Sunday, January 13, 2013

The birth of Beau David Brocato, Part 3: Our Hospital Birth

If you missed Part I: The Plan, read it here
If you missed Part II: Our Home Birth, read it here

It was approximately 7pm when the security guard rolled me up to the nurse's station to check in.  Right away quite a few nurses recognized me... "It's Juli the Doula!"  Somehow in my complete hazy world I made the joke, "Juli-a the Doul-ia"  (ya know, from The Wedding Singer's Julia Gulia)... they at least gave me the courtesy laugh, but I have no idea if they got it and honestly I was so out if it I didn't really care.  They wheeled me into L&D room #1 and had me change into the usual hospital robe from my cute binsi birth skirt that I was wearing.  They probably wouldn't have minded if I stayed in my own clothes, but at this point I was just ready to follow the typical protocol and have a baby already.

The smell of the hospital was quite familiar to me as I had helped many mamas in this very room, so I was actually comforted a little by being there.  It wasn't long before my Dr. arrived to begin talking about options.  First he checked my cervix and of course it was still only 3cm dilated and baby was still at a -2 station.  So I sat on my birth ball while he sat beside me going over everything that I had prepped myself for him to say.

  • Option #1:  Start IV antibiotics for the prolonged ruptured membranes, and get some Pitocin going to see if we could get even stronger (really?!) contractions to get more progress.  (As if the knife-like back labor wasn't already enough).  
  • Option #2:  Leave me alone to keep doing what I was doing but at the first sign of infection he would likely take me back for a cesarean.  
The Dr. told me to trust him and that if I would just let him do his job that he wouldn't abuse the interventions but would likely be able to help me have a vaginal birth.  I also remember him saying he wouldn't let anything happen to me, especially if we did have to go back for surgery.  This was actually really comforting to hear.  I do trust him, very much, which was why I had chosen him to be my backup in the first place.  I'd always seen him make really good decisions in the delivery room, and only used interventions when necessary.  He always gave mamas and babies ample time before making any big decisions, so I trusted that I was in good hands.  I warned him that I'm incredibly sensitive to medications so to PLEASE go lightly on the Pitocin.  He promised to use it very minimally and told me he wouldn't tell anyone if I had to get an epidural to relax.  This made me chuckle (in my head anyway)... my not wanting an epidural had nothing to do with not telling anyone or trying to be superwoman.  I told him that I was petrified of an epidural (for myself, for my baby, and for my birth outcome), but worried that with the stronger pitocin contractions on top of my already pretty excruciating back labor, that I wouldn't be able to handle much more.  They asked why I was afraid of an epidural... "where do I start?", I replied.  I had SO many reasons that I didn't want one. 

So I agreed to Option #1. After all... if I was going to just keep doing what I was doing we may as well have stayed home, so they started getting me all set up with my IV.  I sat on my ball and poor Marilyn and Andy were squeezing the hell outta my hips nonstop and pressing on my sacrum to help relieve my back labor.  Then they began the Pitocin.  I swear it had only been about 10 minutes (or less?) on the Pitocin when suddenly my pain was through the roof.  The contractions became so unbearably sharp (that's the best way for me to describe them... much sharper than before like bone grinding on bone) that I begged (aka yelled) for the nurse to turn it off.  I had to gather my thoughts.  I turned to Andy, and Marilyn, and my mama as I didn't know what to do.  My mom encouraged me that if I needed that epidural then to get it. I know Andy and Marilyn did too, but it was the conversation with my mom that stuck out the most for me. I felt so defeated.  She had both her children without epidurals, my sister had her baby without one, and here I was "unable" in my mind to keep going.  I remember feeling like if only I were at 8 or 9cm then maybe I could hold on and push through the stabbing pain in my back.  Knowing, however, that I was only 3cm and had only slept 1 hour out of the last 33 (and not even knowing that I would still have another 12 or 13 to go)... I just couldn't go on. I told the nurse that I would agree to an epidural if they would just shut off the Pitocin and then start it again after the epidural was administered.  I was shocked that the nurse actually agreed right away.  (I've often seen nurses who refuse to pull back or shut off Pitocin once it has begun, or at least put up a stink in doing so).  At this point I'm sure I probably became quite the drama queen with each grinding contraction, but again I just didn't care.

