Today is Andy's birthday. Hard to believe he's already a year old. Poor kid had the misfortune of being the second child, so unlike Alex who got a big bash of a party, Andy will just have a quiet celebration at home on Saturday.

To mark the first anniversary of Andy's birth, I decided to post his birth story. I meant to post this, like, 11 1/2 months ago, but for some reason didn't do it. For starters, it's really long. For another reason, it's kind of detailed and graphic. So, if you're not up for birth details or mention of words relating to the female anatomy, quit reading now. You've been warned.

At one point, this story included photos, but thanks to my broken galleries, they've disappeared. I'm leaving the img references in there so I can (maybe) go back in and add them back in later. Anyway, without further ado, here it is.

The Story of Andrew Blinn Sandhaus' birth on July 9, 2008

The backstory

This was my second pregnancy, and I was sure I’d go way past my due date, or not go into labor at all. With my first pregnancy, I had a “cold induction” at 41 weeks, and wasn’t effaced or dilated at all. The induction did not go well. After the cervadil but before the pitocin, a contraction caused the baby’s heart rate to go down and stay down. They rushed me back to the OR for an emergency c-section, at which point the heart rate came back up. But the doctor felt it was too risky to labor at that point, and went ahead with the c-section. The baby was fine, but that was the scariest day of my life, and definitely not the birth experience I had imagined. In fact, my birth plan went something like this: want to avoid a c-section, and want to have an epidural.

So with this pregnancy, I knew two things: 1) I wanted to have the baby via the birth canal rather than the OR. And 2) My body probably wasn’t going to cooperate. After all, it hadn’t shown any signs of impending labor with my first pregnancy, so it seemed unlikely that it would get with the program this time.

Despite my skepticism about having a “normal birth experience,” I wanted to do everything possible to make it work out. I was with a Piedmont OB practice throughout most of the pregnancy, and they had said they’d support my desire to have a VBAC (Vaginal Birth After C-section). But there was one sign after another that I was going to end up with another c-section.

I had to see all six doctors in the practice, and each appointment started with “So, you’re having a c-section on July 12.” Each time, I responded, “No, that’s the fall-back plan. I’d like to have a VBAC.” Then they told me about the dangers and risks, we said we understood, and then we had the same conversation all over again at the next appointment. Despite the lip service (“we’ll allow a VBAC trial so long as everything is progressing well”), not one of the doctors was convincingly supportive, and a couple of them were almost hostile about it. One doctor rolled her eyes when she learned I wanted a VBAC. Another said I was being “selfish” for putting my birth experience ahead of the baby’s safety.

Most discouraging of all, it still said on the front of my chart -- in huge, yellow, highlighted letters -- “C-SECTION JULY 12.” Hardly an encouraging sign.

That’s how it came to be that at 37 weeks, we hired a doula and switched to Doc T. It made me nervous to change course so late in the game, but from then on, I felt much better. There were no guarantees, but now I felt like there were decent odds of ending up with a normal, non-surgical birth. And Doc T seemed to think it was not just possible, but likely! We had turned a corner, and finally had trust and confidence in our doctor.

And that brings us to the end of the preface. On to the birth story!

Part 1

On the night of Tuesday, July 8, I went to bed like any other night. It was three days past my due date, but I was still convinced there’d be nothing stirring for at least a week. So when I woke up at 1:10 am, I was shocked to discover my water was slowly leaking, and I was having contractions (I’m still not sure which of those caused me to wake up). In fact, I was in such disbelief that I actually changed my underwear to see if the trickle of water continued, and it did.

The contractions were stronger and more regular than the occasional pre-labor contractions I’d had in previous weeks, so I was pretty sure this was it. But I didn’t want to wake up my husband, Jay, unless it was for real. So for the next hour, I read the ICAN message board while timing contractions. They were roughly 6-8 minutes apart, and increasingly painful. I was surprised at how intense they were since I had heard that contractions were usually not very strong in early labor. Later, I learned that contractions are often more painful if your water has broken since there is no “cushion.”

Around 2:00 am, I woke Jay up and told him I was pretty sure I was in labor. He was excited and jumped out of bed. He took over timing the contractions, and said we should call Doc T. I wanted to wait since I was scared about waking up Doc T in the middle of the night for no good reason. Also, I had heard a million times that you shouldn’t rush to the hospital too early, so I figured we might as well cool our heels.

We timed contractions until 3:00 am or so, at which point Jay said let’s call Guina, our doula, to see what she thinks. By then, the contractions were quite painful so I said okay. Each contraction had me doubled over a table or couch, and it hurt too much to talk through them. I had heard that was a sign of real labor, so that made me think this was probably for real.

