Thursday, March 22, 2007

The Perilous Journey

By 5 p.m. Tuesday, Savannah is very frustrated with her apparent lack of progress on the labor and has gone with no sleep for almost two days.

While she continues to have contractions, they aren’t hitting on the classic ‘three to five minute-apart’ schedule that indicates true active labor and the entrance to the home stretch, as it were.

We call the mid-wife and discuss options. She tells us to come up to OHSU for another inspection to see where we stand. Savannah is not feeling hopeful.

“Pack the stuff (three small bags and camera gear) but leave it in the car when we get there since we’ll probably be coming right back home, “ she says sullenly.

Our travel through 5:30 p.m. freeway traffic to OHSU is uneventful and at full legal speed. But we are not in any hurry. Savvy has some contractions in the car but nothing spectacular.

Once at the hospital, Savannah is again inspected and cries when she hears the news: still 95% effaced, but now she is told she is 5 to 6 centimeters dilated! It seems our luck has turned at last. I go back to the car and get the bags, and get the room set up for the second time. We call Taunia, our doula, and Angela. Both soon arrive.

Savannah is put on monitors and we watch the baby’s heart beat steadily at around 150 beats per minute, which is normal. The display also shows Savannah is having contractions, good ones, about every four minutes, like clockwork. Things seemed to be going well. About three hours pass by in this state.

At about 8:15 p.m., the room is crowded with an OB/GYN, another nurse doing prep work, a new midwife, Tina, another nurse, Sarah, myself, Angela, Taunia and what seems like three other new people, all commiserating about this and that and possible medical issues. I am feeling some stress over the number of people in the small room, but all are professionals and doing a job or talking to Savannah about something important.

Savannah’s monitor shows that she has had three contractions about a minute apart. It seems that we are finally turning another corner to get Liam moving closer to birth.

Suddenly, there is a pause.

A few seconds later, the hospital staff members explode into action, pulling wires out of the wall that were connected to Savannah’s bed, activating a small, laptop-styled ultrasound unit and talking quickly into phones and other devices, using terms like “stat,” “immediately” and “prep for surgery.”

Tina, our calm-voiced, almost elfin midwife, looks me dead in the face and says: “This is a serious emergency.”

Savannah is whisked out of the room on her rolling hospital bed and sped down the hall to an operatory. Nurses and doctors who had just been in the room planning labor in a tub and a natural birth are jumping into scrubs, putting on surgical masks and donning those purple nitrile gloves.

Another nurse I had never seen before enters the room and asks me if I have any questions. Well, yeah, where do I start?

Angela, who had just gone down the hall to get me a cup of water, walks back in the room, eyes wide, and asks me what in the world is going on. I have no answer.

A nurse takes me down a hallway from the birthing room to an empty room outside the operatory. Inside the operatory, staff members are plugging all manner of wires and tubes into Savannah, and beeping monitors surround her. Two male doctors (so far, we had only met females) are busy working on Savannah.

Tina, our midwife, finally appears, dressed in full scrubs.

“We are preparing to do an emergency C-section,” she says quickly. “The baby should be out in a few minutes. His heart rate had fallen to 60 back in the room, and we have to get him out if it does not come back up.”

She hands me a set of scrubs, including a hair net and booties. Then she goes back into the room where personnel continued to swirl around Savannah.

Another nurse appears. She tells me that if they put Savannah under using general anesthetic, I won’t be able to go into the operatory to support her. But if she gets an epidural, I will be allowed in. I put on my scrubs as fast as possible.

I get the scrubs on (hey, they fit pretty good, I remember thinking…), and wait a few minutes. Tina emerges from the operatory. The baby’s heart rate has risen to a safe level, so they are rethinking the C-section.

I wait some more, and take a self-timer photo of myself in scrubs. It turns out ridiculous.

Tina returns. She says Savannah is going to get an epidural, but the C-section is now on hold. Additionally, a small electrode will be attached to Liam’s head in-utero so they can precisely monitor his heart rate. Another internal sensor will closely monitor Savannah’s contractions. I am allowed into the operatory.

About ten people surround Savannah, but I am given a small stool to sit on near where her head is on the operating table. Trying to sit on the stool in the awkward scrubs, I promptly send it skidding into some medical equipment. “My bad” I say sheepishly as I recover the stool. Nothing appears to be broken.

Savannah is one her side and two men are working diligently to insert her epidural lines. Their demeanor suggests they are doing some sort of spinal surgery. One man is doing the insertion, while the other one looks over his shoulder. Both seem highly capable.

The guy doing the work on her back is an anesthesiology intern, and the guy overseeing the work is “Professor and Chair” of the OHSU anesthesiology department. I think we are in good hands for the epidural.

Savannah smiles at me. “Crazy, huh?” she says. I can tell in the tone of those two words that she sees the natural birth plan slipping away. I hold her hand while the activity continues. Not once does she cry.

