The Birth of Mark

mostly from Richard's point of view, with corrections by Beth

Wednesday and Thursday, the 16th and 17th of September, 1998

We had been leaning towards natural childbirth, but we are both glad that we were not at all dogmatic about it. As it turned out, we had quite an unnatural birth, but there is nothing wrong with the result. You can find photos of him on our Web site, where you are probably reading this.

It all started for me at 03:43 on Wednesday, when I awoke to hear Beth coming out of the bathroom and announcing that her waters had broken, pale in colour with a pinkish tinge. We agreed that she could go back to bed for a while and see if the flow continued (Christie, her obstetrician, had suggested an hour's wait to be sure). At 04:30 Beth was sure, and tried calling Christie's office, but was told that they would have to wake Christie up to ask her what should be done. So Beth called the hospital (we were to deliver at Stanford, and had already filed the admission papers), and they said to come in. We didn't feel much urgency, and knew that we would need to be well rested, so we both tried to go back to sleep. Need I add that neither of us succeeded? At about 05:00 I decided to drive over to work and take care of a few loose ends, since my leave of absence was not planned to start until Beth's official due date, which was Friday. This mostly involved sending out a few messages to the people who were to take over from me. I came back about 06:00 and got busy packing my bag to take to the hospital (Beth had packed hers weeks ago) and loading the infant seat into the car. Actually, while Richard was at work, I packed the final items in my bag, ate an apple and took a shower. It's important to have clean hair when delivering a baby!

We arrived at Emergency (where we had been told to go) around 08:10. After about ten minutes in a very quiet emergency room, a wheelchair arrived to carry Beth to Labor & Delivery -- in a hospital the size of Stanford, that's a fair-sized walk. It took the staff several attempts to find our papers (not everyone can spell Treitel), but they didn't waste much time in showing us to a room, dressing Beth in a hospital gown, and putting her in a bed. Our nurse, Judy, told us that since Beth was showing no signs of labour, it would probably have to be induced chemically, and Christie confirmed this when the staff contacted her, so Judy started an IV drip of pitocin at about 09:00, in a very small dosage. About that time we also left a message for the birth attendant we had engaged; she called back soon and we agreed that there was no immediate need for her to come in. Judy took Beth's pulse and blood pressure and strapped a couple of monitoring devices to her belly, of which one was to count the baby's heart rate and the other to sense Beth's contractions. The heart monitor often lost touch with the little heart and needed to be moved to another spot; the contraction monitor presented readings that seemed poorly correlated with the strength of the contractions, though it could generally tell the difference between a contraction and no contraction.

Judy gradually increased the pitocin flow and the contractions grew stronger and closer together (they had started coming perhaps six minutes apart, and I think this shortened to about three by lunchtime). I spent most of my time either holding Beth's hand or watching the traces on the monitors. When the contractions were clearly getting strong and painful, we called our birth attendant again, and she arrived shortly before 14:00. She discussed the situation with Beth and took the practical step of making up the delivery room's couch into a bed for me.

For much of the afternoon Beth talked about epidural anaesthesia: the contractions were, individually, bearable, but were taking a lot out of her. They seemed to come one on top of another with very little break in between. Eventually she decided to ask for an epidural. That also meant that they would finally check my cervix. Judy had a very hard time even reaching my cervix (!) and declared that I was less than 1 cm. dilated, and about 70% effaced, after seven hours on pitocin. That meant there was a long labour yet to come [roughly eighteen more hours, in the end]. The epidural meant I would be numbed for it and so I might actually have some resources left when it came time to push. The anaesthesiologistwas busy with another patient, but arrived within the hour, accompanied by an Assistant Professor who had been a neighbour of ours before we moved to our present house. After an explanation of the workings and possible complications of the epidural, Beth bared her back and the tube was put in (the Asst. Prof. was very helpful in getting Beth's spine bent just so) and very securely taped up her back and to her shoulder. Relief came within minutes. Judy also strapped a blood pressure cuff on Beth's arm, since one of the hazards of the epidural is lowered blood pressure. Intravenous saline solution was administered to forestall this, and Beth never in fact showed any serious drop in B.P.

The pitocin dosage was upped again, and Beth went on contracting. At about 17:45 the baby's heart rate dropped and the nurse did an internal exam to "tickle the baby's head". The baby responded, but nevertheless they shut off the pitocin for a bit and put me on oxygen to make sure the baby's supplies were adequate. Dilation at this point was about 2 cm. Beth then sent me out to Stanford Shopping Center to get myself some dinner (I had lunched at the hospital cafeteria), so I missed the exciting part.

