Sunday, August 15, 2010

Enlarged by One

First, I'll admit it. I was not super excited about a baby in the house. And no way was I instantly falling in love with a crying (even if it were smiling) baby. But it happened. Like bam. Instant. World changing. Lightening striking. Ground shaking. Heart breaking. She is mine, and I am hers, and there's something perfect and natural, yet not exactly as planned and completely magical about the moment it happened.

But before she ever met me she had to make her way out of her mother's womb. That journey started in earnest around Sunday night (Sunday the 8th of August) when Robyn began having contractions. They were relatively mild and inconsistent so we weren't freaking out yet but we knew the time was drawing near when we'd be heading to the hospital. They would especially fall off during the day but come on strong in the night so that Robyn slept little Monday night and almost none at all Tuesday night. Luckily she fit a nap in Tuesday afternoon to prepare her for the hard work that lay ahead. There were plans to induce on Friday if the baby was still cooking but Robyn really really really wanted a natural child birth void of pain killing drugs and knew that it was much harder to achieve this goal if pitocin was used to increase the strength of contractions so she decided to be proactive. She tried some acupuncture, we went on some long walks and finally on Wednesday morning we went to the doctor and had her "membranes swept" which like many of the other things we had tried didn't guarantee anything but sounded better than what pitocin offered come Friday. But the contractions almost instantly got stronger. We went home, stopping for lunch on the way (which we ended early because Robyn was having some good healthy contractions that I think were freaking out some of the other customers). At home we put our hospital preparation plan in motion. Putting last minute items into the over night bag, making sure everything on the checklist was packed, and then waited for the contractions to get even stronger.

Robyn labored at home for six hours. We tried various relaxing techniques: calm music, hot bath, some guided breathing. Robyn had been told earlier at the doctors that she was a little dehydrated so I was being a slave driver and making her drink lots of water. She hates drinking water and told me she was going to throw up, but I didn't believe her, I thought she was just being a bad patient. But alas, she threw up, and then I felt bad, and did a better job of following her lead the rest of the way. After a while we invited our friend Liesel (an angel and a saint in so many ways) over to be support through the rest of the process. I instantly felt more at ease with the third person there, someone who has successfully delivered two children of her own no less, so she wasn't going into this thing completely blind. Like I said there was about 6 hours of labor at home, the second half of which Liesel was there for. Robyn was very concerned about going to the hospital too early and the thought of driving there early and getting declined admittance allowed her to have the strength to labor pretty long and hard at home. Liesel and I finally talked her into going to the hospital, so I called to make sure they were expecting us and we headed over.

I'm sure the car ride over seemed twice as long to me as it really was and probably twice as long to Robyn as it did to me. Almost every corner had another car that needed the right away or a pedestrian strolling at leisurely speeds and more bumps than we'd ever been aware of before. I talked the whole way there, just describing to Robyn what I was seeing and how the obstacles were slowly being conquered. Liesel followed along behind us.

We arrived at the hospital. Robyn was examined and determined to be at 4 centimeters. They admitted her and gave us a spectacular room with two walls completely made of glass overlooking downtown and part of a foggy forest. We didn't realize how nice the view was right away though as it was now 7pm and fairly dark and foggy. Robyn was given a little IV jack and then the nurses and doctors mostly left us alone to labor however we saw fit. For three hours she laid in bed, took another hot bath, walked the halls of the hospital while Liesel, Robyn's mom Lynn (who arrived shortly after we got to the hospital) and I gave her gentle but firm support, reminding her to breath, and that the pain, while unpleasant, was a necessary, natural and useful part of the labor and birth process. Unfortunately for Robyn she was throwing up everything she tried to drink so she remained dehydrated through most of the early labor in the hospital. After three or four hours Dr. Jones (yes that's really his name, and yes we loved having him at the birth, along with pretty much every other doctor and nurse we interacted with at UCSF) came around and examined Robyn again. She was at 5 centimeters and 90% effaced. Robyn was pretty disappointed with this information, and almost cried, she had that defeated look, I could see it coming, but she pulled herself back together, relaxed and the doctor explained that often times the first 5 is the longest and the next 5 can go by really fast (relatively).