Savannah is not nervous. She is calm, and is quickly and lucidly answering questions and responding to requests to move this way and that. Tubes seem to run from everywhere. She has a catheter (those suck AND hurt), two IV lines, an oxygen mask, blood pressure cuff, two pulse monitors and sensors taped all over the place, not to mention the epidural work going on.

Finally, the epidural is in. We have been in the operatory for what seems like three hours, but it has been about 45 minutes. There is much discussion among the staff about the next move.

Finally, a decision is made. Liam’s heart rate is back up and stable. No C-section will be done at this time. Savannah will be sent to a new room close to the operatory. The drug-free water labor option is a scratch. The top knock-out doc prides himself on his epidurals, and he isn’t kidding. After the drugs are administered, Savannah fears her body will go numb. But quite the opposite happens.

The pros at OHSU have set up the epidural levels very light so that Savannah can labor normally without much pain, but she is not numb to everything. She can easily feel the contractions coming and going. A small machine on a post regulates the dosage, with a button on a tether available to Savannah to jack it up at her discretion. She tells me to make the button go away.

The medical team also think her internal “bag of water” holding Liam is posing a hazard. Liam is floating above the cervix, and the water sac is pressing down, the opposite of what should be happening. If the water should suddenly break (which is normal), Liam’s umbilical cord could prolapse, or fall into the space under his head, and an immediate C-section would be required. A nurse pierces the bag with a tiny incision and slowly drains it. Liam’s body sinks down into the proper position. A small success. Savannah is transferred to a rolling bed and wheeled from the operatory.

Back in the room, Savannah is wired for sound, and Liam is clicking away at 150 beats per minute again, except after contractions, when he drops down to just above 100. The staff does not like this. The spectre of a C-section again appears. Tina does not seem optimistic for a natural birth.

While Savannah worked and prepared mightily for a natural birth, especially during two days of painful and sleepless labor, it suddenly appears that it is not going to happen. While that is disappointing, we both know the ultimate goal is a safe delivery for Liam, and what must be done is what must be done for his safety.

Tina brings in Kathleen, an optimistic and experienced OB/GYN. She checks over Savannah as well, including an internal exam. She has long, slender fingers. Some people are born for their jobs, I think to myself.

Kathleen says Liam’s head is acyncyclic (spelling?), meaning that instead of being lined up to drop through her birth canal, it is nodding to one side. Not good. The C-section looks ever more likely.

But Kathleen wants to try something. She does…. something. She fixes Liam’s head with those long fingers, and suddenly we seem to be back on track. Heart rate? Strong and steady. Position? Ready to move. Savannah? Holding on to hope.

Kathleen makes a suggestion. Why not try to push? Just one time, she says, to see what happens.

Savannah takes a deep breath, locks it in and pushes. Liam moves down.

Over the course of an hour, Kathleen and Tina work with Savannah with more pushing. Taunia continues to give support. Savannah changes positions a few times. I try to encourage her but I don’t think she can hear a thing I’m saying, she is not mentally in the room. With each contraction, she pushes hard four times. They are instinctual, primal and powerful movements for Savannah. Liam moves down a little more each time she pushes.

Then the top of his head appears in the gap.

I put on some surgical gloves and move down to the make the catch. Moments later, Liam’s misshapen head (a normal thing called “moulding”) pops through, and a push later he drops into my hands. He immediately cries loudly, and I hand him to Savannah. He lands on her chest, and his little hand finds her lower lip. Liam Joseph Roberson is born at 2:15 a.m., March 21, 2007, the first day of Spring, six hours after the Equinox.

There are lots of tears and hugs in the room. Liam is remarkably clean and in the pink, not the bloodied alien creature some newborns are. He only cries for a moment, then is quiet. He finds a nipple a few minutes later with no problem. My parents arrive for a short hello visit and some photos. It is nice of them to come in at 3 a.m. to support Savannah and myself.

After snuggling with mom and dad for a while, it’s time to move from the birthing room to a suite. There is a small bunk for dad, and I barely fit in it, but after this ordeal, I could sleep on rocks with no problem.

Before any rest for me (the new daddy), there is the first bath, checkup, footprints and myriad checks, probes, and a few injections to take care of. Liam tips the scales at 7 pounds, 6.6 ounces and when stretched out, is 20.5 inches long. He cries during his bath (preserved on video for future embarrassment), but zonks out afterwards when placed on the heated baby holder. Where can I buy some heat lamps?

At close to 5 a.m., we are all in the new room and I can finally rack out on my little bunk. Liam and Savannah get some quiet time together at last.

Two hours later, we are back up again to change poopy diapers, attempt feeding and comfort the little guy. Thirty-six hours later, Savannah walks through the door of our little home in Portland and Liam takes his first nap (a LONG one) in the big bed. Ella, our faithful dog, is a bit confused by all the fuss.

This will be our life for a little while. Thanks for coming along on our journey.

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