2004-04-25, 4:50 p.m.

In the delivery room, pt.1

Around 12:30 in the afternoon, we were moved into an actual delivery room. On the way down the hall, a nurse asked me if I wanted an enema. No one had ever mentioned to me that this could be a part of child birth, but I figured what the heck, if the nurse was recommending it, it might be a good idea. I'll spare you all the details, except to say that it was worth it - later, when I was trying to push Leon to be born, I didn't have to worry about anything but him.

The doctor (not my regular OB) came to examine me again - I was dilated to 6 cm at this point, but my water had not yet broken. You know all those TV shows where a woman is standing in line at the grocery store and her water suddenly breaks, or novels where the labor is announced by the breaking of a woman's water? Well, that's just drama, it doesn't usually happen that way. Sure, sometimes it does, but in the majority of labors, a woman's water doesn't break until much later, sometimes not until she starts to push at the very end. So the doctor and I talked about how long it would take for me to be fully dilated - my contractions were still every 3-4 minutes, and getting more and more intense. Every time one would come, I grabbed Christopher's hand and squeeze while breathing with him, but it was getting harder and harder to feel in control of the process, and I was starting to put fingernail grooves in Christopher's hands. The doctor estimated I'd deliver around dinner - I asked for more specifics, and she said 5pm, 8pm, somewhere in there. Contractions, and therefore labor, speed up once your water has broken, and since I was already 6 cm dilated, we could break my water manually and expect things to progress relatively quickly. But, stronger and faster contractions would also mean more pain, and I was already starting to have trouble with their intensity. I was getting scared that I would not be able to deal with stronger and faster, not for another 4-6 hours.

Christopher and I shared the idea that a natural and drug free birth was the ideal, but that a healthy baby and mama was the goal. Under this philosophy, we decided I would go with the epidural. I would never say to any woman that the epidural is the only way to go - I definitely think that if I had had a better sense of what happens during labor and delivery, I would have been able to make decisions that would have allowed us to go without the pain killers. But for where we actually were at that point in the process, the epidural was definitely the right decision. Although it seemed to slow down the contractions, and therefore probably extended my labor, the epidural also allowed me to rest, to feel calm, to enjoy the experience of waiting to meet my baby. If I hadn�t had the epidural and Leon had been born at 5pm instead of 10:50, I think that I still would have been so worn out from the contractions that I don't know how I would have dealt with the incredibly hard work of pushing.

So we asked for the epidural. It was administered by a nurse anesthesiologist � a very tall black man - and the anesthesiologist � a tiny white haired lady. (Beth Israel is the totally multicultural-staff hospital) They were very gentle, for which I was very grateful - having an epidural is a funny feeling. I sat up on the side of the bed and leaned over a table, with my head on my arms, so that my back was curved. The nurse anesthesiologist put his hands on my arms, to help me hold still, because the tiny little catheter has to go in exactly in the right place, otherwise you can get headaches, or numb one side of the body instead of both. The feeling of the catheter going in isn't exactly painful, but it's something I'd never felt before, so it was darn weird, and if the nurse anesthesiologist had not been steadying me, I might well have flailed and messed the whole thing up.

The epidural started to take effect, and the length of the contractions felt shorter, but the intensity stayed the same. So they gave me a kind of booster shot through the epidural catheter, which took away the rest of the pain. At this point, I was hooked up to so much stuff that any plans I'd had to walk through the contractions were effectively thrown out the window. I had a blood pressure cuff on my right arm, the epidural catheter taped to my back, an IV in my right arm (both to hydrate me because of the epidural and to give me the requisite bag of penicillin every four hours, to counter the type-b strep), and the fetal heart monitor and the contracto-meter strapped to my belly. (Eventually, we had to trade the external heart monitor for an internal, which was attached to Leon's actual head, because he dropped so low in my pelvis that the external couldn't find him anymore.) And I got a regular catheter, since now I couldn't exactly feel my bowels. The epidural was what's called a walking -epidural. I don't think I could have actually walked, but I could still feel my legs and move them around some. I just couldn't feel the contractions, which was good, because I could see them on the seismograph thingy, and although they were further spaced apart then before, they were still very fierce, and long.

