Dressed by Noon

Because I'm a labor & delivery nurse, does that mean I'm supposed to know what I'm doing with my own baby?

Wednesday, August 27, 2008

My Birth Story

I guess it's time for me to cough up the deets about my own birth experience. It's probably good for me to write it all out before I forget the details...

I was ready to give birth from about 36 weeks on. I generally loved being pregnant, except for those last few weeks. I remember laying in bed at about 39 weeks and referring to rolling over as "coming about". But I worked until a week before my due date -- 12 hour shifts on my feet -- and generally tried to keep busy. By 40 weeks I was totally over it and was pretty disappointed to see my due date come and go with no baby. By then I'd tried every trick in the book -- spicy food, sex, Dr. Christopher's PN6 herbs. I even baked a batch of "jump start your labor cookies" -- all to no avail.

At my midwife appointment on my due date (a Tuesday), she told me that if I hadn't gone into labor by Saturday I should come to her office and she'd try to stretch my cervix a bit. So Saturday came and, sure enough, no baby. I walked to her office and she told me I was 1 cm dilated. She said if I hadn't had the baby by our next appointment on Tuesday, she'd get a bit more aggressive with the cervix stretching, but till then I just had to wait it out.

That night at about 11:30, I lay in bed reading when I felt a weird gurgle & a trickle. I did a gravity defying horizontal exit from our bed, took two steps into the bathroom and knew that I was leaking amniotic fluid. It was only a little bit of fluid and it was clear, but it was unmistakeably amniotic fluid.

So I called my midwife. She asked me if I had any castor oil in my house and when I said no, she said she'd put some in her mailbox if Mr. Stewgler wanted to walk down and fetch it. We hatched a plan -- I was to set my alarm for 5 AM. If I hadn't started contracting by then I was to make a cocktail out of castor oil, OJ, vanilla ice cream & a shot of vodka (not kidding) and then go back to sleep. The idea with the castor oil is that it gets your bowels in an uproar and the peristaltic contractions of your bowels sometimes gets uterine contractions going. The OJ & the ice cream are to mask the taste and texture of the castor oil. The vodka was supposed to chill me out (yes, my midwife is one of the raddest people on the planet).

So we went to sleep. Actually we laid in the dark for a while listening to our hearts pound and then we went to sleep. I didn't need my 5 o'clock alarm.

By five AM, I was contracting regularly -- every five minutes or so. I got out the laptop and started timing them with contractionmaster.com. By 5:30 I'd woken up Mr. Stewgler & called my parents to tell them it was on. My mom planned to be in the delivery room with us so she packed her bag and headed for Brooklyn.

And so it went. I walked around the apartment, sat on the exercise ball, and breathed through my contractions. Even without the castor oil, my bowels were in an uproar. I spent the better part of the morning walking back and forth to the bathroom. At some point I called the midwife back to tell her I was in labor. She said she'd come over when ever I wanted her to and suggested that I try a shower and a nap.

My contraction pattern was kind of funny. I'd have runs of intense contractions -- where each one was a little worse than the last, capped off by a total monster which would leave me barfing my brains out. But then I'd get a little break -- they'd space out and get a little less intense. My labor happened in waves.

By early afternoon I was getting pretty uncomfortable. Mr. Stewgler insisted that I call the midwife -- she answered the phone saying that she was just putting on her coat to come see me whether I wanted her or not. She arrived and listened to the baby with her doppler for about 20 minutes. She then suggested that I try taking a bath.

Mr. Stewgler filled the tub & when I got in I instantly hated it. Our tub was too shallow and the sides were too steep and I just couldn't get comfortable.

Of course, I also couldn't turn off my brain. Mr Stewgler tried to make me a bath pillow out of a towel -- I worried that it was our last clean towel & that my mom wouldn't have a towel to use. As much as they tried to get me to focus on the task at hand. I was much more interested in playing the hostess. Was the midwife hungry? Had she tried the jump start your labor cookies? What were they planning to order for lunch?

