[Deb]

9PM - 3:30AM: Early Labor (6.5 hours) 6.5 hours of labor

I felt my first contraction on May 13th just before 9PM; Leo and I were on the subway (#1 line) heading downtown back to my office so I could take a conference call with three colleagues in our Tokyo office. It felt like a Braxton-Hicks contraction with the additional sensation of a tightening around the base of my spine, as if someone put a c-clamp there and gave it a tightening crank. Prior to heading to the office, I had completed a prenatal yoga class and was feeling strong, eager for labor to start at 40 weeks and 5 days of pregnancy. I felt more contractions over the course of the conference call, but was able to talk through them with effort. I was excited because it looked like I would make it to the Birthing Center, which has a very strict policy of only taking women at or before 40 weeks and 6 days of pregnancy. We took the subway home and I had to stop a few times on the walk back to our apartment to manage the contractions. Leo and I got into a routine in which he would start counting and I would either follow or make open-throat sounds to the beat. We got home and started timing the frequency - between midnight and 1AM they were averaging 3-4 minutes apart, lasting about a minute, and were intense. I needed to focus on Leo to get through them. I labored like this until 3:30 AM and we called the OB practice with the details. They told us to come into the hospital.

3:30 - 7AM: Getting to 5 cm (3.5 hours) 10 hours of labor

We went to the Labor and Delivery unit at St. Luke's Roosevelt and I was hooked up to a monitor to measure the timing and intensity of the contractions and see how the baby's heart rate was tolerating them. My contraction pattern was very stable and the baby's heart rate was terrific, however, I was checked by the OB on call and found to be only 3 cm dilated. She told me to either go home, or go for a walk and come back at 7AM. By then it was 5:30 or so and we decided to stay at the hospital. We lugged our suitcase, car seat and diaper bag to the hospital lobby and Leo went to get some breakfast for us. By now I had been up for about 24 hours and was unhappy to be laboring alone in a hospital lobby. The chairs were uncomfortable, the bathroom left much to be desired, but I was figured it was just for an hour and a half. I could manage. After breakfast (I ate some Triscuits and a few bites of a banana) Leo tried to catch some sleep as I counted down till 7AM.

7AM - 9AM: Second L&D monitoring and walking the halls at the Birthing Center (1.5 hours) 11.5 hours of labor

Back at L&D, I was monitored on the machine again for 20 minutes and checked. I had dilated to 5 cm, but the Birthing Center wanted me to be 6 cm before admitting me. So the OB let Leo and I put our things in the Birthing Center and asked us not to settle in yet, but rather to walk the halls. I remember feeling overwhelming grateful for being allowed on the Birthing Center floor and out of the noisy, beeping L&D and that depressing hospital lobby. The Birthing Center felt like paradise. Soft carpeting, soft lights, near silence. I was able to gather myself and focus on opening with each contraction. I walked, and walked, and walked, sipping ice water at every hallway turn.

9AM - 6PM: The Birthing Center (9 hours). 20.5 hours of labor

I was examined at about 8:30 am and found to be 'about' 6 cm, close enough for us to officially check in. The OB on call broke my water (a bloody, watery mess) after her exam, and left me to labor. My memory of things at this point begins to get hazy. I remember not feeling hungry or thirsty and had to keep reminding myself to drink, though I would only take small sips of water. I focused inwardly on getting through the contractions and lost all sense of time. Progressively I felt more and more zombie-like and listless. I dimly remember my friend Meghann coming into the room, and uttered some greeting. I labored mostly by laying on my side, curled around pillows on the bed, and took two brief spells in the tub. Meghann and Leo tried to get me to drink but I would only take sips of water and occasionally apple juice. I was managing my labor on a minute to minute timescale. The spiritual rallying points of the day were when the OB would come and check my progress, which happened every 2 hours or so. I'm not sure how the math works but it seemed like I was progressing, but it was painfully slow going, perhaps because I was just managing the pain of contractions and not trying to open, open, open. The nurse would come periodically to check the baby's heart or take my temp, and offer up something like 'you are doing a great job.' Moving between contractions took every ounce of strength. I could not walk anymore. I could not even shift positions without Leo or Meghann. Emotionally and psychologically, I remember feeling completely lost. Towards the last few hours of my time in the Birthing Center, my energy drained and drained. I said to Leo "I feel like I'm in the weeds here" and "I need coaching or something," Leo and Meghann tried helping me manage the pain of the contractions, they let the on-call OB do her job checking in on my progress - but no one was managing the labor's ultrastructure or directing the labor strategy. I think the OB figured Leo, as an MD, was directing things, and she probably assumed Meghann was my doula, and so I was in good hands. Leo has never seen a natural labor. Meghann has never seen a natural labor. Leo and Meghann assumed that since the OB was so hands-off, this must be how it goes, as in: laboring woman curls up in a ball in pain for 9 hours, baby ensues.