After the epidural went in, maybe around 1:00 in the afternoon, the doctor broke my water. Much to my surprise, it was warm. Of course it was warm, having been inside my 98.6 degree body, I know, but I hadn't thought about it before, and it surprised me.

Christopher and I spent the rest of the afternoon just hanging out. I napped, we read to each other, I ate ice chips, we chatted with the nurse and all the residents who came through to check on us. Our day nurse was Pat, a charming middle aged black woman from Barbados. She had practiced nursing in the US, the UK, and Barbados, and we chatted with her about how the 3 countries compared (The US is great with trauma, the UK with serious illness, and in Barbados the doctors are expert at diagnosing and reading patients� conditions without the help of sophisticated equipment). She was very kind and gentle, and even as the delivery floor filled up that afternoon, she made us feel like we were a top priority with her. We were also attended by Dr. Steve, a tall, skinny red haired family practitioner on rotation with the maternity ward, who was incredibly nice, and dedicated to taking good care of us, and kept having to duck around the ceiling lamps. His last name was actually Dahmer, so he understandably went by Dr. Steve. The intern on rotation was Anya, from Russia, who had blond hair and beautiful big blue eyes, and wore very dramatic eye make up behind HUGE glasses. She was very excited, hoping that we'd deliver while she was still on rotation, because she loved catching babies. We had a great time with all of them, especially Pat, and were really sad when their shifts ended at 7pm. But the great thing about giving birth at Best Israel was just how amazing everyone we worked with was, and it turned out that the night crew was just as lovely, if not better.

For several hours I hovered on the verge of fully dilated, and finally made it to 10 cm � fully dilated � at 8pm. The baby's head was +1, meaning 1 stage beyond locked into my pelvis - he was ready to get born. We had been slowly backing down the epidural, so feeling was slowly returning to my legs and pelvic area, but we were still waiting for my body to be trying to push - apparently, when the baby is ready to be born, you start to feel the need to push, which is just like needing to poop. Unfortunately, my body was still just hanging out, no need-to-poop sensations. But I was mentally and emotionally feeling VERY ready to push - let's get this baby born already!

The only down side at this point was that Christopher had been suffering from a terrible headache all day. I kept telling him to go get some food - he hadn't eaten since breakfast - but he was afraid that if he left he would miss something important. Luckily, when our evening shift nurse came on, and she discovered all this, she basically ordered Christopher to get out and eat something, promising that she would not let me deliver the baby while he was gone. This resulted in my birth partner having cheeseburger breath, which I actually found quite pleasant, since I myself was STARVING.

The new nurse was Maryrose, a short, pretty Latina, who was also 5 months pregnant, with twins. Maryrose taught me, and us, how to push. I say us because Christopher was the one holding my right leg (Maryrose had my left foot propped up in her hip), and doing the counting. When Christopher came back, I was ready to start really pushing, and we were joined by the doctor - Dr. Lewis-Morris (who is my new favorite doctor of all time � another beautiful woman, black and apparently from the south, judging by her accent � it seems we were attended only by very good looking people�), an intern I hadn't yet met, and another, attending doctor. I had my combination audience, coaches and cheering section in place.

As Maryrose taught �pushing�, it meant that when a contraction started I took a deep breathe, lifted up my head and pulled my knees up to my chest, grasped the backs of my legs, and pushed for a count of 10. Then I released the breathe and starting again, repeating usually 3 or 4 times for the duration of the contraction. The key is to push with one's bottom, not the shoulders - this is surprisingly tricky to coordinate, especially when one's bottom is still half numb.

I found that the act of pushing itself didn't hurt - what hurt for me was my lower back and hips - I was stiff and achy from all the pressure of pregnancy, compounded by laying on my back and hips all day. Then there was the awful hunger-indigestion I was feeling, which meant that my stomach hurt when I took the requisite deep breathe, and also when I exhaled. As a result, for the first 80% of my pushing, all the pain and yelling had nothing to do with the baby getting pushed through the birth canal. And at one point I threw up - a side affect of the hormones - but I was so used to throwing up that it just felt practical, and didn't upset me the way throwing up used to, before pregnancy. I also had chattering teeth - another side affect of the changing hormones coursing through my body - and then I got incredibly itchy, which I then discovered was an uncommon side affect of the epidural. Having never spent any time in a hospital, I found it all very fascinating