Wednesday, September 24, 2014

Caleb Tarasovich | Birth Story

Caleb Tarasovich joined us on Wednesday, July 23rd, 2014. This is his birth story.

I decided not to separate this into multiple posts. It's very long. Caleb's birth is just the mid point of his entire birth story, and it takes many words to document a birth that started in a birth center and ended with an ambulance transport to the hospital (don't worry - everyone was okay!) Enjoy - or don't! - I won't be offended if you choose to skip over the post.

For a good two weeks prior to Caleb's due date (July 25th) I had been incredibly antsy. Both Taras and I had guessed early on that our boy would join us right on time according to his due date, and that's exactly what happened. I probably could have just sat back and enjoyed those last weeks of pregnancy a bit more, rather than obsessing over when exactly he'd come. But I was so ready to meet our son!

The three evenings leading up to his birth I kept thinking that something might be up. Each night I'd eat a full dinner, then an hour later I'd be starving. All three nights we happened to be out - going for walks, running errands, etc. - and we'd grab me a plain little cheeseburger from Five Guys. I'd inhale the burger. Then, by the time we got back home, I'd be starving again. So I'd have a protein smoothie before going to bed. Every night for three nights. I was convinced my body was signaling me to store up protein and energy. On the third night of this, that Tuesday, I noticed some consistent Braxton Hicks contractions. The episode was short-lived but it was the only time I'd had any sort of consistent practice contractions. I thought that just maybe something might be going on.

Sure enough, I woke up around 4:30am on Wednesday morning, July 23rd, to go pee for the 12th time that night (ha! that's probably a slight exaggeration!) and I noticed some bloody show. The midwife instructed us to call her if this happened. Being that is was 4:30 in the morning and I didn't have any other signs of labor, we decided to get some food in me and then call our midwife at a more reasonable time. I had a big bowl of Trader Joe's O's, not knowing at the time it would be my last full meal. We sat in bed, eating and chatting, as we watched the sky light up outside of our bedroom window. We definitely had a reserved feeling of excitement as we made guesses as to how long it'd be before we'd meet our son.

At 6am we texted our midwife. We still had no other signs of labor so we decided an actual phone call at that hour was unnecessary. Our midwife called us almost immediately and we all decided to meet at the birth center at 9am just to check baby's heartbeat, my blood pressure (it had been creeping up a bit during the past couple weeks) and to generally assess where we were in the process.

Taras emailed his coworker to say he'd be into the office late and that he'd be missing an early meeting. Since I still wasn't having contractions, we figured this would be a long process and we both agreed it made sense for Taras to go into the office, then come home once my contractions started progressing. We didn't want to waste any of his days off.

Since we had time to kill until our 9am appointment, we decided to go out for breakfast. Breakfast was sort of our thing during pregnancy - we'd go to breakfast after our prenatal appointments and talk excitedly over eggs (him) and chocolate chip pancakes (me) about how our lives were soon to change forever. I remember so well the time we pulled out the just-taken sonogram photos to ooh and ahh over, as the waitress looked on with a smile. I remember sitting at a table with tears streaming down my face as I reeled after an appointment when we were told my cervix was short - a diagnosis that could have meant pre-term labor and/or bed rest. And I remember saying prayers of thankfulness at breakfast two weeks later when another ultrasound showed that my cervix was just fine. Breakfast tables around Portsmouth saw us through this pregnancy - the highs and the lows. And it seemed only appropriate that we'd have one last breakfast together as a family of two.

By 6:30am we were walking out the door to drive to breakfast - to The Golden Egg, where I could fulfill my craving of their chili and cheese omelette (so good!) - when I had my first contraction. It was exciting to have that first contraction! We continued on our way, figuring contractions would be mild for a while. Surely I'd be able to enjoy one last meal before labor really picked up!

By the time we were halfway to breakfast, I had a couple more contractions, and they had quickly picked up in intensity. When we made it to the restaurant, I knew two things for sure: I was having painful back labor and there was no way I'd be able to make it through a meal inside a restaurant. Taras went inside to get our breakfast to go. I stayed in the car and had another contraction or two and tried really, really hard to focus on using the relaxation techniques we'd learnt at birth class during the prior eight weeks. (Side note: since we planned for a natural childbirth at a birthing center, we took Bradley Method birth classes. I can’t imagine going through a natural birth without the education we received during these classes.)

The contractions continued to progress in frequency and intensity during the drive back home. Taras kept an eye on the car clock, taking a mental note of how closely the contractions were together. As I gathered myself between contractions, I looked outside the car windows and noticed that it was such a beautiful summer day. We passed runners and cyclists doing their morning workouts and I kept thinking about how it was just another day to all these people. But for us, we were possibly going to meet our baby today!