Around then I ate half a peach, thinking I might not get to eat for a long time. It seemed like a good idea at the time, but in hindsight, maybe notsomuch. (This is the part of the story called foreshadowing.)

Guina told us to call Doc T, and he said to go to the hospital. I was surprised since I thought he’d tell us to labor at home for a while. Looking back, it makes sense because once your water has broken, you need to deliver within a certain timeframe to avoid infection. (Doc T has a more flexible take on this than most doctors. His view is that mother and baby need to be monitored, but as long as both look good, then he’s not on a strict timeline. Other doctors insist on a c-section at some cut-off point, usually between 18 -24 hours, I think.)

We started packing a duffel bag, and must have made too much noise because Alex, our 21 month old, woke up crying. My mom was in town and asleep in our guest room, so Jay woke her up and asked her to help with Alex. By now he was up and running around the house, enjoying the late-night party.

At 3:30 am, we drove to Emory Crawford Long Hospital. I kept telling Jay to drive slowly and avoid bumps, which were painful during contractions. At one point, we had to pull the car over for an especially bad contraction. The hospital is only two miles from our house so we got there quickly, but it’s a long walk from the parking deck to the maternity ward, and I had at least two contractions along the way.

When we arrived at check-in, nobody seemed to be in any particular hurry. I guess they see the same thing dozens of time every day, but we were eager to get inside to figure out what was going on. I stopped in at the bathroom in the waiting area, and felt a twinge of nausea. (More foreshadowing.)

Finally after 10-15 minutes, we got into a triage room. It was 3:45 am. They hooked me up to a monitor and everything looked fine. Baby was averaging ~ 160 bpm. They also did a check to see if my water had really broken, and it was positive! We were having this baby today. I was in shock. Somehow I didn’t think my body would ever go into labor on its own, so despite the pain, I was happy. Until...

BLAAAAARRGH! I threw up everywhere. All over the floor, the bed, myself, and everything else in sight. So much for that peach, or for last night’s steak and green beans dinner. The room looked like a rainbow of vomit. I felt terrible physically, and was mortified.

After a significant clean-up effort, the nurse checked my cervix. I was excited because I was sure I would be at least a few centimeters dilated. After all, I’d been having fairly intense contractions for several hours.

My cervix was thinned out, but only dilated a finger-tip. I was crestfallen! I had made almost no progress. That news, combined with the throwing up and the incredibly painful contractions, did me in. I burst into tears.

Jay tried to comfort me while the nurse entered stuff in the computer, put the IV port in my arm, etc. Until now, I felt like the pain at least had some benefit, but now it seemed like I was suffering for nothing. I wanted some kind of pain medication, but they said they couldn’t give me anything until I got into an Labor & Delivery room (we were still in a triage room).

Finally they moved us into our room. The nurse came in and gave me some narcotic pain relief (Nubain, I think) through the IV. It didn’t make the contractions hurt less, but did “take the edge off” and make me drowsy, to the point where I was able to doze on and off for a couple of hours. The nurse said it would last for 4-6 hours, and I should try to sleep as much as possible.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_7974.jpg[/img]

Around 5:30 am, Guina the doula called back. She was at another delivery on the north side of town, so a back-up doula, Kim, was going to come be with us. I continued to snooze, and at 7:00 am, Kim arrived. We didn’t really know what to expect from a doula, but were glad she was there.

At 7:30 am, we got a new nurse, Lydia, who would be with us for the rest of the day. She checked my cervix and reported it was still dilated a finger-tip. In other words, still no progress. It was incredibly disappointing.

Around 9:00 am, I decided to try brushing my teeth. Bad idea. I threw up again, but this time nothing came up except lots and lots of water.

At 9:30 am, I had a lemon Italian ice, which was refreshing and tasty. I was still really groggy, so I also asked for a coffee. There is a funny photo of me sitting on the birth ball and leaning against the hospital bed, my face contorted in pain, and clutching a cup of coffee. Such is my commitment to that most wonderful steamy beverage!

When I’d complain about the pain, Kim would suggest that we try a different position, and that usually helped for a while. Occasionally I would stagger into the bathroom to pee, and inevitably end up doubled over the sink during a contraction. The pain was intense.

At 10:30 am the nurse did another exam. The baby’s head was further down, but my cervix was posterior and dilated only half a centimeter. Ugh, I had been in labor for over nine hours, and still almost no dilation. I was terribly discouraged, and knew we were in for a long haul. It also occurred to me that at this rate, I could end up with another c-section since my water had been broken for so long.

After laboring on the birth ball for a while, I got back in bed. Kim set me up on my left side with my right leg supported by pillows. The contractions slowed down to every 8-9 minutes. I moved back to the birth ball and Kim gave me a back massage.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/labor.jpg[/img]

Around noon, Doc T stopped in. I was glad to see him because it made the whole thing seem more real, and it was reassuring to know he was around. Doc T said he was fine with waiting, even though my water was broken.