I think I got in and out of the tub twice. I just couldn't decide what I wanted. I remember saying, "Oh God, I'm one of those laboring women."

At some point I asked the midwife when she'd check me to see how dilated I was. She replied that because my membranes were ruptured she didn't really want to check me until I felt the urge to push. Because we were still at our house, I was kind of disappointed by this news. I had hoped to head to the hospital somewhere around 6 or 7 cm's -- late enough in my labor that I'd spend most of it at home but early enough that I wouldn't be trying to walk three blocks to the hospital in the dreaded transition stage of labor. So I asked her to check me, even though she didn't want to, just so we'd know where we were in the process. She declared that I was 5-6 cm's. Woo-hoo. I seem to remember that my mom and I high-fived and then we started getting ready to head to the hospital.

Getting to the hospital was a feat in and of itself. We live three blocks from the hospital so we weren't about to drive there, but in that moment three blocks seemed like a long way to go. I made it down our five flights of stairs with no contractions, but I had three contractions (one per block) en route. My mom took photos of each contraction and they're hilarious. Even without the photos I think I will forever remember those spots. When I walk down the street I can't help but feel a special fealty with the fence and mailbox and bench that I hung on -- my special connection with Hicks St.

At the hospital, we walked straight into the labor room. My midwife gave me the option to have an IV or not. Knowing that I hadn't kept anything down all day I opted for some IV fluid. I even offered to let a nursing student or orientee start my IV since I have great veins, no needle phobia & a BIG karma debt to repay. They put me on the fetal monitor for about 30 minutes and, of course, I watched it like a hawk. I explained the whole thing to Mr. Stewgler while my mom & the midwife talked about knitting.

By the time my 30 minute monitoring strip was finished, the jacuzzi tub was filled and I was so excited to get in. That tub was the greatest thing EVER. I had two jets on my lower back and it felt totally awesome.

I just re-read the last few paragraphs and I feel like I need to mention that I was indeed having MAJOR contractions every 3-4 minutes. The great thing about contractions is that when they're over, they're over and you really feel fine. So, sure, one minute I was huffing and puffing my way through a contraction, but the next I was talking about fabric or Japanese food. As my midwife says, "That's the beauty of labor."

OK, so I'm in the tub for about 20 minutes when I start bearing down involuntarily. I seriously couldn't stop myself. At this point I've been at the hospital for less than an hour. So they haul me out of the tub (in this hospital you can labor in the tub, but you can't deliver in it) and my midwife checks me again... 9.5 cm's! Awesome. I was totally psyched to have progressed so quickly.

The only problem was that I felt like pushing but I wasn't fully dilated. My midwife declared that if I needed to push then she needed to reduce my cervical lip. Translation, she needed to push the little ring of remaining cervix up over the baby's head while I pushed (because cervical tears are nothing nice). Let me tell you folks, this hurt like crazy. Mind searing pain.

I think it was around this time that I asked for an epidural. I knew, in my head and my heart, that I didn't really want one, but it felt good to ask. My midwife totally ignored my request. Seriously, it was like she was deaf to the word epidural. Hilarious.

Pushing was kind of an out-of-body experience. For the first 45 minutes I was dealing with the cervical reduction. For the next 45 minutes I felt like I wasn't making any progress. For the last half hour I was digging deeper than I'd ever dug before. By the end I was holding my own feet & was fully committed.

The final details are kind of a blur. I guess that's just the way it is -- one second you're pushing and the next you're holding a baby. I remember my midwife telling me to reach down and grab her. I remember her eyes popping open right away. I remember her cord feeling kind of short. I remember that pushing out the placenta was one of the best feelings in the world.

In hindsight, I think it's really interesting that any sort of somatic memory escapes me. In this moment I can't describe or even really remember what it felt like. Do contractions feel like strong menstrual cramps? I have no idea. I remember that it hurt at times and didn't hurt at times and that's the best I can do.

