got him breathing better.

I had more trouble delivering his placenta than I did delivering him, and I was bleeding a lot. But at that point, I was transfixed watching him, watching Dean watch him, so I didn't really sweat the Pit they attached to the INT to control the bleeding and help deliver the placenta. I probably should have, but I couldn't breastfeed the baby right away because of the excess fluid. Turned out, he'd come down the pipe so fast that he didn't get all the amniotic fluid squeezed out of his lungs and tummy.

Because when it comes right down to it, I had him in about two hours flat, and only pushed for 15 minutes, if that.

I had a small tear that needed repairing, and once he was stable they brought him to me to breastfeed. Lisa disconnected my IV, saying, "They probably want you to have a second bag of this but I know you don't want it and you definitely don't need it." As he tentatively latched on, I murmured his name, Jesse.

The doctor not only congratulated me but also--significantly--apologized to me. "You did say that if you could just get to 5......."

Jesse Heath Mosher, 9 lbs. 11 oz., 23" long, with a 14" head. 11/11/2009, 9:47 p.m. And absolutely beautiful.

The story doesn't exactly end here, though. Jesse's first night will be another blog post in a bit. :)

Before that, though, a couple of observations. I think if my midwife had been available for my labor, I would have gone into active labor more quickly. I also think I could have avoided tearing had I been able to give birth in the squatting position instead of flat on my back. That said, in my heart I feel like my midwife DID deliver my baby. She gave me nearly all of my prenatal care, and took time to educate me so that I would be empowered if she wasn't there, and helped fill me with a passion I didn't know existed--or, should I say, still existed.

She asked me, at about 6 months along, if I would consider a homebirth, saying that I would make a good candidate for one. I think, at this point, if we had another freak oops and a sibling for Jesse, I would. But the chances of that are very slim. Jesse was against the odds. A gift, if you will--and how apt is it that "Jesse" means gift?

Jesse's birth story, part 2

The nurse iterated again how she was concerned about not being able to get an IV in me fast enough if there were an emergency. I finally consented to an INT, in which they set up the access but don't actually run an IV through it, thinking of an acquaintance whose wife had recently died because of a freak hemorrhage at the birth of their baby. By doing this, I managed to reassure both doctor and nurse that I wasn't completely "unreasonable." But of course for the next several hours they kept offering to hydrate me via that access. I'd wave my cup of newly refilled ice chips at them--not acknowledging that I'd drunk the last cup's melted leavings before refilling it--and say no.

At 2 pm, I still was at 3 cm, but the baby had at least engaged and now was at -1 station, and my cervix was continuing to melt away. The doctor assured me that the dose of Pitocin she wanted to give me would be the smallest dose possible, and that really, all I needed was "a whiff" to get my labor going. She also admitted that she wasn't accustomed to reactions like mine, that she was accustomed to a certain process. "Look," I said, fighting the urge to remind her that I was her patient, not a process, "I'm not trying to be difficult. But a natural childbirth means a lot to me, and everything we do that disrupts that interferes with my ability to bring forth this child and bond with him." That was my third refusal.

My labor pains were only noticeable when I was standing up, and it was still so bleah that I was beginning to doubt myself. I'd been refusing cervical checks by the nurse, because--as they had pointed out to me--the risk of infection does go up once the water's broken. I confided in Dean that I was scared they were going to accuse me of failing to progress. I'd watch the monitor and despair every time the baby's heart rate seemed to go below the "normal" range. "If I could just get to 5 cm," I told him. But by 6 pm--the next time the doctor came--I was only at 4 cm and 80 percent effaced, and the baby was still at -1. Again she wanted to Pit me; again I turned her down, insisting that if I could get to 5 cm, I'd be fine, and to "just give me a few more hours, please?" I was practically whimpering at this point.

At 7, the nurse shift changed, and in walked my guardian angel, Lisa. The previous nurse introduced her as "our best natural childbirth nurse," and Lisa took one look at me--by this point looking badly worn down by the repeated pitocin badgering--and said, "Well, the first thing we gotta do is get you out of that bed and onto the ball." I got up, went to the bathroom, and when I came out, she had an exercise ball in her hands. "I talked to the doctor," she said. "There will be no more talk of Pitocin. Now I want you to sit on this ball and every time you feel a contraction, start bouncing. We'll get that baby down."