Robyn redoubled her efforts and she labored on for three more hours. The contractions were coming stronger, we were all tired but felt like we were again making good progress. Liesel, in her wisdom, also recognized Robyn's disappointment with only reaching 5 centimeters and suggested to me, out of Robyn's hearing, that we tell the doctor not to tell Robyn how far along she was next time, instead he could tell me and I would decide if it was news that would help or hinder her. So I talked to him before he came to do the exam and he agreed not to say how far along she was unless she had made significant progress. He did the exam and then sort of sat silently (everyone in the room, even Robyn somehow) knowing what it meant. He called me outside and let me know that she was only at 5.5 and gone back to 70% effaced. I knew this information was going to break Robyn's heart and determination. On top of this bad news, the doctor thought that at this point it would be a really good idea to try some pitocin as Robyn's current contractions weren't pushing things along at all. She was already exhausted, she couldn't go on like this for another 10 hours, and possibly have very little progress, and then be expected to push out the baby.

So back into the room I went and told Robyn, it was one of the hardest things I've ever had to say to her, but there was no way around it. So I told her what the doctor said and she was indeed disappointed. She really didn't want to augment the contractions but she also knew she couldn't keep going as she had been. So she consented to pitocin, which she knew also meant consenting to pain killers. The doctor came in and explained that even with pitocin it would probably still be another five hours before she reached a full ten centimeters. She said, "I can't do it Shawn, I can't go that long." I convinced her to try a couple of the more powerful contractions to see if she could handle it and she did try, but it was too much at this point, she was too tired and the labor had already gone on longer than I think we had all envisioned. She convinced me she wanted some drugs, so we started with Fentanyl (a narcotic) to battle the pain and an IV to fight the dehydration. The pain was lessened for about two minutes but as the pitocin kept coming on the contractions became stronger and stronger. The Fentanyl was mostly useless. Her water broke with these new stronger contractions and meconium was found in it so we were told the pediatricians would be on hand when the baby was born to make sure her lungs were cleared. This meant that the baby would not be put directly on Robyn after the birth. This was another blow to the birth we had envisioned and it weighed heavily on our hearts. After about an hour of these new more intense pains Robyn said she needed an epidural. I knew this was the thing she wanted least of all from the on set so I made her tell me twice, which she did without hesitation and so I told the nurse about her request and the process began. Unfortunately the process was not fast, and on top of that the baby was showing some signs of distress due to Robyn not getting enough oxygen. The head doctor came in and put her on oxygen and said the baby's heartbeat needed to be more regular before Robyn could get the epidural. They suspected the oxygen would fix that and it did fairly quickly, but at the same time the doctor who would be administering the epidural had to go over all the benefits and side effects of it before having Robyn sign off on it. It was sort of ridiculous in the moment as Robyn was in unbearable pain, laying on her side, nearly fetal, with an oxygen mask on her face. The doctor would list a side effect then have to pause as Robyn went into a contraction. But finally it was finished, the tools were brought in, and the procedure began. For an epidural they basically put a needle in your spine and drip some fluids into your spinal cord to deaden your nerves from your uterus down. And with such a delicate operation you are of course suppose to sit very very still, which is a thing that is not easy to do when you're going through the final powerful drug induced contractions. They had Robyn sit on the edge of the bed and lean over a table. I grabbed her hands and tried to talk her through it. As a contraction came on she tried to bite my finger. I had to pull away quick or I'm sure there would have been some stitches involved. It took about two contractions for the procedure to be finished then another few for it to actually take affect. And then, like magic, the pain was gone.

The doctor checked her cervix again and she was at 9.5 centimeters and 100% effaced. She had for the most part gone from 0-9.5 centimeters drug free and with some very powerful pitocin induced contractions. We were all so very proud of her and how long she fought the good fight. I knew she was probably disappointed that the labor didn't go as planned but at that moment the lack of pain I think made up for that disappointment. It was now 7am August the 12th. The doctors thought Robyn should rest before starting the final push, and she still had .5 centimeters to go so they told her to sleep for three hours and they would be back to start the final step.