I know this -- giving birth was the most empowering experience of my life. Bar none. Hands down. My mantra at the end of my pregnancy was that childbirth is one of those rare opportunities to really see the stuff of which you're made. I know now that I'm made of will and guts and power. Mountains and mountains of power.

Lapses and Gaps

We here at Stewgler HQ have been all over the place in August. We spent a week in SoCal with the west coast cousins which was totally awesome -- IK's first flights included. Upon our return, I had to work six (12-hour) days straight to make up for the days I missed while in California and IK went to her first session of "Camp Nana" since my work schedule was so nuts.

All is well, but we're still digging out from the mayhem. I'm determined to get back to a more regular posting schedule soon.

To tide you over, I'm posting my birth story which I've been working on for a bit. Enjoy.

Tuesday, August 5, 2008

Seriously

Why would anyone ever make baby food with a hand-cranked food mill when the Cuisinart blender wand is in the world?

Yes Doctor, Do You Take Cream and Sugar?

Since I went back to work, it's been nothing but HUGE babies and c-sections. Honestly, I'm beginning to think that I'm jinxed. Actually, I've been thinking that maybe IK was my good luck charm (she was with me in utero from the first day I worked on L & D).

In eight months on L & D I never had a baby bigger than ten pounds. In the last four shifts, I've seen THREE eleven pounders! After hours of valiant pushing all three mom's ended up in the OR. I'll be the first to admit that in all cases a C-section was indicated, but it's never been more clear to me that some sections are better than others.

Scenario A: Midwife attended delivery. Mom pushed for two+ hours in a variety of positions, after laboring down (meaning that she waited a while to push after she was fully dilated -- this allows the baby to descend using the strength of the contractions rather than having the mom push with the baby in a high station). When it became clear that the mom's pushing wasn't bringing the baby down, the midwife consulted a physician who agreed that a c-section was indicated. The parents were involved in every decision and went into the OR feeling confident that we'd tried EVERYTHING to make a vaginal delivery happen. Though it wasn't the delivery that the parents hoped for, the vibe in the OR was happy and everyone celebrated the arrival of the 11-pounder.

Scenario B: MD attending delivery is covering for the doc who provided all of this patient's prenatal care. He proclaims the patient fully dilated and instructs me to start pushing with her right away while he reads the directions on the Via Cord cord blood collection kit (he'd never seen one before... RED FLAG). So we start pushing though the patient is totally numb from her epidural and has no urge to push and no sense of when she's contracting. We push for an hour and as far as I can tell she's making no progress. At my hospital nurses don't do vaginal exams so I pop out to check in with the MD. He's MIA so I ask the resident on duty to page him, "You mean he's not in there pushing with his patient?" Nope, I say and she rolls her eyes and picks up the phone. He moseys into the patient's room fifteen minutes later, does a dry glove vaginal exam, declares that she's pushing great & disappears again. By the time he comes back, she's been pushing for two hours -- we've tried a few different positions to no avail. He walks in and seeing no baby about to enter the room he announces that it's time to do a c-section. The patient says, "No, I can keep pushing. I don't want a c-section." To which he replies, "The risks of C-section include blood loss, organ damage, infection and death." (I swear those were his exact words). The patient asks for a second opinion.

Long story short, we end up in the OR. By then I'd mopped up the situation to the best of my ability -- tried to soothe her fears, answer her questions and offered my speech about childbirth being great preparation for parenting. So the 11 pounder is born and in the midst of the cord blood collection the MD sticks himself with the needle. He strips off his gown and gloves and goes out to wash his hands. When he returns he asks me to get the patient's chart so he can see the results of her last HIV test.

