Faking It

Many of you already know this, but for those who the news has not reached, Joshua Lucas Scarpelli was born on May 31 at 4:52pm. He measured 21 inches and 8 pounds, 9 ounces. He is a healthy baby, other than UV light treatment to break up some jaundice in him, which is a pretty common thing for newborns.

Our stay at the hospital lasted from Sunday May 30th at about 3pm to 5pm on June 3.

This is the first part of a three-part post discussing the Good, the Bad and the Ugly related to Joshua’s arrival. There simply isn’t much to say about the Good, other than to share it. We have a baby and he is healthy and wonderful. I’ve found that we grew adept as new parents remarkably fast. We are only seven days into his little life and we already know his cues and are plotting out his routine and care. We are fast on diaper changes, a mean breastfeeding team and can soothe him from a tantrum to silence in about 30 seconds flat (when he is of a mind to be soothed).

The Good, however, isn’t something I need to educate you on. You’ll know the good. You’ll feel it radiate through you once you’ve hit your stride. You’ll simply walk around feeling a sense of accomplishment that is rare. It’s something that is rarer for me than it should be. I don’t sit back much and think to myself what good work I’ve done, but I find myself doing it all the time with Joshua and the care we’re providing him.

What I do want to educate everyone on are the many niggling little items that none of the books I’ve read about having a baby seem to cover, or the things that they play up so much that you think that if you’re handling it differently, you’re handling it incorrectly.

The biggest learning tool in the Good category for us has to do with our flexibility. In another way of looking at it, this could very easily be considered Bad or even Ugly, but I think it showed that we know how to flow with the course of the birth, which is exactly what so many of our friends had advised us to do. We went in, as you well know if you’ve been reading along over time, wanting to do a fully natural childbirth. We took Bradley method classes to get us to that point and read books on the practice and did exercises at home, the whole nine yards. Bradley was effective for us while we could use it, too, but we couldn’t use it very long.

Janelle had a “non-textbook” labor process. The notion of textbook labor is a bit asinine and I should have probably realized that more, but that’s what Bradley really prepares you for. This is not to say that the Bradley lessons would never have helped us. In fact, they probably enabled Janelle to fight through her labor as long as she had. We just were not able to do much beyond cracking a tiny bit of the toolchest available to us from our Bradley learning.

Prior to heading into the hospital on May 30, Janelle had dilated to 3cm (in case you’re not a medical or pregnancy buff – the cervix needs to dilate to 10cm before the doctor’s consider the mother’s body ready to deliver the baby) all on its own, without her really being aware of the work her body was doing. Then, the next thing we knew, her water broke at about 2:15pm on May 30th, about a week before his due date. We went in to the hospital, and they let us know that we were going to be there until we had the baby.

Right away, our expectations were off. The Bradley training tries to get you to labor as much as you can away from the hospital so that you can labor in the manner of your choosing… but after your water breaks, chance of infection in mother and child end up increasing more over time. Doctors want the baby out, or for significant progress to have been made, within 24 hours to keep risk minimal. So, before our labor process had really even started in earnest, we already could not follow some of what we had spent months prepping for.

But the hits kept on coming. Janelle began to feel her contractions around 5pm. So, after she was gowned up, we would walk loops around the delivery ward, stopping every few minutes so that Janelle could lower herself to the ground in a squatting position to alleviate the discomfort. Things were going along just like the labor that had been described to us would go. Janelle would be able to walk like this and allow her labor to progress in relative speed and comfort. We were handling it as we had been taught and things were looking good.

By 7pm, she could barely move, and she stayed that way until 9am the next morning. Rather than being able to move and adjust her position to increase her comfort, her discomfort was so intense it prevented almost any and all movement for her. She ended up sitting in a rocking chair, or propped on the hospital bed with her eyes closed, trying to focus on being relaxed as I ceaselessly massaged the round ligaments at the front of each of her hips (I mean ceaselessly, I massaged that area for about 12 straight hours without more than a few seconds pause). For her, labor pains manifested themselves as a strong urge to push… but you are explicitly told you cannot push until the time is right, when you have dilated to 10cm. So, for 14 hours, Janelle fought this urge and it rendered her inert and unable to call upon any of the preparation we had done for labor.

The final straw came at 9am on May 31. Through our sleepless night, Janelle had been progressing at a rate of 1cm of dilation for every two hours of labor. When we checked at 9am on the 31st to see her progress, she had stalled entirely. No change. That far along in labor, with the 24-hour infection care time limit approaching and Janelle having reached the limit of her endurance, we opted to get her an epidural.