I continued to labor, switching back and forth between sitting on the ball and standing. I couldn't go very far -- just a few feet -- since I was hooked up to monitoring. The contractions intensified in both strength and intensity.

At 1:15 pm, I was at the end of my rope, and told Kim I didn’t think I could take the pain anymore. I had wanted to stick it out as long as possible since I knew epidurals sometimes caused labor to stall. On the other hand, I wasn’t sure I could handle the pain continuing at its current level, and I was even more scared about what would happen if the pain got worse and I had to wait a long time to get the epidural. Kim calmed me down, and we set a goal of getting to 3-4 centimeters and then re-evaluating.

At 2:15 pm, Doc T did a cervix check. I was at 1 ½ cm and the baby was at 0 station. Doc T knew I wanted an epidural, and he had said I needed to be about 4 cm dilated to get one. I think he also knew I was in bad shape at this point, both in terms of pain and mentally. So, he unexpectedly stretched my cervix from 1 ½ to 4 cm by manipulating it with his fingers. This was excruciating and put me over the edge. I cried for the next five minutes. But, I was now cleared for an epidural.

At 3:00 pm, Anesthesiology showed up and everyone had to leave the room. I had been laboring for fourteen hours, and was not holding up well, so I was overjoyed to see them. But then things got a little ugly. They must have had trouble getting the epidural in because out of nowhere, I felt a startling shock in my right knee, and I let out a yell that made the doctor and nurse jump. They had to try it again, and the second time around there was a less severe shock in the other leg. Finally the epidural took effect and the pain went away. The epidural insertion process was longer and more painful than I expected, but I was still ecstatic to have it.

That was the turning point in my birth experience. In my mind, everything after the epidural is “part two,” also known as “the better part.” :)

Part 2

Around this time, Guina showed up and Kim left. Now that my pain was gone, Guina, Jay and I were able to sit around shooting the breeze. After a while, Jay, who had been dutifully sitting by my side and helping however he could, left to get some food.

At 3:30 pm, a nurse anesthetist named Debbie came in to give me a pep talk about having a VBAC, and told us about her own VBAC. She was sweet and funny, and nattered on for quite a while. She would leave, and then pop back in to offer one “last” word of encouragment, then leave, and pop right back in again.

Now that things were calm, Jay decided to drive home to check on our 21-month-old Alex, and to let my mom come visit. Before he left, he said, “It’s so nice to have you back. I missed you!” and he gave me a kiss.

At 4:00 pm, Guina and I watched Oprah, and at 4:30 pm, my mom arrived with Jay. It was great to see my mom and I was in a good place now. I sat in an upright position in bed and we all hung out.

At 6:00 pm, just as my mom had given up hope of meeting him, Doc T showed up. He did a cervix check and I was at 6 cm! I had been worried about the epidural slowing things down, but it seems to have had the opposite effect. Guina later hypothesized that maybe the epidural allowed me to relax, and my body was able to do its thing.

By 7:00 pm, I was starting to feel contractions again so the anesthesiologist came in to give me more medication.

Doc T decided it was time to start a low dose of pitocin to speed things up (I’m guessing because my water had been broken for about 17 hours at this point). He also inserted an “intrauterine-pressure catheter,” a scary-looking thing which measures the frequency and intensity of contractions. This makes it possible to see how the contractions are affecting the baby, and to adjust the pitocin accordingly.

Around 7:30 pm, a new nurse, Selena, came in and checked me again. I was at 7 cm and very soft. She was about to start the pitocin drip, and I asked her to be very conservative with it since I was scared about uterine rupture, and had heard pitocin can increase the risk. She said it went up to forty and she was starting me at a two, so that put my mind at ease.

At 8:00 pm the contractions were stronger, and Jay occupied me by talking about all the food we would have after labor. I lay on the bed with my eyes closed as he described my favorite meal from Apres Diem, including the wine selection. Then we talked at length about all our favorite summer beers.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_7978.jpg[/img]

Jay also amused himself and the med students by watching the strength of my contractions on the monitor, and calling out the numbers like a sports commentator. He’d say, “It’s at 80...85...90, I think we’re going to break a hundred...oh there it goes! 110! look at it go!” Jay also decided that he didn’t like the name intrauterine-pressure catheter, so he renamed it the “cooter index.”

We also had a good time chatting with the med students. Shirin had been a nurse in her native country, Iran, and told us stories about that. Andrew told us he couldn’t believe any woman would want to have children due to all that pain. He was about to witness his first birth, and seemed intrigued but a little freaked out about the whole thing. We told him there were decent odds that the first baby he helped deliver would share his name, and that really tickled him.