At first, it felt silly, but not only was this a more active way of getting labor going (and I wish someone had told me to do this at noon), but it also allowed Dean to be more active with me. He pulled up a stool behind me and held me steady while I bounced, and rubbed my back between the contractions. Suddenly, the contractions strengthened noticeably, and for the first time, I needed to concentrate to stay with them. Not yet ready for breathing, I chanted a mantra as I bounced, "Baby down, Mama open." Dean started saying it with me, and suddenly the energy in the room changed. It was 7:45 when she came back with the doctor to check me. The doctor's eyes widened.

I'd hit 5 cm/90, she could feel the baby's head, and my contractions had doubled in strength.

What a difference it makes to have a supportive environment! THANK YOU LISA!

So then...

Onward to part 3...

Jesse's birth story, part 1

These things are always done in parts, it seems, but there's something about recounting the story in as much detail as I can remember. I didn't really record anything about my first son's birth, and really regret it.

When I found out I was pregnant, I could not remember exactly which day my last menstrual cycle had started. I knew it was either Feb. 3 or 4, which meant my due date was either Nov. 10 or 11. I went with the 10th, but the doctors went with the 11th. It didn't much matter to me because I was anticipating an early baby. But, of course, Nov. 10 came and went and still no sign of little JHM.

But on the morning of the 11th, I woke up at about 6 a.m. to find a small puddle under me. I woke my husband and asked him if he thought that was my amniotic water, and he said yes, definitely. But I didn't necessarily agree--I got up and went to the bathroom, and it was a decidedly longer pee than I usually had that late in pregnancy, so I thought my bladder had leaked. I went back to bed and dozed until the alarm went off an hour later.

This time, when I sat up to get out of bed, I felt the gush.

Now, I was already between 2-3 cm. dilated, soft but not effaced. It's not unusual for 2d time moms to dilate first and then efface, but since I wasn't feeling any strong contractions, I decided to hold off on rushing to the hospital. More anxiety-provoking for me was the fact that my midwife's normal day off was Wednesday. I kicked myself for not asking her what to do if my water broke and I wasn't in active labor and she wasn't on call or available. Of all the scenarios, that was not what I pictured: in my family, typically, active labor commences with the water breaking.

First, I got elder son off to school, letting him know that I would not be here when he got home. I waited for the office to open and called; got Scottie the nurse, and she told me to go to the hospital. I asked her about the OB on call--she was new to the practice, and not only had I not met her, I didn't know anything about her. Scottie reassured me. I was still daunted, wishing hard that my midwife would somehow pick up on the psychic resonance of the numerologically auspicious date, but we slowly got everything together and headed to the hospital. Oddly, they had trouble confirming that my water had broken because I couldn't seem to produce another gush for them. I was still 3 cm, and only 50 percent effaced. Part of me wishes that I had just turned round and gone home, because it didn't take long for me to realize I'd just consigned myself to a medical labor and delivery, and I would have to fight tooth and nail to get the natural childbirth I wanted.

It started around 11, when the L&D nurse assigned to me wanted to start an IV because the doctor had _already_ ordered Pitocin for me, as well as nothing by mouth other than ice chips. She had never met me, remember? I refused the IV and the Pitocin and said that the doctor would need to come in and explain to me why there was a medical indication for this intervention. The nurse seemed daunted, and at that point I knew she wouldn't be an ally. She expressed concern about my tiny veins and the difficulty she would have starting an IV if there were an emergency. I insisted I needed to talk to the doctor first, and set about walking around the labor ward to try and get contractions going.

By 12:30 I had a good labor pattern going, even though I wasn't really feeling the contractions any stronger than I had during false labor. They were definitely every 2-3 minutes, though, so I expected there to be some progress. The doctor came in and checked me, and I was still 3 cm, now 70 percent effaced. She again said she'd like to start Pitocin, arguing that since my water had broken there was a chance the baby would go into distress and she'd like him to arrive "during the day while there were still plenty of people here." I think my eyebrows shot off my face. I explained to her that I didn't agree that Pitocin would get him here faster because sending me into hard labor too early might trigger what I call intervention cascade, in which Pitocin contractions are so hard and violent that even the most pain-tolerant mothers beg for relief, usually in the form of an epidural; then, once the epidural is in place, the mother is no longer able to work with the contractions, creating a stressful environment for mother and baby.