So next thing I know they're ordering me an epidural and I'm feeling completely defeated yet relieved at the same time.  I was exhausted and the contractions were still getting stronger.  I never thought I'd say it, with all my fears around epidurals, but I couldn't wait for that anesthesiologist to get there!  I was so nervous about a needle in my spine, and having to sit still through the procedure was pretty near unbearable since the only way I'd been coping thus far was to move through each contraction.  I sat petrified hugging my nurse and squeezing Andy's hand.  Everyone else had to the leave the room.  The anesthesiologist mentioned that I might feel a "zing" down one leg like hitting my funny bone and BOY did it zing!  Weirdest jolt ever.  As the contractions hit even harder while I was sitting as still as possible,  I grabbed something very tight and squeezed with everything in me so that I wouldn't move.  Then I heard, "that's right, you just squeeze me... just keep squeezing me".  I realized I was squeezing the nurse's love handles!!!  (And I swear she was really quite thin). I hope I didn't give her a complex cause I managed to grab a really big handful of skin!   Next thing I knew they were taping me up and after a few short minutes I was laying down with instructions to rest.
Now I realize that I'm an odd bird when it comes to this next part, but to be quite honest I hated having that epidural.  I know, I know, most people think it's a cakewalk from then on, but not me.  First off, I remember it made me itchy... like claw-my-skin-off itchy and while I knew that was a common side effect for some people, I didn't realize how overwhelmingly itchy it would be.  They offered me a narcotic to help with it, but I wasn't willing to have a baby that was sleepy or unable to breathe from a narcotic so that was easy for me to decline.  I just told myself over and over again "my skin feels fine, I'm not itching, I'm not itching...".  It's odd not being able to feel your lower half, yet you can still feel that it itches.  But the itching was the least of my concerns.  Next, half of my epidural wasn't really taking so I could still feel my left side.  The pain level, however, was much less than without the epidural, so I figured I'd just keep breathing through my contractions.  The nurse noticed and said that I should be able to sleep through them, which clearly wasn't happening, so they called the anesthesiologist back to come and give me another bolus of medicine.  After that, my lower body was SO numb that it didn't feel like my own.  Like at all.  It was dead to the world... I remember laying there and the nurses would move these massive heavy legs in front of me, but they just weren't mine.  They were fat and hot to the touch, but it was literally like touching someone else.  That completely weirded me out and I started having fears of having to get up and leave in an emergency... after all it was almost Sept. 11th and it's hard not to think of random emergencies, right?  Not being able to move my own body was terrifying for me.  Yet even that wasn't the worst of it.  The hardest part for me to deal with was that I began having chest and head tightening with each contraction which to me meant that I was clearly going to die. (Clearly).  I couldn't feel my belly or back anymore, but I knew every time I was having a contraction because my chest would slowly start to tighten which would then squeeze it's way up to my head and it seemed harder for me to breathe.  At this point I was actually glad to be in a hospital... when you can't feel your body and you are laying there in the stillness, all you are left with is your mind. Mine can be awfully good at convincing me of some pretty frightening things, so this little combo wasn't such a good mix for me.  My nurse assured me that she was watching my vitals and that my heart looked just fine.  This did help, but no one could explain why my chest and head would squeeze with each contraction.
I felt bad for my team.  Normally, as a doula, everyone gets a slight rest once a mom gets an epidural.  It's usually a welcome break for all involved when it's been hours upon hours of such hard work.  But I wasn't resting at all, and therefore neither were they (not much anyway).  They all took turns standing by my side.  I remember my mother standing close, rubbing my hair, kissing my forehead and comforting me while I was finally able to articulate what I had been feeling prior to the epidural.  Then she and Andy decided to try and get some sleep since they had both been up with me for so long. In fact, I forgot to mention in the previous post that my mother was the one squeezing my hips in the middle of the night back home while Andy got some rest.  She worked tirelessly for her baby the way I was working so hard for mine.  It's kind of beautiful when I think about it. Needless to say I was incredibly grateful that she was still in town for all of this!
At this point my brain wouldn't stop and I felt so anxious just laying there unable to move.  The tightening in my head and chest was making everything worse and I worried whether my heart would be able to handle pushing when the time came.  Marilyn stood by me and just placed her fingers in the center of my chest and offered me essential oils to smell.  It immediately calmed me.  Then of course the shaking/trembling started.  I remember my teeth were chattering and Andy thought I was cold.  I see this so often with moms and I let them know that it's completely normal. But being on the other side, it didn't feel normal.  I couldn't tell if it was truly from the medicine, or the hormones, or because I was so anxious.  It felt like I was panicking.  Either way, whether it was caused by my worries or caused by my hormones or caused by the medications, it definitely felt awful and therefore it made me worry.  I remember thinking this was NOT what I had in mind when it came to my birth.  I had pictured myself staying nice and relaxed, knowing what to expect at each stage and what to do.  I knew that my baby would feel everything I was feeling and I wanted his entry into this world to be calm and peaceful.  And yet here I was feeling very panicked, and nervous, and jittery, and wide awake. Though to be honest, with my history of anxiety which always crept up during hormonal times, I'm now surprised that it didn't ever enter my mind that the crazy hormones of labor might just snag me again! Thankfully Marilyn stayed by my side for many hours to help keep me calm while the others slept.