In my final hour in the Birthing Center, I remember laying in the bed, realizing that I had stopped contracting, but at that point I didn't care. After hours and hours of endless waves of pain and, essentially, isolation, I had totally lost my spirit.

6PM - 9PM: Dr. Rhee Saves My Birth. Part I: Bringing me back to life. (3 hours). 23.5 hours of labor

At 6PM, my OB, Dr. Rhee, relieved the on-call OB and came to check me. After observing me and performing an internal exam, she summoned Leo to the hallway. I remember laying there lost in space, but grateful that perhaps something - anything - would happen now. Dr. Rhee and Leo came back to the room a few minutes later. She got right in my face and laid it out:

Caitlin, you are 8 cm dilated. 8 cm is active labor but your uterus has stopped contracting. Active labor does not just stop; you are massively dehydrated and the baby is in posterior position - not ideal. Listen to me: you need to be much stronger to turn this baby and push him out. We can do things the easy way or the hard way. Option one is we take you upstairs to Labor and Delivery, give you an epidural and an IV to hydrate you and let you rest, and give you some pitocin to start the contractions again get you fully dilated so you can push. Option two is we try to continue this way, but it's going to be incredibly hard..

I remember feeling a tangible wave of gratitude that someone was in charge and had a plan, I also knew what the trailing off part of option two meant: I was headed for a c-section. There was no question. "Let's go with option 1." I was in a wheelchair on on my way within minutes. Despite my hopes and efforts for a natural birth, I was not sad at all about leaving the Birthing Center, which ironically turned out to be an emotional torture chamber. I was immensely grateful for the promise of physical and spiritual renewal, by any means necessary at this point.

The transfer from the soft, dim, silent birthing center to the L&D floor must be some metaphor for the transition from the womb to the world: I was wheeled from dim softness and calm to beeping, bright chaos. My memory of the next several hours is patchy. They transferred me to a bed, and a nurse tried to get an IV line into my hand but the vein collapsed. So they set up the IV into a vein in the crook of my elbow. I remember there being some commotion about this as being problematic for the pushing phase but the nurse was desperate to get fluids in me. I was hooked up to a pressure cuff, baby heart monitor, contraction monitor.. I remember the anesthesiologist coming in and having me sign forms. The epidural took awhile as the first attempt by a medical resident failed, but the attending took over and managed to get it in. None of this bothered me at all. I was just so grateful that there was a plan and things were happening. No more endless wandering in the weeds.

I remember the feeling when the epidural hit. My legs became warm and tingly and the pain faded to black. I felt numb all the way up to my chest in fact. My skin became itchy, but I could ignore it and not scratch. With a deep exhale, I sunk into delirious delicious painlessness and, incredibly, drifted off.

9PM - 10:45PM: Dr. Rhee Saves My Birth. Part II: Pushing out the baby. (1.5 hours). 25 hours of labor.

After what seemed like a long soak in the tub of sleep, I heard the greatest sentence I'd ever heard: "You are fully dilated." Dr. Rhee asked me how I felt and the words that came out of my mouth surprised me: "I feel calm and hopeful." I was incredibly rejuvenated. I was excited and ready - eager - to work. I could hardly believe that underneath the zombie me of the Birthing Center, this awake and alive me was available to be summoned. With rest, hydration and a break from the pain, I came back to life.

