The last OB appointment I was able to attend was on Tuesday, July 6th, one week before Peter was born. I weighed 137 pounds – 13 pounds more than I weighed at my first OB appointment back in Cambridge when I was only 6 weeks, 6 days pregnant. I gulped down nasty orange sugar water for the gestational diabetes screening affectionately known as The Glucose Challenge Test. I met with Dr. Maria Narducci, who told me I looked great. We listened to the baby’s heartbeat, and she measured my fundal height. I thought it was delightful to finally be far enough along in my pregnancy that laying a tape measure to my abdomen was informative. We talked again about cord blood banking. My blood work was done, and I was given a RhoGAM shot. There would be another shot as my due date approached. I scheduled my next OB visit for 3 weeks out. Looking back, I wonder at how everything seemed routine; there were no red flags, no indications that my life would change dramatically in 7 days’ time.
The following weekend was quite warm. Sunday afternoon, we invited a couple of Son’s coworkers to our house and watched Spain win the World Cup. I read about cloth diapers on the internet during commercial breaks, dreaming of becoming a crunchy mommy in October. My abdomen was feeling vaguely crampy on and off throughout the day. I drank a lot of water, trying to stay hydrated. That afternoon, I found the faintest tinge of pink on my toilet paper when I used the restroom, but I attributed it to the fun in bed my husband and I had had that morning.
Getting ready to sleep at 11 p.m. that night, I found a bright red stain in my underwear. I called my OB while Son was showering. The OB on-call told me to go into the hospital to be checked. I pulled Son out of the shower. The drive to Umass Memorial took less than twenty minutes but felt much longer: it was dark, we were worried, my cramps were becoming recognizable contractions, and we had never driven to that hospital before. We were there by 11:30. The receptionist at the ER infuriated me by refusing to even glance in my direction as she spoke with someone on her side of the window. After twiddling my thumbs in the waiting room for five minutes, a security officer recognized that we should be let up to the 4th floor’s maternity unit.
A young man in the elevator asked how far along I was. “Seven months,” I told him. (I was actually only 6 months along, but I had just started reading about the 7th month in my copy of What to Expect When You’re Expecting and was getting ahead of myself.) He told me my baby would be fine.
Thankfully, the admissions representative in the maternity ward was quick and efficient. The nurse who looked after me in triage was cheerful and upbeat, reassuring me that I’d done what she would have done in my situation and that it was unlikely that I would be delivering a baby any time soon. I slipped into a hospital gown and socks and put my clothes into a plastic bag where they would grow smelly over the next few days.
I was given a belly band outfitted with sensors to monitor the baby’s heartbeat and my contractions. Sure enough, I was contracting every 4 minutes. In an attempt to stop the contractions by hydrating me, I was hooked up to an IV bag. This did nothing for my contractions, but it did necessitate multiple trips to the restroom over the next 3 hours. A resident checked my cervix at about 12:30 a.m. It was not dilated. A vaginal swab was taken to test for group B streptococcus (GBS), and I obtained a clean-catch urine sample. There was talk of having a fetal fibronectin (fFN) test done to see if I was likely to deliver within the next two weeks.
Son and I were left to wait for several hours while instruments continued recording my baby’s heart rate and my contractions. The nurse graciously replaced a burned-out light bulb in my triage bed space so that the panel of harsh fluorescent bulbs could be replaced with dim lighting that allowed Son to doze a bit. I was tired and my mind was blank, but I couldn’t sleep. The resident was a bit disinclined to check my cervix again, preferring to leave it alone because an fFN test can give a false positive if done within 24 hours after a pelvic exam. The OB on-call, however, insisted that my cervix should be checked again, and it’s a good thing she did. At 2:30 a.m., 2 hours after my initial check, my cervix was 1 cm dilated and 75% effaced. “Well, that’s going to be your ticket to stay with us tonight,” the resident told me. An ultrasound was done to check the baby’s weight. The resident found it difficult to measure the length of the baby’s femur, but with the help of the head resident, he determined a mass of just over 1 kg. “Oh, you’re all baby!” the head resident exclaimed when she first saw my relatively small, round baby bump. Before I could worry over this observation, though, she reassured me that my baby appeared to be just the right size for 27 weeks’ gestation. I started taking nifedipine to suppress my contractions, and at 3:30 a.m. I was given the first of two steroid shots to jump-start my baby’s lung maturation. I was transferred from triage to a labor and delivery room.