At around 1am or so (I think) Ali, my photographer/one of my closest friends, walked in.  I was SO excited to see her sweet face as she walked up to my bed and hugged me saying, "ohhhh friend...". For some reason it felt like such a relief to have her there by my side and I just broke out in tears.  She was so sweet to come.  This was the weekend that she was unavailable and yet she still made it in the middle of the night, exhausted from all of her other goings on, AND to top it all off she too was pregnant in her first trimester!  (I can say that now that it's public news!)  Marilyn was then able to join the others for a nap and Ali stayed by my side, holding my hand, and chatting with me. I told her about everything... from my water breaking to how we'd ended up here.  She was so amazing and calming and encouraging that you'd think she was a doula too!  Ali and I tend to think similarly so she knew just how to talk me down from all of my "what if's" that I was constantly throwing out left and right.  After quite some time, and I don't remember what time it was, I was calm enough that Ali was also able to go lay down for a little nap.  During that time my sister, back in Richmond, was also my rock.  She would text me funny, completely random tidbits to sidetrack me and make me laugh.  I knew she was thinking of me constantly and praying from afar.
In the middle of the night at some point, my OB came into the room to check me.  He walked in and there were bodies all over the place sleeping in the dark.  "WOAH.. " he said, "it looks like a refugee camp in here", which made everyone laugh.  I was nervous for him to check me... I kept thinking, what if there hasn't been any change?  Thankfully, there had actually been some progress... I was now 6cm dilated but the baby was still at a -2 station.  This worried me.  I feared that he was too big, since everyone loved predicting that I had a massive baby, and that perhaps he wouldn't be able to descend into my pelvis. {note to readers:  don't ever tell someone who has to pass a whole person through a small opening in their body that said whole person looks like he's going to be huge! Even if you think it, just shut the heck up and move on!} I also worried because he was still OP and now I wasn't able to get into all the positions I could have had I been mobile in order to get him to rotate.  Ugh.. I'd seen it plenty of times before with other mamas, and now it looked as though it may just be my fate too.  At this point Marilyn suggest we use her peanut ball.  Thankfully our nurse knew exactly what the peanut was from working at another hospital where it was a standard tool (I feel like she was from Minnesota or something), and so Marilyn ran out to her car to grab it.  {In case you have no idea what I'm talking about, or are a doula and would like to order a peanut: click here}.  So together, the group moved my heavy ass legs to get my body on its side to place the peanut between my legs.  The key is to have your upper hip pointing forward towards the mattress instead of stacked above your lower hip.  This rotation towards the bed, coupled with the widened hips propped by the peanut, allows for the pelvis to open and gravity to help rotate the baby around to a more ideal position.  The nurse was so sweet, I remember she couldn't get a good heart rate on the monitor for the baby in this position so instead of making things convenient for her and making me move, she stood for what seemed like many hours holding the monitor to my belly and moving it every time he would shift.  I felt so blessed to have such a great team even if this wasn't the picture perfect scenario for my birth.