It was time to push. Dr. Rhee really connected with me and explained how I would need to work. Leo would hold one leg, Meghann the other, and I would claps my thighs, elbows up, curl my back, and push at the peak of each contraction. We would do three sets of a 10-count push per contraction. We got started. "ONE...TWO...THREE...FOOOOOOOUR..FI VE..." I felt very in control of the pushes, and loved pushing. My yoga-trained abs were working fantastically. We would push one set of three on my back. For the next contraction, I would turn and do set of three on my left side. For the next contraction, I would turn and do one set of three on my right side. Over the course of the next hour I brought the baby down from +1/2 station to +4. The baby's heart rate sometimes decelerated to the 80s during the pushes, so we would occasionally rest during a contraction to recover. During these rests Dr. Rhee would rub my legs or bend them at the knee back and forth. Ahhhh. This is what my soul and body longed for. Simple human touch. One of my cherished memories of the pushing phase was when Dr. Rhee took out some lavender scented moisturizing cream and rubbed into my legs during a recovery contraction. The simple act of being 'tended to' fed my soul, simply put. I cannot convey how much that loving care meant to me. Not only did Dr. Rhee offer me physical soothing, but emotional soothing as well. She talked about how much she loved birth. We have a great picture of her hamming it up for the camera with me in my 'legs in the air' pose. I totally drank in her energy.

During the final several contraction/push episodes everyone kept saying 'almost there, c'mon almost there' and I gave each push my all: 10 on a scale of 1-10. But it wasn't quite enough. After my first hour of pushing, Dr. Rhee explained that if needed, she had prepared the vacuum and forceps, both of which she could use, the vacuum being preferable as it was less traumatic to the vagina. An hour and 40 minutes into pushing, I asked Dr. Rhee if we could use the vacuum. I saw a look of disappointment flash across her face. I explained that I was I was giving it my all with each push, and it wasn't enough. I remember her saying "OK, the patient needs some assistance." I felt that I had disappointed her, as her language felt very clinical - but I was not confident I could get the head out myself. We rested a contraction and then started the first push with the next. ONE...TWO..THREEEEE... I pushed with all of my might, expecting that with the vacuum, the head would be out in the first push. No dice. We started the second set ONE...TWOOO....THREEEEE.... again, I gave it my all, and again, it was not quite enough. I remember Dr. Rhee said that they would only use the vacuum for three pushes, then resort to forceps. So at the start of the next 10-count, I thought THIS IS IT - MAKE IT HAPPEN. I strained every muscle in my body to the absolute maximum. I remember blacking out and seeing a star field streaking by.. then I opened my eyes and was surprised to see my body surrounded by 5 or 6 screaming people. It was like I had fallen asleep in a movie and woke up in an action scene - and it took half a second to realize this was no movie this was really happening and I was the center of the action. Then I felt the an explosion of warmth in my vagina, and a slither, and it was over. Later on, Leo would tell me that I actually birthed his head myself and then they used the vacuum to deliver the body. He also told me that the cord was wrapped tightly around the baby's neck at birth, which explained the decelerations.

Our son was rushed to a plastic bin in the corner of the room. I remember my first instinct was to look at Leo and yell "GO! GO!" because I knew he would be conflicted about leaving me. I'm sure I asked what was going on about a hundred times, and was kept in the loop. "He's getting suctioned." "He's breathing but he's breathing a bit fast." "We're giving him oxygen." In the meantime, Dr, Rhee delivered the placenta. I felt exactly like you would imagine. A floppy warm bag. It only hurt because I was raw and torn. Dr. Rhee explained that I had a first degree tear going from my vagina to my perineum, and a small urethra tear. She started stitching but I could feel the pierce, stitch, pierce, and told her. She gave me some lidocaine and finished stitching me up. When he was stable, they weighted him, did the footprints and eye ointment, and Leo gave him some additional oxygen. Finally, after what seemed like forever and a day (it was about 30 minutes), the L&D nurse brought him to me swaddled. "Can I do some skin to skin?" As Dr. Rhee left, she said "Of course you can!" and the L&D nurse unwrapped him for me. As I watched Dr. Rhee gather her things and leave, I felt a wave of pure gratitude towards her. She saved my birth. Plain and simple. And her parting offering to the room was to let everyone know who was in charge in her absence.

Afterward

I finally, finally cradled my newborn on my chest. I talked softly to him, and told him how sorry I was that there was so much drama and how everything must be so loud and cold and bright. And that it was going to be OK now (since we've been home sweet home, it has).

I wish I had hired a doula because I think I could have birthed naturally with the kind of intimate coaching and nurturing Dr. Rhee provided in the 11th hour. Still healing, I'm already looking forward to trying again someday!