As the sun rose that morning, I heard a mother in the room next door wailing and screaming. A few minutes later, I heard the sound of a newborn baby crying. The sound brought me to tears, though I’m not exactly sure why. Perhaps they were tears of awe at the miracle of new life. Perhaps they were tears of jealousy as I knew that my baby would probably not be capable of crying if he were born anytime soon. Perhaps they were tears of fear that I would soon be subjected to the kind of pain the mother next door went through. Perhaps they were tears of self-pity as I felt woefully out of place among the enormous bellies of ladies late in their third trimester.
My OB visited shortly thereafter. She pronounced me 1-2 cm dilated, 90% effaced. The results of the GBS culture were not back yet, but I was preemptively put on antibiotics via IV. I continued to receive nifedipine by oral tablets every 3 hours. The contractions slowly waned with the help of this calcium channel blocker. A nurse brought me a cart of books. I picked out a Reader’s Digest and Ken Follett’s Code to Zero. I mourned the fact that my microbiology textbook was at home; I needed to study for Friday’s exam. I dozed a little, having gotten no sleep the previous night. By noon, my contractions had all but disappeared. By 2 p.m., my GBS results came back. I was GBS negative, so the antibiotics were discontinued. I was unhooked from the IV, taken off the fetal monitors, and allowed to eat. Son had bought some vegetarian sushi and a strawberry NutriGrain bar from the hospital cafeteria. I gobbled them up happily, though I did have to defend my sushi from a suspicious nurse: “It’s vegetarian!” At 4 p.m., I hurried to order dinner because I could feel that my contractions were returning, and I wanted to eat a decent meal before anyone could tell me not to. Orders to lift my meal-ban had not reached the nutritionists yet, though, so I had to ask a nurse to call them again.
I was moved to an antepartum room. The beds were supposed to be more comfortable there, but I couldn’t feel much of a difference. I was just happy that the new room still had a private shower. Son went home to get a change of clothes and other supplies, including the much-missed microbiology textbook but not including a camera. I wasn’t planning to deliver my baby anytime soon, so the thought of bringing a camera never crossed my mind or Son’s. I ate my dinner and called my parents. While I spoke with my mom over the phone, I felt confident that this would all turn out similar to my brother’s delivery: I’d stay on nifedipine and bed rest for a month or two; my uterus would continue to contract but my cervix wouldn’t change; eventually my water would break; and I would have a c-section since, like my brother, my baby was breech. Some NICU time seemed inevitable, but everything would be alright. I did, however, wonder how I would be able to finish the remaining 3 weeks of my microbiology course while on bedrest. My mother shook her head, knowing full well that I had bigger things to worry about than coursework.
Son returned while I was wrapping up my phone conversation. I sheepishly indicated that he should go home get a decent night’s rest. It’s a good thing he didn’t listen to me.
At 11:30 p.m. the resident who had looked after me the previous night checked my cervix again. It was still only 1-2 cm dilated. I indicated that the contractions had returned, but I was simply told to let a nurse know if they became more painful. The doctor left, and I fell into the first deep sleep I’d had in about 40 hours.
Two hours later, I awoke to increasingly painful contractions coming roughly every five minutes. I waited until 2 a.m. for my dose of nifedipine, figuring that the contractions would surely ease after the drug kicked in. Then I waited some more. By about 2:30, I had to admit to myself that the nifedipine was not helping. I wanted to be able to wait until 3:30 a.m., when I was supposed to get my second steroid shot, to inform the nurse that my contractions were progressing. But by 2:55 a.m., I couldn’t sit still, and I called my nurse. The nursing shift change was at 3 a.m., so of course no one came immediately. I got up and started pacing in a futile attempt to ease the contractions. Son awoke, concerned, and when the next contraction came, I embraced him and cried. He wanted me to call the nurse again, but I couldn’t find my voice. He called her for me. At about 3:15 a.m. my new nurse came to check on me. She asked me to rate my pain from 1 to 10. I gave it a 4. She of course assumed that my contractions weren’t painful enough for me to be in active labor. She put the fetal monitors back on my belly, and I struggled to stay lying down. The pain quickly rose to what I would have called a 6. In retrospect, my pain-o-meter was probably a bit miscalibrated. At 3:30, the nurse returned and gave me my second steroid shot, and by 3:35, the resident finally returned to check on me.