At some point towards morning the doctor came back in to check me again.  At this point I had been mentally prepping myself for the last few hours for him to potentially see no change and to suggest that we do a cesarean.  I was so afraid, but kept telling myself that it was going to be ok, no matter what he had to report.  So he gloved up, squirted some lube on this glove, and asked me to butterfly my legs in the usual cervix-check-fashion.  I took a deep breath as he began his exam.... hoping, praying.  Suddenly he was offering me a fist... as in to give him a fist pump (with his clean hand)... and he said, "I don't feel any cervix!  You're complete... and the baby is.... (digging for another minute).. at a +2 station"! (or was it +3? I've forgotten). He said that he could feel that I had plenty of room in my pelvis for him to rotate and that he was now making his way down!  I was shocked!  I cried out, "REALLY??!?"!!!  Those who were sleeping woke to all the commotion and we started picking up the 'refugee camp' to make room for delivery!  He actually had to run into a scheduled cesarean at 8am so he told me to hang tight, labor down for a bit (this is when your body brings the baby down with more contractions rather than having to push for hours), and that we could start pushing around 8:30am or so while he was in the OR.  He was sure that "unless she's a crazy pusher" he would be back in time for delivery.  My legs were so numb from that second bolus that I asked them to pull back on the epidural so that I could feel to push.  They called the anesthesiologist in and it wasn't that much longer before I started feeling the typical "butt pressure" (or more appropriately termed "rectal pressure") from the baby's head moving down so low.  I also started feeling a bit nauseous which I knew was completely typical of this stage of labor.  Just then my mother and Marilyn walked in with coffee and gave one to Andy.  I think he gave me a kiss and I smelled it on his breath, and right then I knew that I was going to puke.  (I normally love the smell of coffee!).  The nurse got me a plastic container to hold just in case, and I asked for a piece of gum or something to take the icky taste and smell away.  Andy gave me a piece and I remember the nurse warning me that sometimes producing saliva makes the puke come faster.  I put the gum in my mouth anyway, chewed about 2 times, and literally threw up in the bucket right then.  As I was vomiting I could feel my stomach pushing down on the baby.  I asked the nurse if it was possible to "puke out the baby's head" from all the puke-pushing.  She thought I was fine, but it felt awfully close to me.
Many mamas have fearfully asked me if they were going to poop when pushing.  I always explain to them that they might, but it's always just a little and everyone is so used to it that it's really a non-issue.  But as I was sitting there and starting to feel more and more pressure it felt like I was pooping just sitting there!  I remember asking the nurse to check under the covers because I was "sure I just shat the bed."  She peeked and assured me that I hadn't... but man was that pressure intense!

At around 8:35/8:40am everyone got into place- both Marilyn and Andy grabbed a massive leg and I started pushing.  I remember I could still feel my chest tightening with each contraction and so I didn't want to hold my breath to the count of 10.  I still pushed with all my might which made me incredibly hot and thirsty. Marilyn was giving me water to drink and putting cold compresses on my forehead between pushes which felt amazing!!
It wasn't long before they told me to reach down and feel the top of my baby's head.  It was incredible!!!  He was so close! I asked everyone if they could see any hair and they all nodded with big eyes, "oh yes! lots of hair!" I started gently stretching my vagina around his head with my fingers... amazed at what was happening. Ali was clicking away with her camera and I kept hearing "oohs and ah's", and "yes Juli, push like that!" when I was making more and more progress.  Andy was adorable.  He kept kissing me and telling me how amazing I was doing.  His eyes would get big watching (yep, he looked!) and he would turn and encourage me more and more.  
I don't know how many more pushes there were, but it wasn't long before the nurse asked me to stop.  Normally at this point they bring the Dr. in but for some reason he wasn't coming.  I asked through sweaty panting where he was, and she was reluctant to admit that the dr. was still in the OR!!  WHAT?!  At this point (and yes I could feel everything) I was gritting my teeth saying "I can't stop though.. I can't wait!", so she quickly called in another OB to catch my baby.  Within a minute or so this woman came in and sat on the bed.  Part of me was disappointed as I really wanted my own backup to be there... he had been with me through so much of this journey and we already weren't having the birth we had hoped for, so I wanted HIM damn it!  But another part of me just HAD to push RIGHT NOW.  "F**k it", I thought... and started bearing down. {Please excuse my language... but L&D isn't for the mild mannered. When the going gets tough, the sailor mouth gets going!} Right then my OB burst through the door and suited up as quick as he could.  YAY!  

I remember he sat down and as I was pushing he said something about thinking this was going to be a pretty big baby... I grunted out, "NOT. HELPING." He laughed and said, "why?  He's coming out this way now!" (Clearly spoken like a man!) :) I remember saying at one point, "I can't... I can't anymore, I just can't"... I was so tired and it was so hard, but he was so close.  Then I thought "damn it Juli, you have to, otherwise it's surgery", so I gave it one last MASSIVE push through that terrible burn (and to be honest it felt like I was tearing straight up through my clitoris.  Sorry for the TMI).  I felt a sort of pop, and then the dr. was telling me to hold off a second because the baby's head was out!  He unlooped the umbilical cord from around his neck and then asked for another easy push.  Or maybe it was another big one....  I can't remember.  I just know that baby was so tight and I needed to get him out NOW!!  Next thing I knew there was this huge release as our sweet baby boy came slipping out of me and was gently placed onto my chest.  He cried immediately and I was SO relieved to be done!
I could hear all the cheers in the room and the sound of Ali's camera click-click-clicking away, capturing every single precious moment.  I looked over and saw my mom and Ali holding each other crying.  I looked up at Andy, he was crying.  And most importantly our little son was perfect, I couldn't even see him very well from my angle, but I just knew that he was. I gave him immediate kisses and began singing to him... the same song that I'd been singing to him for many months.  "Sleepy Man".   Not a lullaby per se but a song that meant a lot to me and felt appropriate.  I remember towards the end of the song, my Dr said, "I don't want to interrupt your singing, but I need you to give me another little push..." I did and out slithered my placenta.  It felt SO amazing to get it out... like a huge weight just plopped out of me.  (Well, Juli, I guess that's because a huge weight had just plopped out of you!) Of course I pretty much immediately asked the Dr. if everything was ok. "Am I bleeding too much?", nope.. very normal. "No amniotic emoblism?", with this one the dr. chuckled and assured me that I was fine.  Sigh of relief... I'd lived!