An epidural, not something I covered much in the blog to date, means that we had to give up on the plan of natural childbirth. An epidural involves insertion of a plastic tube into the base of the spinal cord. Via this tube, anesthetic is delivered and sensation to the nerves at the base of the spine is numbed, reducing pain for the mother by about 80%, so they estimate. The decision to move away from natural childbirth was a tough one. It came at the end of 27 hours without sleep, most of which involved considerable discomfort for Janelle. She was barely in any shape to make decisions, and I was faced with the traumatic task of either telling her that she needed to continue to suffer, or give up on the dream birth that we had envisioned.

Suffice it to say, this was a bit of a tipping point for my breakdown. I spent a good two hours that morning trying not to just be a sobbing mess on the floor. It was much harder than I had anticipated to watch Janelle suffering as long as she was, to listen to her tell me that she didn’t know if she could carry on and how intensely uncomfortable she was and then to tell her she just had to be strong and let it all happen.

We opted for the epidural knowing that a birth that was filled with this much discomfort and anguish wasn’t the kind of birth we wanted, principles be damned. Also, and more critically, we knew that getting Janelle’s body to relax would mean our chance of avoiding a C-section and having a healthy baby would increase. After it was administered (far easier than expected… but the discomfort of getting a NEEDLE IN YOUR SPINE didn’t really phase Janelle at all, which is not surprising considering what she had already been putting up with) we were both able to sleep. We both promptly passed out (I have no actual memory of falling asleep, I just remember waking up again) and rose three hours later. Soon after that, Janelle was ready to begin pushing and we commenced.

She pushed for almost the entire three-hour maximum the hospital will allow before they intervene. It’s not good for a baby to be trapped in Mom’s pelvis for too long as she tries to push him out. With each contraction, he’s getting compressed pretty well, so if those contractions aren’t moving him downward, they’re just kind of a hassle for him. For new mothers with an epidural, they allow three hours for pushing, instead of the two to two-and-a-half they allot for all other mothers. After the end of that timeframe, if the baby has not arrived, they will suggest either a vacuum-assisted delivery (literally, they use a suction cup to help pull your baby out as Mom pushes him out) or a C-section if the baby can’t be reached for vacuum assist.

For the first 90 minutes that Janelle was pushing, Joshua didn’t move in the slightest. This is where the problem with the epidural comes into play. It numbs so much sensation below the waist that it was very difficult for Janelle to locate the specific muscle group she needed to be focused on in order to be pushing Joshua out. Thankfully, before the pushing began, we directed the staff to cut the medicine rate being delivered via her epidural in half, specifically so she would regain feeling. After that first 90 minutes, she began to be able to feel the proper location to push and it was fairly quick work after that.

90 minutes later and I could see Joshua’s head began to ease his way out of his Mom. I hadn’t been expecting that I would want to watch that happen, as there is much ickiness that occurs, but once I could begin to see his head, I couldn’t really stop from watching. Partially, it was nice to be able to give Janelle very honest encouragement about how close Joshua was to being born, but it was just fascinating to see the scale of things.

Baby heads are really malleable and so when they are being pushed out of their mother, you are bound to get a bit of a conehead effect for them. But what the net effect of this is for the observer is that it makes the head appear FAR smaller than it actually is as it is emerging, because all you’re seeing is the round little top of the head, being pushed out and sqooshed out as the vanguard. When Janelle gave the final push that popped the entirety of Joshua’s head out, my reaction was pretty close to a “Holy shit!”

And that was that. The nurses immediately hoisted him to Janelle’s chest where they toweled him off and suctioned fluid from his mouth and nose and then he began to wail in earnest, always a good sign and something encouraged for the first few hours to help expel fluid and other gunk from the lungs. We both just looked on in awe for a bit, listening to him cry and trying to memorize his little features (almost pointless since brand new babies can sometimes look very little like couple day old babies which can look very little like year-old babies).

We tried to have him nurse right away, with minimal success (more on this in another post), and ended up needing to give him about 20mL of formula right away as his blood sugar was very low. Babies of diabetic mothers come out with a higher insulin count than most babies, and as such tend to have low sugar numbers. Joshua was around 49 right after birth, and their cutoff for “too low” is 45. An hour after birth he was at 39, and it was time to get nourishment into him quickly and any way we could. He downed the 20mL of food with a speed that I now understand was pretty staggering. The bottle was bone dry in under a minute flat.

We have a hungry little boy.