May
16th
The
baby is 6 days past its due date. I am feeling icky and waterlogged (I’d been
retaining water in increasing amounts for about three weeks) but wanted to get
out and do something, so my mom and I went to the Magritte exhibition at the
San Francisco Museum of Modern Art. After an hour of walking around, I noticed
that my hands were so swollen and full of water I could barely make a fist. I
sat through lunch with one or both hands up in the air so the water could drain
out. And I felt like I had a headache, and just felt odd. We decided to call
the advice nurse at the ob/gyn’s office, and she suggested that I come in to be
monitored, because I might be showing early signs of preeclampsia (a
circulatory problem).
So
we went to the hospital, to the maternity floor, and I got hooked up to a fetal
heart monitor, and a monitor for contractions. My blood pressure was elevated
somewhat, but after a couple of hours of monitoring, the staff decided in
consultation with the midwife on duty that I was okay to go home. I had an
appointment for similar monitoring the next day anyway, and the midwife (Tekoa
King) suggested that we arrive at the hospital with the stuff I’d need to have
the baby the next day.
May
17th
More
monitoring, this time in the ob/gyn’s office. Similar situation to yesterday,
and after about 2 hours, Tekoa King decided, with my agreement, that it was
time to get the show on the road. I wasn’t showing major, absolutely definitive
signs of preeclampsia, but the situation wasn’t likely to improve and the baby
was a week late.
So
Kevin, my mom and I walked across the street and presented ourselves at the
maternity floor. We were given our choice of rooms and picked a lovely corner
one with a view of downtown and of Mt. Sutro, which the bed in which I was
eventually to spend a lot of time faced. I appreciated that as we live just on
the other side of Mt. Sutro.
>>May 17th
>>1:05pm – medication to open cervix
>>We’re in the hospital. Marge is with us. They’ve begun inducing labor, albeit slowly. They’ve given Jill misoprostil, which is a very small tablet placed on the cervix. It causes the cervix to soften. Currently Jill is about 50% effaced and one centimeter dilated. This medication should help the effacement and dilation. Sometimes it causes actual labor to begin. If not, they will administer pitocin to induce full on labor.
>>We have about 2 ½ hours to go before they administer more misoprostil.
At this point, no pain at all. We hung out, I was hooked up to the monitors, and it was very low-key. Had some lunch (#44 and rice rolls from Mihn Tri).
>>Brian – anesthesiologist
>>Chris – RN
>>Amy – RN
>>Erica Weiss – Resident
>>Ann Chuang – Resident Administered misoprostil
>>Tekoa King – Mid-wife on-call
>>The view from the delivery room is great. The bed faces the woods. It’s a corner room so the other windows look out over the city.
>>2:40 contraction
>>2:54:50 contraction 25 secs
>>3:12:20 50 secs
>>3:15pm. So they just put an IV into Jill’s arm.
Actually,
Amy, one of the nurses, put two in, one first in my right arm, which was a
misfire for reasons I don’t recall, and then one in my left, which was to be
there over two days later, as it turned out. It was quite a contraption, with
multiple tubes and lots of tape. But it wasn’t hooked up to anything yet.
For a while, Mom, Kevin and I played a card game, Wizard, until my contractions started to get worse, and, simultaneously, I got too stupid to play well.
>>4:02:20 25 secs
>>4:27:15 30 secs
>>5:13 30 secs
>>mioprostil administered at 5:10
>>Lenora – RN
>>5:18:20 30 secs
>>5:25:50 50 secs
>>5:35:40 45 secs
>>5:42:00 20 secs
>>5:47:30 15 secs
>>5:49 45 secs
>>5:55
>>6:00
>>6:07
>>6:22
>>6:25
>>6:35
>>7:05
>>7:08
>>Jill stomachache
By
this time, I was uncomfortable. I was feeling most of the contractions in my
back, and the only way I was comfortable was to lean way over, so I spent a lot
of time kneeling on the sticky plastic couch and leaning on my elbows on the
windowsill. I stopped feeling like a dork when it really started hurting,
somewhere around 5:30 I think.