She stared at me. "My priority is delivering a healthy baby," she said, implying that my belief in intervention-free natural childbirth stood in the way of this. "My baby _is_ healthy," I replied, gritting my teeth. She and the nurse combed through the print-out of the monitor, looking for evidence that the baby was in distress. "Look, the heart rate dropped here," she said. "He turned away from the monitor," I said. She was quiet. "Yes, you're right, it's only a partial reading, but if it drops again, I _will_ put you on Pitocin."

Then began the fight over the IV, again.

At some break between all this, I wrote on my midwife's Facebook wall: "Missing you right now."

Onward to part 2...

Week 40: Right on time!

I was given two different due dates during my early pregnancy. The first, given by my GP, was Nov. 10. But the midwife's nurse gave me Nov. 11, and I thought the different so marginal that I just went with the first one I got.

But the baby decided that the midwife's nurse was correct, and chose yesterday to arrive. It also happened to be a day that said midwife was not available, but what are the odds that a baby will show up on its due date? (Considerably higher, I guess, when you go with two due dates.)

Please welcome Jesse Heath Mosher to the world. Birth story to come.

Week 39: Imminence

On Thursday, my checkup revealed that I was nearly 3 cm dilated; my midwife was confident that I'd go into labor that evening. In fact, I kind of did; similar to my episode of Oct. 26, I wound up with regular, painful contractions every 7 minutes. But as 9 p.m. loomed, I became anxious: at midnight, birthday politics would kick in. My husband's daughter's birthday, over which she claims exclusive domain, is Nov. 6.

But I needn't have worried; by 1 a.m. things had calmed down enough that I went to sleep. I've had about a dozen contractions a day since then, but was ok with that, too. This feels like it should be the week. Since I've been kinda couch-ridden for most of these days, D. took me out to his parents' place for a change of scenery yesterday; we experimented with bumpy roads and spicy venison chili, but nothing happened.

Today has been mostly quiet, aside from a few contractions this morning. I have to admit I'm a little disappointed, because 11/9 happens to feel like a good day, and it was so beautiful out. I finished up a little freelance work, got out for a walk in the afternoon, and wound up just feeling exhausted, which has been the main theme of the past four days. After picking up Elder Son from school, I conked out on the couch for a couple of hours. To hell with nesting, which I have the desire to do but none of the energy--but again, that's more fodder for why the baby should have come on Thursday, because last Wednesday I was a whirlwind in the house.

I've dropped several pounds over the course of this week, however, and I'm noticing the water retention--a brief phenomenon for me this pregnancy--is abating.

Right now, I'm thinking tomorrow or Thursday. Wednesday would be an interesting day for him to show up too--numerologically, 11-11-2009 is a 33 day, plus it's Veteran's Day--but every time I show signs of labor on days when my midwife isn't available (and Wednesdays are one of them) I find myself highly anxious about anyone trying to "manage" my labor.

And that brings me to my feelings on induction. I'm carrying a big baby and I know it; big babies run in the family. But they can get rather lethargic about showing up, and often need prompting in the form of stripped membranes or broken water once the cervix is ripe, which mine is. I consider these physical interventions, and for some reason, I don't have a problem with physical interventions the way I do with chemical ones such as Cervadil or Pitocin, or surgical ones such as C-sections done when they don't need to be. I also know that in our family, once the water breaks, the labor moves *very* quickly, particularly in subsequent babies. It's nice to have my mother's recollection of her sisters' and younger brother's births as well as her birth stories of me and my brother, as well as my aunt's tales of her two big boys, in knowing how my body works and it giving me strength and faith to know what I will most likely experience having my second: that chances are, it will be as gentle a birth as I had with my first.

That faith goes a long way toward actually looking forward to childbirth and embracing the pain that comes with it.