Once home, Taras helped me up the stairs. I got into bed and laid on my side, in the side-relaxation position that we had practiced a gazillion times during the prior weeks. I focused on relaxing and taking deep breaths, but I had varied success with fully relaxing through the contractions. In large part, I was thinking about how painful the contractions already were. Was my pain tolerance so low that even early labor was this bad? How did other women so easily get through these early contractions? Taras timed the contractions - they were coming every six minutes and lasting anywhere from 30 to 60 seconds. It was becoming clear to Taras and I that I had entirely skipped those early, easy contractions. In between contractions I tried to eat some breakfast - we knew how important it was for me to be fed and hydrated. I think I managed to get down a few potatoes and two bites of a bagel. I wanted nothing to do with my omelette.

Before I knew it, it was time to go to our 9am appointment at the birth center. I had a couple contractions during the car ride over. It was getting progressively more difficult to draw on the relaxation techniques to make it through each contraction. And the pain that comes along with back labor had started to intensify.

At the birth center we confirmed that baby's heartbeat was good and that my blood pressure was fine. Then came the question we knew to expect: did we want to get checked to see how dilated I was? We were prepared to answer "no" to this question. Your mental state can have an impact on how well your labor progresses and, often, learning that you're not as dilated as you expected based on the contractions can cause frustration and make labor digress. Taras started to answer "no" for us, as we had previously agreed on. But I was too curious and overrode our prior decision in favor of being checked. I needed to know. If nothing else, I wanted some sort of validation for how strong I felt the contractions already were. I promised myself I wouldn't get caught up on the numbers - I had a clear understanding that labor doesn't progress unilaterally. I checked in at 2cm, and that was after only three hours of labor.

We agreed with the midwives on a plan of action: we'd return home to continue laboring and then check in with them at 3pm. They told me not to get caught up in how painful the contractions already seemed - that as labor progresses so does my ability to handle the pain. (They were right.) They also suggested that I think of these early contractions as just painful menstrual cramps. But I knew better. I have always had painful menstrual cramps and these contractions felt much more painful than that. I think right then I decided that I was actually further along than what my cervix was showing and I knew that this baby would be joining us sooner rather than later. As we left the birth center, Taras emailed his coworker that he, in fact, wouldn't be making it in to work. His coworker replied "enjoy the process.” We both thought it was an odd response, but looking back on the day it makes so much sense.

Once back home, I got myself into bed. We had strict instructions to get some food and fluids in me. And I tried hard. But the contractions were too strong. I could only get fluids down. By this point, anything I had learned in birth class was out the window and I felt like I was in survival mode to get through all the contractions. Poor Taras kept trying to coach me through the contractions and to get me back on track with what we had been taught, but I wasn't having any of it. I had officially reached that point in labor where he couldn't reason with me. It was my way or the highway.

I labored in bed for another couple of hours. Halfway through, we decided to quit timing contractions for a while. He ate the rest of my uneaten breakfast. I managed a few more bites of a bagel. Then I threw up everything all over our bedroom floor. I tried to make it to the bathroom, but you can imagine how fast I was (not) moving.

We decided to put me in the tub to see if the warm water would help with the contractions. By this point I could tell the contractions were super close and I asked Taras to time a few. They were three minutes apart and were lasting about a minute. The standard of when to go to the hospital or birth center is when the contractions are consistently five minutes apart and last at least 60 seconds. I think we went through that phase right when we decided to give ourselves a break from timing the contractions (ha!).

While I was still in the bath, Taras called our midwife to update her on our progress. It was probably around 1:30pm at this point. We all agreed it was time for us to get to the birth center.

We grabbed our bags and slowly made it down the stairs and into the car. I had a contraction getting out of our house. Then another in the driveway. Taras and I knew we had waited too long to make the transition to the birth center and I knew the car ride would be brutal. It was. I felt every single bump that we drove over. I had six more contractions during the normally 12 minute drive to the birth center. Taras tried to pull over each time to help me through the contractions (thank goodness our drive was all back roads). The only thing that gave me any relief with the painful back labor was when Taras would forcefully shove his fist into my back.