Our
friends Nick and Kim arrived at some point in the late afternoon / early
evening. They went out to get sushi – I thought I could eat some miso and some
cucumber rolls, though by the time the food showed up, I really couldn’t. Too
bad, as it was the last time I’d have an opportunity to eat for a long time.
I
need to find a better way to say this somehow: for now, this is where I want to
commend
and thank and express my gratitude for my friend Nick, who is a primary care
doctor
at SF General. He agreed to help with my labor, and made arrangements for
coverage
for himself at work and home (he has 3 kids under age 7) and was there
every
step of the way, helping us understand what was happening. He was the best
labor
help I could imagine, and I am so grateful to him.
Mom
and I tried to take a walk around the maternity floor. I recall not making it
very far.
>>Vicki – RN night shift
>>Carolyn Manning – Ob-Gyn
>>Anna – Nurse
>>Dr. Jacoby came in at 9:40. Since Jill is experiencing regular contractions (more frequently than one every eight minutes) they are not going to give her any more misoprostil at this time.
At this point, I still felt really uncomfortable. Nick showed me some ways I could stand and sit that would help, but I just felt too uncomfortable to try anything new.
>>9:58 - shower
I’d always heard that a shower or bath could help bad contractions. Maybe it does, but in this case, a shower really didn’t help a whole lot. Kevin tried to hold the handheld showerhead over where it hurt most on my back, but it really didn’t help all that much.
>>10:15
>>10:18
>>10:20
>>10:22
>>10:25
>>10:27
>>10:30
>>10:33
>>On the monitor since 11:20 – intense contractions
>>Fentanyl administered 11:50pm 100 mg
This is when I decided that it was just too much, and I needed something to not feel the pain of the contractions as intensely, and so I could find some way to get some rest. I got Fentanyl, which is a narcotic that’s put into the IV that had been hooked up earlier that afternoon. From the first moment I got it, I decided that the drug needed to be renamed My Friend Fentanyl. It didn’t make me stop feeling the contractions and the backache, but it did make it possible to lie down and relax. It was good because not only was I able to get a little sleep, but Nick and Kevin and Mom were able to get some rest, too. Due to the lateness of the hour and the drug, everything for the next few hours was a bit hazy and the night actually went by pretty quickly for me.
>>2:02 Fentanyl 100 mg
>>4:45 Fentanyl 100 mg
>>4:52 Jill Thinks her water broke
Yes,
my water broke! It was quite something – I was lying in bed and felt a little
trickle and stood up and whoosh! A flood. I had no idea how MUCH there was going
to be! And it just kept coming for ten or fifteen minutes. Though it made a
mess, it was actually fun, because it was one of the few thing in this induced
labor that felt somewhat normal.
>>5:55 1 ½ cm dilated 1 cm long
This was disappointing to hear. I felt like my body was doing so much and that’s all there was to show for it? The doctor (I think it was still Dr. Jacoby) decided that this was a good time to start the pitocin to get the contractions going more and increase the strength of the contractions, which would help my cervix continue to dilate.
>>6:00am approx. Fentanyl 100 mg and 2 units of pitocin
>>7:26am Fentanyl 100 mg
>>Amy Rabon – Morning RN
Amy
was an incredibly great nurse – really calm and fun and very prepared for
anything. She helped immensely through what was going to be an unusual day.
>>Orestes O’Brien – Anesthesiologist
>>7:45 Epidural tap in spine
I decided to get the epidural because at this point, I’d been in labor that hurt for 17 hours, and I knew I still had a long way to go. Getting the epidural wasn’t bad – the thing I felt the most was the injection of local anesthetic. I had to hold still, and it was somewhat difficult as my instinct was to move, but I think I did okay. As it happened, the anesthesiologist had to do the epidural twice (just like getting the IV twice the day before) – I believe it hit a blood vessel the first time, so I was more prepared the second time he did it. It was NOT scary at all.