Over the next hour hour and a half, the pitocin was gradually increased to four, then six. I had some breakthrough pain on one side, so Anesthesiology gave me more juice in the epidural. After that, I wasn’t feeling any pain, but was starting to feel a lot of pressure. I suspected it was almost time to push.

At 9:45 pm, Doc T checked me and I was fully dilated and at a +2 station – ready to push! I couldn’t believe this was going to happen. Doc T asked if I wanted the mirror, and I did. It was a little shocking, all the blood and gore (plus, staring at your own vagina), but very cool at the same time.

Doc T told me how to push, and things started to happen fast. I wasn’t sure I knew how to do it right, and clearly I didn’t because everyone started to holler at me about what to do differently. I was relieved when Guina said, “Okay everyone, she’s getting too many different orders all at once; let Doc T tell her what to do.” After that, I think I got the hang of it because Doc T wasn’t correcting me anymore, just coaching and providing encouragement.

I pushed until 10:20 pm, when Doc T said something about forceps. The baby’s heart rate was going down quite a bit with each contraction -- which is not unexpected, but not something that should go on for too long, I guess. I knew Doc T was skilled with forceps, but it scared me anyway. There’s just something unsettling about having giant salad tongs stuck inside you, and yanking on your baby’s head. And sure enough, as soon as I saw the forceps, I couldn’t look in the mirror any more – too scary! I closed my eyes and hoped this would be over soon.

Doc T said he wasn’t going to yank the baby out, but rather help by gently pulling on the baby with each one of my pushes; meanwhile, he was teaching a resident how to use the forceps. The pulling must have helped because after a couple more rounds of pushing (and 21 hours of labor), Andrew Blinn Sandhaus (Andy) was born. Jay and I both cried, and Doc T asked Jay to cut the cord.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/born2.jpg[/img]

Andy cried right away, but everyone in the room was so quiet that I wondered if something was wrong. I had to ask several times if everything was okay, and was assured that it was. They toweled Andy off and put him on my chest. I was overwhelmed with joy. I remember Guina telling me to talk to him, but I couldn’t think of anything to say. I was literally speechless, and totally over the moon.

I was pretty glad that the epidural was still working well because Doc T and the resident spent a while putting humpty dumpty back together again, if you know what I mean. I had a second degree tear and needed stitches (I forgot to ask how many, but it took a while). Luckily I didn't feel a thing, at least until the epidural wore off.

Oh, I almost forgot the most graphic detail of all. After the placenta came out, they put it in a blue plastic bin and set it off to the side. I have no idea what they were going to do with it, but we said we wanted to see it and examined it in great detail. It was amazing in its bloody grossness, and even more amazing because our baby [i]grew in that thing[/i]. For anyone about to give birth, I highly recommend checking out your placenta if you aren't easily freaked out by that kind of thing. We took photos of it, but will spare you. :)

The nurses had warned me that they would need to take the baby for a blood test soon after he was born. They worry about infection if it's been longer than eighteen hours since your water broke, and in our case it had been several hours beyond that. I stalled as long as possible to prolong the snuggling and breastfeeding.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_8004.jpg[/img]

About an hour later, around 11:30 pm, they took Andy for his blood test, and I made them promise that they would be quick. They said we could have him back by midnight. Doc T stuck around for a while chatting with us, and Jay said something about being impressed with how Doc T had anticipated everything that would happen, and taken all the right steps to make things work out. Doc T said the most important thing he did was to “stay out of the way” and let things take their course.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_8028.jpg[/img]

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_8035.jpg[/img]

Around midnight, we were moved to the “Mother / Baby room.” Andy joined us in the room around 12:15 am. I couldn’t sleep much that night due to the adrenaline. The next day, Jay called friends and family and told them about Andy. He kept describing the birth like this: "For the first half of it, nothing much happened. Then after she got the epidural, things started to move quickly." After hearing this version of the story a few times, I had to tell him that the "nothing much happening" part of it was the hardest, most painful thing I'd ever done! ;D

On Friday morning, about thirty-six hours after Andy was born, we went home to join Big Brother Alex, Grandma Betsy, and a house full of pets.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_8069.jpg[/img]

Overall, despite a lot of pain and some dark moments, it was a very positive birth experience, thanks to Doc T and the doulas. We got the VBAC we wanted, had a good experience with our doctor, nurses and hospital, and of course ended up with a healthy baby boy. And while there are no guarantees with any future births, I’ll be a lot more confident that things will work out, which is an added bonus.

[img]http://www.katebroun.com/gallery/2008/07/andy_birth/slides/IMG_8114.jpg[/img]
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