At this point the whole mood of the delivery changed. What was in the beginning a very tense, stressful, painful process, one in which I had a very specific planned out role of supporter and comforter, became much more calm and pain free. Robyn smiled, even laughed, and I felt a little lost in what my new role in the process would be. I even had time to go move the car before our meter started running at 9am. When I got back I went to sleep for two hours as did Robyn. I think Liesel and Lynn both stayed awake; one could't have asked for better angels and guardians.

I awoke to the sound of doctors talking. It was about 10 am. They wanted to check her again soon. I called Jason, and asked him to come up as I wanted him around. They checked Robyn a few minutes later and she was ready, 100% effaced and 10 centimeters.

We were privileged to deliver our baby on a weekday afternoon when UCSF has midwives at the delivers. Our delivery was overseen by Midwife Judith Bishop and first year resident Doctor Long assisted her. I think Judith was perfect for Robyn and her desires and made the process, that hadn't gone as planned so far, feel a bit more natural and intimate than one might expect from an M.D. directed procedure.

The midwife helped Robyn through three hours of directed pushing. She tried a few different positions and finally settled in on a "birthing stool", which Robyn really loved. At the end of those three hours, Judith directed Robyn to stop pushing and the readjusted her so that she was sitting on the bed, we could see our baby's little head crowning. The doctors turned around to prepare for delivery, putting on new gloves, getting the required tools in place, when Robyn said, "uhh I think she's coming out." And she did, quick as lighting and everyone in the room jumped for the baby and Judith caught her just as her head popped out and quickly twisted her shoulders in place and pulled her out. It was amazingly fast and probably left everyone in the room's heart racing. I cried, Robyn cried, I laughed, Robyn laughed, we cried, we laughed. I cut the cord, the pediatricians checked her out (under my watchful eye), wiped her off and let me carry her over to Robyn's waiting arms. I wish I had a picture of that look on her face at that moment. When my memories fade as I get older it's going to be one of the memories I try to hold onto the hardest and I will be saddest about when that clear, brilliant picture of love and joy slips from my mind. Robyn's uterus was bleeding a little more than the doctors wanted so there was some "minor" work that still needed to be done that unfortunately caused Robyn some pain during the first few minutes we got to spend together with our baby but won't matter in the long run. There she was our baby, later to be named Berkeley Lynn Kessler, alive and born at 1:21pm August 12th, 2010, weighing in at 6lbs 3oz and 20 inches long. Our family, enlarged by one, but infinitely bigger.

In the end Robyn was pleased with the whole experience. She loved the support and comfort she received during the first painful phase and also loved being able to be completely present for the second phase thanks to the epidural.

That night in the recovery room, I closed my eyes and all I could hear was the baby's heart monitor that was hooked up during delivery. At other times I'd hear little noises that reminded me of the sounds Robyn made while in deep labor pains. I realized that she'd probably make the same noises if she were seriously hurt or tortured, that in some ways I never wanted to hear that sound again. And somehow the baby's heart monitor was linked to it. I worried I'd live the rest of my life with those two sounds floating in the recesses of my brain. I closed my eyes to sleep and instead I cried. I cried a husband and a father's cry: full of love, full of fear, full of worry, full of pride and back again to full of love. I eventually succumbed to exhaustion and in the morning whatever powers are out there in the universe did me a favor and swept those sounds from my mind, so much so that even now when I try to imagine them I can't conjure a clear memory of them in my ear.

Thank you to everyone who helped us through this and everyone who has been so excited for us. Especially thank you to Liesel and Lynn for all their support, no way we could have made it through without you two. And thank you to Jason, who probably doesn't feel like he did much, but just knowing his strong arms were nearby meant the world to me. And thank you to Robyn, for creating the most wonderful little life I've ever seen and for loving me.

Saturday, August 7, 2010