From that moment on he never stops putting himself first -- he asks the resident a litany of questions over the patient's open abdomen (what are the side effects of AZT?, what are the chances that he'll get hepatitis if she has hepatitis?, etc.). Keep in mind that the patient is hearing all of this. So then he orders me to draw blood on the patient for new HIV & hepatitis tests. I ask if it can wait till we're out of the OR (since I'm supposed to be attending to the newborn AND have to do three more counts to make sure he hasn't left any instruments in the patient while he's busy worrying about himself) and he doesn't answer. So I go about my business until he stops me in the middle of an instrument count to order me to draw her blood for labs NOW. I explain that we're not supposed to stop in the middle of a count and he says he'll walk out of the OR if I don't draw her blood. I should have told him to go, but instead I threw him a look and stopped my count to draw her blood.

Never once did he offer his happy congratulations on the birth of this beautiful child. He never spoke to the patient again except to ask for her consent for an HIV test. The whole thing made me so sad.

My point, I guess, is not to have you pity me for having to follow this a-hole's orders, but rather to warn anyone out there who might not yet have met their OB's covering doctors. Sure, this patient picked the hunky young MD who gives his patients every chance in the book to deliver vaginally and is willing to put the time in to help her push to make it happen. It's not her fault that she had her baby on a Sunday and therefore got the dorky old doc with a self-aggrandizing attitude problem and a penchant for c-sections that allow him to be home for lunch.

Word to the wise. Ask the hard questions about what happens if you have your baby on a weekend or a holiday or during a week when your doc is pool-side in Cabo. And remember, it's probably not too late to switch to a midwife.

Wednesday, July 23, 2008

Wouldn't you like to be a hippie too?

I'll admit that I've always had a bit of a fringe streak. In high school, my skater friends called me "Grateful Kate" (though for the record there's nothing I hate more than jam bands, The Dead included). I never really embraced space dancing or tie dye, but I always tried to live gently and mindfully.

As an adult I've tried to walk the line between our urban reality & our farm fantasies and as a mom I'm trying to mind our family footprint.

Living in NYC there are a few things we have going for us from the start. We have access to awesome public transportation and we use it. Sure the subway can be maddening -- it seems always to be too hot or too cold, too smelly, too crowded & too slow -- but it makes this city work and is often the best/fastest/easiest way to get from point A to point B. I'll admit that I tend to avoid taking the stroller on the subway because it means I'll have to navigate stairs & locked gates, but I'm sure I'll get used to it. So yeah, we drive little & subway much.

We live in a small space. There is no space in our apartment that isn't used and used well. Yes I often long for modern conveniences like a dishwasher, garbage disposal, washer/dryer and would LOVE to have a coat closet, designated parking, a yard or space for a garden, and a second bathroom, but it feels good to live so small. I once had a friend visiting from Cali tell me that he loved my kitchen because it was organized so that everything was in arm's reach. I pointed out that my kitchen was so small that if it wasn't in arm's reach it was in the living room. The point is that I'm proud of how we use our space. We aren't afraid to reorganize so that we're making the most of what little we have.

Brooklyn is the height of neighborhood living. We could live our entire lives within a 15 block radius. Hospital, funeral home, clothing stores, food shops, book stores, five & dime, butcher, bakery -- you name it, we can walk to it. Because of this concentration of commerce, we can live our entire lives on the shoe leather express. Now you know why we splashed out for a fancy stroller. Keeping it in the hood is a great way to keep it green.

In terms of baby stuff we're trying to make green choices. G diapers instead of disposables (LOVE the flushable option -- no diaper stink in our house). Organic formula. We're planning to make as much baby food as we can (hopefully with locally grown organic produce from our CSA). We clean the house with baking soda & white vinegar (though we don't combine the two as that would turn cleaning day into a science fair). We buy organic & local when we can.

I think that's the point of all of this. We do what we can. Yes, we'd love to be canning the products of our garden and living off of its bounty all winter, but we have to come to grips with the fact that we don't have a garden to grow veggies in or a pantry in which to store its fruits. I'm not saying that we give ourselves a pass because we live in the city. I like to think that the benefits of the city and the concessions to city living tend to balance out.