>>8:20 approx. Started epidural
>>Baby’s heart rate decelerated temporarily.
>>8:40 They’ve been having trouble monitoring the baby’s heart rate.
>>Erica put a clip on the baby and they’re getting much better readings. The cervix dilated 3 cm.
>>They’ve turned the pitocin off at 8:45.
>>Victoria Mancussoman – Chief Resident
>>Amnio infusion to remove meconium from amnio fluid and help circulation through placenta in process
>>9:30 Catheter for bladder going in
>>9:40 Turbuline lasts for 30 min. inhibits contractions to allow baby to rest
This
was a weird, scary hour. The epidural caused my blood pressure to drop, which
in turn caused the baby’s heart rate to drop. In order to better monitor the
baby, Erica (one of the residents) put a little monitor attached with a wire
onto the baby’s scalp. I didn’t like this as I knew it screwed into the poor
baby’s head. But I also knew that it (apparently) wouldn’t hurt the baby, and
at this point, I knew they needed to know what was happening with the baby to
make sure that s/he wasn’t in distress.
The
doctors realized that when my blood pressure fell, the baby let some meconium
(fetal poop) go in my uterus. This is bad, potentially – it’s sticky and the
baby might inhale it and, if so, it can adhere to the baby’s lungs and cause
respiratory problems. So they put a uterus flushing device in to try to keep
the amniotic fluid that remained somewhat clear.
The baby continued to have a decelerated heart rate, enough so that an hour after they’d turned off the pitocin, they gave me an injection of turbuline, which brought the contractions to a full halt. It also felt like a quadruple espresso – it made me very jittery. I figured it was as close as I was going to get to a cup of coffee that morning, so hey, it did have that one benefit. Mostly, though, I hated it and was really upset that things seemed to be going to wrong and that the baby might be in trouble.
>>three days recovery in hospital
>>six weeks less 10lbs
This was when the doctors started talking about the possibility of needing a Caesarian section. I signed a consent form in case they needed to do an emergency c-section, but we also talked about continuing to try to go for a regular delivery.
>>10:55 Dr. Cummings. Baby looking better: gotten rest
>>10:30 Jill’s feeling a little jittery because of turbuline
>>10:32 Victoria advised that they can take a blood sample from the baby’s scalp – if the ph is normal we can proceed with vaginal delivery
>>10:40 Dr. Robertson. Check-in status check. Baby looks like its recovered from contractions
>>11:30 Dr. Robertson ordered start of pitocin. Starting at 1ml
>>12:00 Increased pitocin. Baby doing fine. Contractions; not so many.
>>12:25 Dr. Robertson. Baby doing OK. Contractions regular; can increase pain meds slowly
>>12:33 Pitocin increased to 3ml
>>12:45 pain medication increased .6 to .8 mg PC bivivocain (like lidocain) and fentinol
>>Jeffrey – Resident anesthesiologist
>>1:00 Pitocin increased to 4mU
>>1:30 Pitocin increased to 5mU
So
for several hours, things seemed to be going really well, which was awesome! I
couldn’t move myself very well, but it didn’t matter to me at the time. The
only frustrating thing was that I was lying on my left side, which meant that
my right ear was facing up (I have pretty bad hearing loss in that ear) so it
was difficult to know what people were saying. But overall, this was a good,
optimistic couple of hours. I was really hungry, but was told that I couldn’t
eat or drink – I was on the all ice chips all the time diet. What a drag. At this
point, my mom and Kevin and Golda and Nick went to have lunch, and I remember
asking that they eat out of the room I was in so I wouldn’t have to smell any
food and get yet hungrier.
>>So the baby seems to be doing much better. There are no more dramatic dips like the ones Sparky had after the epidural. Then the heart rate dropped dramatically. They were moving Jill from side to side. They turned the pitocin off pretty quickly. Erica put monitoring equipment inside the uterus. Finally they gave Jill medication to stop the contractions. After about 45 minutes or an hour they started administering pitocin.