As he checked my cervix, pain and pressure mounted, and I struggled to lie still. He pulled his hand out and told the nurse quietly, “I feel nothing but membranes.” “This is it,” I thought. I closed my eyes and gave in to my internal struggle. My water immediately broke all over the bed, and my baby’s feet slipped out my vagina.
The next 15 minutes passed in a whirlwind. My bed was broken down, and I was wheeled to the OR. Babies couldn’t be born in an antepartum room. Especially not premature babies. And especially not breech premature babies. I was quickly surrounded by many nurses and doctors. I don’t know how many; my eyes were closed. I later learned that the instant summoning of a host of medical professionals was precipitated by “Code White”, the code call for a child needing immediate resuscitation. On the way to the OR, a doctor exclaimed, “This is not the way it’s supposed to happen!” To any medical professional reading this who routinely works in labor and delivery: that is not a very comforting thing to say as a mother lies with her 27-week fetus’ legs hanging out her vagina. Nor is it a particularly insightful comment.
Four pairs of hands transferred me to a harder surface after we reached the OR. An anesthesiologist began asking me about my medical history and family history of allergies. I was at this point unable to carry on a proper conversation, so my responses were yelled between gasps for air. I thought the whole interrogation was silly. There obviously wasn’t time for anesthesia, much less a c-section, what with my baby being already half-delivered. Someone began stroking my forehead. I figured it was a nurse, and then I wondered whether it was an angel sent from heaven, and then I wondered whether it was my husband. I peeked my eyes open. No such luck: it was a nurse. Son was still scrubbing so that he could enter the OR.
My legs were lifted, and I was told to push. I briefly wondered what the mechanics of pushing were. My birth preparation classes had not yet started, and I had not even read that far ahead in my copy of What to Expect When You’re Expecting. I tried briefly to push with my legs; this seemed natural given the flexed position they were being held in. Then I decided that since the baby was in my abdomen rather than my quadricep, it would probably be more effective to contract my abdominal muscles.
Push, gasp, push, gasp, push – through one contraction – with accompanying screams. Communication from The Medical Professionals indicated that I could stop. A wave of relief swept over me as the pain vanished. I felt incredibly selfish. I had just delivered a tiny, silent baby, and all I could feel was relief that the pain was over. The pain was immediately replaced by uncontrollable shivering. I was reassured that this was normal, and my angel-nurse covered me generously with blankets. “Congratulations! You only have a small tear, so I’m not going to give you any stitches,” the OB told me. “Was the placenta already delivered?” I asked. It had been. “Funny,” I mused to myself. “I thought that there is usually a few minutes – or at least a few seconds – between delivery of the baby and delivery of the placenta.” I would later learn that the umbilical cord was very short, supplying only enough blood to complete the newborn blood screenings. Good thing we hadn’t counted on being able to bank the cord blood.
“Did anyone get a time of birth?”
I then gathered that The Medical Professionals were debating whether they could muster enough free hands to lift me onto a fresh bed for transport back to my room. I opened my eyes for the second time since my water broke and shimmied myself onto the adjacent bed. Now that I no longer had a half-delivered baby in my birth canal, I felt remarkably mobile and independent.
It was eerily calm back in antepartum. The lights were dim, and the nurses attended to me in subdued voices. I grimaced when I overheard my nurse saying defensively that usually labor hurts more. Presumably, she would have called the resident (or better yet, the OB!) more quickly if she’d known that my son’s feet would be sliding out my vagina a mere twenty minutes after I gave my pain a rating of 4. I wondered how a compassionate human being could trivialize the pain of a woman who has just been through an anesthesia-free labor and delivery. I promise that my labor and delivery was quite painful, even if I didn’t scream as loudly as expected.
A nurse asked whether she could bring me any beverages. I requested she bring whatever is appropriate for a lady who yelled herself hoarse. Turns out that’s ginger ale. I mused over the new piece of jewelry that had been fastened to my wrist while I had my eyes closed: a plastic band decorated with a row of ducklings and a hand-written insert reading: Glab, Kristin 07/13/10 @ 0351 Dr. Reine. I found it odd that I did not know what this Dr. Reine looked like, though she had just delivered my son. I found it odd that after only 27 weeks and 5 days of pregnancy, my womb was empty. I hadn’t even made it to the third trimester.