When I came back, there were effectively no contractions going on. At a pitocin dosage ten times the initial value (but still low in absoulte terms), Beth had had a four minute contraction -- they are supposed to last no more than about 90 seconds -- which had been followed by a prolonged reduction in the baby's heart rate -- it is supposed to dip during a contraction and recover very soon afterwards. Beth had been given a drug to relax her womb, and of course the pitocin had been stopped again. The drug effectively stopped labor for a while. Christie was called and came by to advise, and installed an intra-uterine pressure gauge and fetal monitor, which gave much more reliable and accurate readings of the contractions and the baby's response.

Soon after this time the shift changed and we got another nurse, whose name was Marlene.

Once it was clear that the danger was past, the pitocin was cautiously restarted, and even more cautiously increased as the evening wore on. Marlene sat with us all night -- the other nurses had divided their attention between us and one or more other mothers -- slowly increasing the pitocin dosage so that Beth could have the baby, while watching the monitors closely with my inexpert help; there was no longer any need to hold Beth's hand in the physical sense. I was examined internally at about 22:00 and found to be only 4-5 cm. dilated, meaning that I had a long way to go yet. Beth managed an hour of sleep -- yes, the epidural was that effective -- and so did I, on the couch. They checked me at 03:30 and I was about 7 cm. We tried having Beth lie on one side or the other, and the left side led to another alarming dip in the baby's heart rate, but the right side seemed safe enough. Unfortunately, this eventually meant that the anaesthetic drained downwards to that side, so that Beth had some severe pain in her left side. She asked the anaesthesiologist for an extra dose, which she (a different anaesthesiologist) administered willingly the first time and somewhat hesitantly when a second dose was needed.

Christie came in early the next morning, around 07:00, and pronounced Beth dilated over 9 cm. She asked Beth to refrain from pushing yet (though she was feeling some pressure down there) because she had to go off and deliver another baby down the hall.

Christie came back around 08:00 and told Beth to start pushing; by then the shift had changed and we had a new nurse, Marilyn, with a student nurse, Leilani. Christie told Beth what position to use for pushing (I held one of her legs up for her and Leilani the other) and we got busy about 08:15. Christie watched the business end of things while I mopped Beth's brow and watched the contraction monitor (Beth couldn't always tell, due to the epidural, when a contraction was well enough started that she should push) and with my other hand supported Beth's head so she could hold her breath better. At one point fairly early on, Beth said she was feeling nauseated and, for the first time in the entire pregnancy so far as I know, she puked; my stomach heaved in sympathy (it nearly always does that when someone else is being sick) and the nurses thought they might have to get rid of me, but after a minute or two I reassured them that I would be OK as long as Beth was. So we went on pushing. Somewhere along the way I did my back a minor injury from which it has still (two and a half weeks later) not recovered.

For the first hour or so all I could see was Christie's gloved fingers and some dark mass inside Beth that might have been anything. Eventually the darkness came nearer the surface and resolved itself into a scalp streaked with what might have been hair, or blood, or both. At some point or other, Christie detached the two intra-uterine monitors, since they were taking up room in the birth canal. By dint of holding on to Beth's leg between the contractions as well as during them (so that the head wouldn't slip back in) we got to a point where several inches of the scalp were exposed, and after that things happened rapidly. I remember saying, "Head's out!" and Beth saying, "What?", and a few seconds later Christie was holding up a blood-streaked baby, attached to an umbilical cord that looked much thicker and much bluer than I thought it would (that thing is supposed to carry oxygenated blood, right?) and proclaiming, "It's a boy!!!!" The look of joy and pride and oh-so-much-else on Richard's face was indescribable! It took alittle while before I remember to look at my watch, but it was about 09:45.

I have no memory of the cord being clamped and cut, though I had agreed in principle that I would do these things if asked. Nor did Mark make much noise; he was handed to Beth, who held him briefly while I took pictures, and then Christie (I think) noticed that his skin was rather bluer than it should be, and said something like, "Get the paediatricians." Well, actually, since she's American, it would have been, "Get the pediatricians." What happened then would have done credit to any TV sitcom. Within a handful of seconds half a dozen medics had rushed into the room and were gathered around the warming tray where Mark was now lying; they administered oxygen and possibly other things. I tried not to get in their way. They left after a few minutes, and handed back to Beth a live, healthy baby boy. His name is Mark.