Thing
resumed an out of control, scary feeling like earlier in the day. I remember
hoping that they wouldn’t have to give me more turbuline, which they didn’t.
Mostly I remember being really scared for the baby – I didn’t know what the
effect of her/his heart deceleration would be. Nick and the UCSF doctors kept
saying that it would be okay, but it was really frightening. I tried to focus
on staying optimistic and being as cooperative as possible to minimize any
problems.
At
this point, also, I was very loaded down with medical stuff. There was:
-
the
IV
- the epidural
- a catheter for my bladder required for the epidural (ick – didn’t hurt but no fun)
- the wire for the baby’s head monitor
- the internal monitor to measure my contractions
- and the meconium-begone uterus flushing device
Because of the epidural, I couldn’t actually feel most of this stuff very well, but it was uncomfortable.
>>1:55 Jill’s feeling gaseous
I was told this was part of the labor, but it felt odd. Because my upper stomach hurt, the epidural didn’t help.
>>1:58 Amy went to get anesthesiologist to give Jill more pain medication. Jill’s feeling pain.
>>2:00 pitocin increased to 6mU
>>2:20 doubling epivocain 1/8 concentration. Fentinol 100 mg
>>Orestes O-Brien – Anesthesiologist
>>3:22 Erica exam 5cm dilated and 90% effaced meconium
We were told that this was good – that if I could make it past 5cm, I’d likely dilate the rest of the way within 5 hours.
>>3:30 Turned off pitocin. Heart rate dropped (2 minute “Brady cardia”)
Here we went AGAIN. I was tired and feeling a little beaten down, and remained really worried about the baby. Apparently, I’d had a “double contraction” – don’t know what that is, but it made the baby go into distress again.
>>3:55 Pitocin on
Since
the beginning of the day, I’d remained nearly totally on my left side, and
perhaps because of that, I started to feel a lot of pain in my right shoulder
and neck. I didn’t know why, but associated it with lying in that position with
no ability to shift my weight around. It started out bad, and got worse quickly
– soon, it was the only thing I felt and the only thing I could focus on. After
a while, I started to cry, and I really felt for the first time during all of
this (well over 24 hours at this point) that I wasn’t going to be able to do
it. At one point, my back hurt so much that I thought I was going to have a
heart attack.
The
back and neck pain created a really funny moment, though – I was trying to
communicate to Kevin that I wanted to turn in a certain direction, and he
interpreted this as a request for him to turn around. So suddenly he was
turning his back to me, doing a very nice pirouette for no reason that was
apparent to me at all. I was near tears and asked him why on earth he was
turning his back to me and, almost in tears himself, he said, you asked me to
turn around! I don’t think I laughed at the time but I was able to note,
somewhere way back in my brain, that it was pretty funny.
Everyone who was with me – my mom, Kim, Nick and Kevin, came to my rescue by massaging my shoulders and neck nonstop for a couple of hours. It was the only thing that made the pain somewhat bearable. If they stopped for a moment, I would start to panic. I can’t say that the upper back pain was worse than labor pain would have been, but it’s easily the worst sustained pain I have ever felt.
>>8:25 Pitocin off. Weighing pros/cons of c-section.
And
for the fourth time, they turned the pitocin off because the baby wasn’t doing
well. Everything was really bad for me for several hours, but when Dr. Gates,
the attending doctor at that time, let us know that we could try once more with
the pitocin, but that we should also think about opting for a c-section, I was
able to access some logical part of my brain, and Kevin, my mom, Nick and I had
a fairly rational discussion about it.
