Friday, May 20, 2011

Papa's Perspective, part 2 (I want to see)

Zora arching (and throwing gang signs)
I want to see
Peach, now Zora Gloria Lockman, presented face-first.  Without the back of her head pressing on Melissa's cervix, Melissa simply could not dilate enough for a vaginal delivery.  As a newborn, she often arches backwards, trying to see ahead and above her, while her amazing, wide blue eyes take it all in.  We like to think that she wanted to come into the world seeing where she was going.

Several years ago, Melissa became trained in a therapeutic modality called Somatic Experiencing.  The idea is fairly simple.  Habits lodge in the nervous system.  The way we cope, and the way we react to trauma, is best understood as a pattern that we maintain right now in our nervous systems - not as events in our history.

This framework has made a lot of sense to us in understanding our beloved, eccentric, and otherwise incomprehensible Teacup, a dog who needs soothing and swaddling.  Now, that same framework makes sense in understanding Zora.  Here's what I mean:

Zora's go-to position is arching backwards and looking above and behind her.  Sometimes she goes to this position when she is calm.  When I rock her (and sing Baba Hanuman - now easily into the hundreds of times), she often arches her head backwards and looks straight up at me with those bright blue eyes, eyebrows straining to open her eyes as wide as possible.  When we put her on her stomach at 6 days old, she was able to lift her head and turn it to either side - quite unusual for a newborn.
Perhaps she thinks she's a dog?

Arching is also her go-to position when she is upset.  She pushes away and arches her head and chest backwards.  (Somehow, I think this means we're in for it when she's a teenager.)

Understanding this somatically, it is hard to believe that she just learned these behaviors after she was born.  It seems more likely that she's been learning to arch for a while in utero - the pattern maintained in her nervous system in response to stimulus or stress.

So for us, it makes sense that Zora Gloria Lockman was born via cesarean birth.  The doctors that we talked to engaged in (what seemed like fairly unfounded) speculation about whether Melissa's fibroid (that was not even on her uterus) or the large amount of amniotic fluid kept Zora floating and prevented her from tucking her chin and engaging the back of her head.  While those things may well have an effect, no one could provide us any evidence that this was the case for Zora or that those factors generally prevent chin tucking.

More importantly for the way that I see the world (I don't want to speak for Melissa), that model turns Zora into a passive object tossed about by the peculiarities of Melissa's internal organs.  (Incidentally, the docs framed several other aspects of pregnancy - turning head down, dropping into the pelvis - as events about which we could only be passive even though there is empirical evidence that pregnant mamas can affect those things.)  Of course Zora was affected by Melissa's internal organs, but Zora was also becoming a separate organism.  She was organized separately from Melissa.  Late stage fetuses hear sounds, recognize voices, open their eyes, and respond to movements.  And part of the way Zora's nervous system organized was to arch.

Which brings me back to one of the first ways that I can understand my daughter.  Permit me some poetic license here; I don't actually think that she had conscious intention about her birth process.  Still, it makes for a nice story to help me make meaning about who my daughter is: Zora wanted to come into the world seeing where she was going.

Sunday, May 15, 2011

Papa's perspective, part 1 (Grit and Grace)

Melissa's high school track and cross-country coach gave her an award for "Grit and Grace."  That combination of traits made her a champion runner.  Those same traits saw her through a grueling three-day labor with unusual double- and triple-peaked contractions, and eventually ending in a cesarean birth.


Quick primer on dilation: 10 cm = time for mama to push baby out; 5 cm often means active labor; women can walk around a few centimeters dilated for a week or two before going into labor.  Melissa was 2 cm dilated at her check up a few days before starting labor.

First day and sleepless night:
Melissa thought that her water broke on Thursday (5/5) morning.  She became crampy, and had her first identifiable contractions around 1 pm.  Because we thought the water broke, we assumed we were on the clock for the birth (there is a concern of infection when labor takes too long after water breaking).  Melissa labored into the evening and night.  We went to the hospital at 4 am when her contractions were roughly 5 min apart (though still somewhat uneven).  Her water had not broken; in fact, there was so much amniotic fluid that Peach was floating too high and not engaged into Melissa's pelvis.  Melissa was 4 cm dilated.