The doctor checked me out and I had a few very small tears that he decided to repair.  As he began to stitch, I hollered out that I could feel EVERYTHING and that it felt like he was putting a fish hook through my vagina.  "That's pretty much what it looks like," he joked. I could feel the thread of the stitches pulling and I decided to focus on my little boy rather than all the action downstairs. We decided to tell everyone his name as I held him to my breast and he began rooting for my nipple.  Beau David Brocato.  He latched on immediately and we sat blissfully nursing, loving, and thanking God that we'd finally done it!  We spent the next few hours bonding with him.  No one was to take him from my chest.  It was beautiful and perfect.  After those first hours had passed they checked his weight, 7 lbs 13.8oz, and his length, 20".  Andy got to hold him for the first time, so he stripped away his shirt and they put Beau skin-to-skin on his chest.  They brought him a warm blanket to wrap around them and I could just see Beau looking up at his daddy while cooing the cutest excited little sounds.  We all laughed at how vocal he already was!  We continued to take pictures and basked in the sweet moments as a family of 3.
While my birth was nothing like I had planned or perhaps I should say, preferred... it really was perfect in it's own way in the end.  I do have a different perspective now, of course, than just being the coach on the sidelines.  But now more than ever, I know that every birth is different, every woman is different, every baby is different and you just never know until you get out there and give it a go.  You make the best decisions that you can as the circumstances arise and you have to be ok with them.  At the end of the day, I didn't give a crap where I was, who I was with (minus Andy of course), or whether or not I had a medicated vs. unmedicated birth... I just wanted my baby to be ok and to live to tell the tale!  Will I try for a natural birth if we have more children?  You betcha!  But the experience was so positive, all in all, that we think we'll just have a hospital birth next time with our doula.  (Who would have ever thought I'd say that!) Do I think that had certain circumstances been different (like his fetal position) that I could have done it without medication?  Indeed I do.  But I also know that I could be wrong and if I were to have the same sort of experience again, that it would be ok and that we'll make the best decisions that we can in that moment because it too will be different from this one.  Do I feel just as passionate about natural birth, our body's ability to do this on its' own, and the need for less intervention surrounding birth?  Yes!  I'll always feel that way, but I'm also grateful (as I always was) for the interventions that we have in place when we need them.  Can I say that had I stayed home and just left well enough alone that we wouldn't have had a successful home birth-- long-- but without complications?  We may very well could have had a beautiful birth at home.  I'm not playing the "had I not gone to the hospital one of us would have died" card.  All I know is that we had to make some tough decisions and didn't personally want to risk it for a specific experience or idea, and in the end we received the best gift in the entire world-- no matter where we chose to birth.

No matter what path a baby takes to enter into this world, he deserves that moment to be a joyous celebration filled with love and wonder and that is exactly what our sweet baby Beau got!

From the many things I already knew surrounding birth, I had no (real) idea that my life would become so amazing and beautiful and sweet and hilarious and blissful and blessed and filled with such joy and love and anxiety and fear and exhaustion, or that we'd be faced with the toughest decisions we'd ever have to make (and those aren't even the ones at the hospital!), or that I wouldn't change any of it for the world. It's amazing to me that in one moment- that first sweet breath of life- I could fall so deeply in love with another human being in a way that has truly changed my life forever.  
Thank you for taking this special journey with me.  It was a long one but proved to be the best journey that I've ever experienced!

*Photo credit to Ali Caudill Photography.  


  1. "...and it's only just begun... "
    :) thank you for sharing so honestly and beautifully, dearest Juli.
    For those WITH and for those WITHOUT, this is account is enlightening and lovely.
    xox C

  2. So very beautiful Juli!! Congratulations!