I remarked that the second steroid injection, given twenty minutes before Peter’s delivery, probably didn’t help much. My nurses agreed. Then they provided assistance for my first postpartum trip to the restroom and recommenced their routine vital signs checks. In addition to temperature, pulse, and blood pressure checks, rolling over to have my girl parts inspected and demonstrating my ability to flex my feet were added to the ritual. But soon enough, there was nothing to do but lie and wait.
The three hours I waited to be allowed to see my son rank among the longest hours in my life. Fortunately, Son had already seen him and was able to reassure me that our son was, in fact, alive. Son missed the delivery while he was scrubbing, but he was able to see our baby before he was taken upstairs to the NICU. He saw the radiant warmer, he saw the nurse inflating our son’s chest with a resuscitation bag, and he saw our son open one eye to look upon his dad for the first time. He was able to reassure me that our baby was pink rather than the dusky blue my sister had been at birth. My sister was born 7 weeks premature and suffers from cerebral palsy. I couldn’t allow myself to fear that my baby wouldn’t survive, but I couldn’t help myself from fearing that he would be permanently handicapped.
Later, a neonatologist, Dr. Alan, stopped by to give us an update. “Congratulations. Does your son have a name?”
I was speechless. Did he have a name? Did we have to make the final decision already? Luckily, Son replied, “Peter. His name is Peter.”
Alan reassured us that Peter was alright. He was in a bit of “shock” after his birth, but he was now breathing on his own with the help of Continuous Positive Airway Pressure (CPAP). He did have some bruises on his legs because he was pulled out feet-first. We could go see Peter in about an hour and a half, after he had been fitted with umbilical catheters.
Alan left, and I was finally able to cry. On the one hand, I was devastated. I couldn’t believe what had just happened. Just two days ago, I had been imagining how much my belly would grow in the upcoming trimester. Now my belly was empty, and my newborn son would have to spend the upcoming weeks in intensive care. On the other hand, though, I was grateful to be assured that my son was doing well. He had just been in a bit of “shock” at birth. Surely, I would also have been shocked if I were introduced to the world in such an abrupt and unforgiving manner. Only later did I learn that this “shock” translated into Apgar scores of 1 and 4.
I’ve often wondered what Peter did to earn that first Apgar score of 1. He obviously wasn’t breathing after delivery, and I assume he wasn’t responsive or showing muscle tone. Son had reassured me that Peter was pink when he saw him, but evidently Peter wasn’t pink in his extremities one minute after delivery; otherwise, he would have at least earned an Apgar score of 2. Did Peter earn that single Apgar point because he was pink (though blue at the extremities) after birth or because he had a heartbeat (though <100 bpm)? To think of my son born either without a heartbeat or without pink color in his body is frightening to me. But given his first Apgar score, one of these scenarios was true.
At 6:00 a.m., I couldn’t wait any longer, and I called my parents in Minnesota. My mother asked what time Peter had been born. She had woken up in a state of premonition at about 3 a.m. Central Time, just after Peter’s delivery in Massachusetts. My family groggily made plans to fly to Massachusetts that morning. I am forever grateful to them for making that spur-of-the-moment trip to see their firstborn grandchild. I don’t know how I would have coped with the next four days without their support.
We called the NICU several times to ascertain when Peter would be ready for visitors and were finally invited to see our son after the nursing shift change at 7 a.m. I don’t really remember the first time I saw Peter very distinctly. That first visit to the NICU was much like the second, third, fourth, fifth, and sixth visit. Each time we made our pilgrimage up to the 5th floor, Son got a bit better at steering the wheelchair, and I was less sore. But the happiness, anticipation, and anxiety were the same each time. I loved to look at Peter’s delicate little features. I loved to listen as the nurses taught us about the NICU and answered all our questions. I loved to be near my son, but I was always on the brink of tears because my son was not inside me any longer. He was not in the safe womb where he was supposed to spend the next three months sheltered from light and noise and breathing tubes and nurses’ needles.