Second day and (mostly) sleepless night:
Melissa has always been sensitive to people and emotions around her.  During her labor, this manifested by her body shutting down contractions when there was bad news or when medical personnel were not terribly sensitive.  So, around noon on Friday, when Melissa discovered that she was still only 4 cm dilated, her contractions stopped.  The hospital gave us the choice, and we decided to go home to continue her labor.  The doctors prescribed sleep medication, so Melissa got a couple of 30-45 minute stints of sleep in the afternoon.  At night, she had one blessed 4 hour stretch with no contractions; otherwise, they came every 15-20 min (making sleep difficult).  Melissa also couldn't eat (perhaps 12 crackers in 24 hours) because she was vomiting during some contractions.

Third day and sleepless night:
On Saturday, we returned to the hospital per instructions for tests to ensure that Peach was tolerating the contractions.  Lo and behold, Melissa was 7 cm dilated at 11 am, so the hospital told us to stay.  Melissa's water still hadn't broken, and the doctors refused to break it (concern that the baby was too high, so the cord could come down first).  They wanted to give her Pitocin to stimulate stronger contractions, but she refused this intervention.  Then came the killer contractions...

Melissa earned her appellation, Grit and Grace, in these hours.  Though we don't like the term, her contractions were "dysfunctional," probably as a result of so much fluid distending her uterus.  She had double and triple-peaked contractions, often lasting 4+ minutes.  There was generally no break between these monster contractions.  (Normal is 60-90 sec contractions w/ as much break in between).  Melissa was at her edge and could have broken down.  She didn't.  Melissa put her head down and made these low-pitched growls and roars, sounds I have never heard from her before.  We would call and repeat: I can do this; every contraction ends; opening; relax what you can; and occasionally, fuck Pitocin.

At 10 pm on Saturday, Melissa was still only 7-8 cm dilated.  Melissa was terribly discouraged and somewhat delirious from two nights of no sleep (on top of the marginal sleep for the last month of pregnancy) and no food.  Again, her body just shut down the contractions for a couple of hours.  The doctors still refused to break the water, and urged Pitocin.  Melissa agreed.  They kept upping the dose, but Melissa said that the Pitocin-induced contractions were mild in comparison with what she had been through.  It was hard to see how this would dilate her enough to deliver Peach.

Then, around 1 am, after 60 hours of grueling natural labor, Melissa was done.  I was concerned because her heart rate was riding very high, even between contractions.  We asked the doctor if she could get sleep medication to rest (or just try to rest naturally).  The doctor refused, reasoning that her labor needed to be progressing.  Thus, her choices were becoming increasingly steered by exhaustion and the yay or nay of the doctors.  The only option for getting some relief and rest was an epidural; at this point, Melissa heartily agreed.  She knew, and her support team knew, that she had reached the end of her extraordinary natural labor.

Interestingly, before the epidural was in, the doctor broke Melissa's water, without asking for her consent.  (More on this in another post.)  The contractions began coming hard and fast - and with regularity.  Alas, Melissa was into her third night of no sleep after many hard hours of contractions.  These were too much.  After a number of strong contractions, naturally induced by the broken water,  the epidural took effect.  It was 2:30 am.

At 5:30 am, I awoke to the doctors talking with Melissa.  Despite three hours of contractions - spurred by the water breaking and additional Pitocin, Melissa was still only 8 cm dilated.  Peach was presenting face first, and without the back of her head pushing on Melissa's cervix, it simply would not dilate.  The doctor tried to move Peach to get the back of her head to come down.  It may have been during this procedure (or perhaps something else - a little foggy here) that Peach's heart rate dropped.  We moved Melissa to her other side, then back to the first side, then hands and knees.  Peach's heart rate was still down.

Thus came the step at which medical teams excel: fast emergency procedures to save the baby (and mom).  They wheeled her down the hall to do a "splash and crash" - an emergency cesarean birth with the goal of 4 minutes from decision to baby out.  They said that I could come to the operation if things were settled.  They never called me.  I just stared down the hallway, wondering if our daughter would make it, if my wife would be okay.

Peach emerged from Melissa's belly at 5:51 am.  She was just fine, if a little bruised and scraped from being face first into Melissa's cervix.  She was under a warmer and crying when I came in to see her (Melissa was still being closed up).  I put my face to her forehead and sang, "You shall come out with joy," a song we sang to her in utero.  She stopped crying and looked around with those wide blue eyes - and hooked her Papa for good.  Melissa, you did it!  You birthed a wonderful baby girl, and there is nothing passive about this birth story!