It
was tempting to try to hope for a miracle that would allow the baby to be born
vaginally. But we didn’t want the baby to keep on going through cycles of
distress, and I wondered if I’d be able to deal with several more hours of
labor on top of the 32 hours I’d already been at it. Nick suggested that we
should think positively about the c-section, and that helped. Dr. Gates
mentioned that she’d had 2 kids, one each way, that that recovery was similar
for each. Kevin suggested that they check me once more to see if I’d dilated
further, and if I hadn’t, we should go for the c-section. I liked that idea,
and as it turned out, I hadn’t made any further progress (after all that
time!). So it became really clear that the best thing to do for the baby was to
have her or him come to us via a c-section.
It
took about 20 minutes to decide, then we waited a bit for the medical team to
get ready, and then they took me to the operating room, which was very close
by. Only Kevin was allowed to join me, and he went off to put on surgical
clothes. I remember still feeling horrible pain in my back and neck, and the
anesthesiologist promised to give me some of My Friend Fentanyl to help me
relax a little. I was also shaking tremendously, which I was told was a side
effect of the epidural (as it turns out, the back and neck pain was also a side
effect of the epidural – I was told this by another anesthesiologist the next
day, but don’t yet fully understand why).
I
could see very little during the operation, which was, of course, just as well;
my view was restricted to the ceiling above me and to the curtain they’d put up
in front of me. I didn’t know if Kevin could see over the curtain but I asked
him not to look – I didn’t want him to have to carry around the image of me cut
open and taken apart. I wasn’t well aware of the passing of time but it seemed
to be about 25 minutes before the baby was out. Kevin just talked to me the
whole time – I can’t recall what he said but I can recall being so grateful
that he was there. I didn’t feel scared but just wanted the baby out and wanted
to know that the baby was okay.
When
they pulled the baby out, we didn’t get any info at all – we heard a little
crying but not much. Some of the doctors and nurses took the baby over to the
corner of the room, and we didn’t hear anything except for some strange little
cries for a couple of minutes. Kevin asked, finally, “Is it a boy or a girl?”
and we were told that the baby was a boy. Wow! We were really sure we were
going to have a girl. One of the doctors also told us that he had huge feet (he
still does!). But they also told us that I couldn’t hold him because he had
fluid in his lungs and needed to go to the intensive care nursery for a while
to be observed to be sure he was okay.
This
was really sad for me because I wanted so much to touch the baby. I probably
already was crying, but I remember crying much more as I was so overwhelmed and
worried about him. They did let me see the baby, all bundled up, and then they
ran out with him. Kevin followed, and Kevin stayed by the baby, touching him
and being his welcome into the world, for the next hour and a half or so while
he was monitored and warmed up and observed.
They
put me back together, and I think I just cried the whole time, except for when
I threw up. After about 30 or 45 minutes, they brought me to a recovery room
and I got to see my mom, but couldn’t see the baby yet. I think I had more
emotional recovery to do at that point than physical recovery.
I
did calm down, and got reports that the baby was doing well, and finally Kevin
brought Elias to me, which was so exciting! Elias was very calm, and was
wearing a weird blue hat that he’d been given in the nursery – we called it the
Rasta Hat. I held him and looked at him, and then gave him an opportunity to
nurse, which he did right away! I was overjoyed. He took to nursing like a pro
immediately. And I knew that everything would be okay, and it has been more
than okay. Elias is a terrific, wonderful, completely healthy, calm, happy,
sweet baby, and the first weeks of being a mom have been so much more fun and
joyous than I could ever have expected.
>>It’s 2:45 am. Elias Abraham has been born. We decided to have the c-section.
So
that’s is the story of how Elias got here. I didn’t have time or space yet to
say how grateful I am to Kevin, my mom Marge, my friends Nick and Kim and my
mother in law Golda, all of whom were indescribably wonderful and supportive. I
love all of them, and couldn’t have done it without them. I hope to find the
words to describe how much they helped and how grateful I am in a future draft
of this. But for now, I’m going to leave it here. After 32 hours of labor, here
ends the tale of 8 pound 2 ounce Elias Abraham Davidson Eberman’s birth at UCSF
in San Francisco on Thursday, May 18, 2000 at 9:44pm.