My challenge to everyone is to do what you can. If we all did a little bit to "green up" our lives, the collective benefit would be great. Here are a few suggestions of little ways to make a big difference...

  1. Buy a stainless steel water bottle. Plastic is bad for the environment, but it's also bad for you. Drink your water from the tap (tap water is more tightly regulated than bottled water) out of a reusable metal bottle rather than buying plastic bottles of water.
  2. Replace your Comet with baking soda. You'll be amazed how well baking soda works to scour your sinks & tubs. And it's CHEAP.
  3. Walk more. Don't let me catch you moving your car around within a strip mall parking lot. If I can carry all of my everything up and down five flights of stairs, you can walk from Target to Bed Bath and Beyond.
So put on some Joni Mitchell and think about what you can do to be a little more mindful of your footprint. Remember that when Kermit said, "It ain't easy being green," he wasn't talking about environmental living.

Rainy Day Shopping

I call it the law of inverse reality. The less money I have, the more I shop. I am totally in the hole right now and yet I'm spending IK's nap cruising the internet rather than cleaning the bathroom, running the roomba, putting away the laundry, etc.

Here's what I have my eye on...

  • G Diapers: IK's soon going to outgrow her small sized G's so we need to get some mediums. I keep seeing G diaper banner ads with all sorts of cool colors and prints, but they're not actually for sale on their website. I imagine that maybe they're selling down their current stock (which seems to be dwindling as many of the colors they do have are sold out in certain sizes) in anticipation of launching these new patterns, but come on people don't tease! You know how I feel about delaying gratification.
  • Svan Highchair: Yes, you're right, IK's not eating solid food and she can't sit up yet, but the SVAN is on sale!
  • Ecotobi Envirosax: Now I know I have PLENTY of canvas bags from professional conferences in which to carry my groceries, but damn, these are cute.
  • Some sort of vintage or vintage looking locket that I can put IK's photo in to wear to work (Frau Von Schnellinger... I KNOW I'm a dork so you don't have to tell me).
  • Baby food freezer containers: I'm trying to motivate to make some baby food out of this summer's bounty (AKA our CSA stuff that we can't manage to eat in a week). I have a food mill and a food processor, but I need some sort of container to freeze the food in. I could go low cost and get a couple of extra ice cube trays and a box of freezer bags (freeze the food into cube sized servings & then store the cubes in labeled freezer bags). Or, I could get something like these freeze and serve cups. Maybe I'll start with ice trays.
Ahhh. There's so much great stuff to buy out there on the internet. Guess I'll go pay my AmEx bill to bring myself back to reality. This is the major perk of going back to work. Give me six weeks of paychecks to dig myself out and this internet shopping train will be back on track!

Saturday, July 19, 2008

Reality, crashing

Ever since IK was born, folks have been asking me if I like motherhood. I freaking love it. I mean what's not to love? You get to hang out with a baby who gets more and more interesting every day. You bask in the unconditional love. You spend early mornings snuggling her tiny bod & afternoons drinking iced tea in the park while she snoozes in the stroller. You watch the balance in your checking account dwindle to nothing.

So yeah, motherhood is great. Motherhood on maternity leave is totally awesome. And then there's working motherhood.

The last four months have flown by & it's time for me to go back to work. I'm really excited about it. I think it will be great for IK to spend some more quality time with her dad & I'm looking forward to having something to talk about other than her. OK, OK, so I'm freaking out a bit. I'm mostly nervous that I don't remember my job, but I'm sure it's like riding a bike (she said hopefully).

Which isn't to say that I don't get nauseous every time I think about tomorrow. I feel like the last 3.5 months has been "la-la motherhood" in which I got to spend all day every day with her. Now we're leaving fairy land and entering reality.

Wish me luck! Wish us all luck. I know she'll be fine & will have an awesome day with her dad... I just hope that I don't sob all the way to the subway.