We finally made it to the birth center. I would guess it was around 2pm. They were filling the birth tub with warm water and offering me hope that laboring in the large pool of warm water would help me feel better. I was willing to do anything at this point, as the contractions seemed to be at their peak of intensity. I labored in the tub for what seemed like a blink of time but it was probably more like an hour and half. They showed Taras another way to help me through the back labor - he had to squeeze the back of my hips together as hard as he could.  (Taras was steadfast in his position behind me on the outside of the tub, where he had the best angle to help with my back contractions. At one point I remember looking up at him to see sweat pouring down his face. He later told me how physically demanding labor had been on him and for a few days later he would comment on how bad his back hurt - and we'd giggle together about how ridiculous it was that labor took such a toll on him!) I used noodles to help float in the water and try to relieve some pressure, while the midwives and Taras took turns shoving coconut water and emergen-c in my mouth. I silently repeated, “I can do all things through Christ who strengthens me” (Philippians 4:13) over and over again as sort of a mantra to get through each contraction.

As more contractions passed I started feeling the more intense need "to poop," which is usually a good indication that the time to push might be near. I remember some of my final contractions in the tub being so strong that the midwives had to calm me down after the peak of the contraction, reminding me that the most intense part of the contraction was over and that I needed to save my energy for the next one. After a few rounds of those contractions and me continuing to declare that I felt like I was going to poop, the midwife checked and said that I was fully dilated and the baby was ready to come out!

I didn't want to give birth in the tub so we moved me into the bed. At this point, poor Taras couldn't do anything right. Every time he tried to help me, I'd ask him to stop. I remember one time I even asked him to stop “petting me” (he was just trying to soothe me by rubbing my arm).  But then I would let the midwives soothe me and touch me and I'd obey everything they told me to do. Ha! I'm not sure what that was all about. Sorry, husband. But Taras did hold my hand tight the entire time, and he frequently leaned into me, whispering encouraging words and hugging my shoulders.

I was happy the contractions spaced out as we moved into the pushing stage. It was nice to catch my breath a bit between each round of pushing. Despite having practiced pushing, I couldn't seem to get the hang of it in those moments. For some reason I kept feeling like it was a lot to coordinate: holding my breath, looking downward, and pushing, all at the same time. With each pushing contracting I kept thinking that I wasn't doing all the steps properly, and I'd ask the team to help me remember what to do each time I pushed. It was so weird how out of sync I felt with my body.

There was a moment when the midwife had me look at her and confirm that I understood that if at any point she instructed me to push hard with everything - if the baby was in distress - that I needed to agree I could do that. I agreed. After a couple more pushes the midwife couldn't hear the baby's heartbeat, likely because of where the baby was in the birth canal. But she told me I really needed to push with everything during the next contraction. The head needed to come out. They asked if I wanted a mirror to see. No, thanks. I pushed with everything that next time. I remember it felt like I was pushing forever. I pushed through the burning and exclaimed multiple times "it hurts so bad!" His head came out and he let out a scream before his whole body came out. And he took in some fluid right then. "He has hair!" they all let me know. With the next push, the rest of him came out, at 4:27pm, after about an hour of pushing (we're guessing - everything was happening too quickly for Taras to pay attention to the exact time of things). After a solid 10 hours of labor (6:30am-4:30pm), our baby boy was here!

They put him on my chest immediately. But we all knew he had taken in fluid and the priority above oohing and ahhing over him became making sure he was safe and well. While he laid on my chest, the midwife checked his vitals. He was so beautiful and so slippery! His respiratory rate was at 80, which is the point at which the midwives are required to call and consult with a doctor. All his other vitals were perfect. And he was perfect. His skin was beautiful. His eyes squinted open to look at me. I continued to hold him tight on my chest, with Taras by my side, as one of the midwives kept tabs on his respiratory rate. The midwives were wonderful during all of this, assuring us that our boy was fine. But regardless of how calm we were, this whole time was a blur. These moments that are usually spent in pure bliss, soaking in your new baby, were overridden by making sure he was okay.

We did manage to count his fingers and toes (but we didn't study his toes long enough to notice he had a couple of webbed toes!), notice just how much hair he had (I called it his Russian fur coat), look at him in awe, and give each other a celebratory kiss. When asked if he had a name, Taras and I looked at each other, almost unsure. Throughout all that was happening, we both seemed to hesitate since we felt we hadn't had enough time to just stare at him and make sure the name worked. But after a moment we said, "yep, Caleb!"

At the same time the midwives were keeping track of Caleb's progress, I was being checked to see how much damage was done when I pushed Caleb out. Turns out I had a 4th degree tear and would have to go to the hospital to get repaired.

After a little bit of time, the midwife told us that they needed to call the hospital and consult about Caleb. They assured us that he just swallowed some fluid and it needed to come out, but it was affecting his respiratory rate and they were required to consult. They knew the hospital would want Caleb to be transferred to their care, so they prepared us for that. Once they were off the phone with the hospital, they let us know the ambulance was on the way. Since I needed surgery to repair my tear, both Caleb and I would be transferred by ambulance to the hospital. The midwives hurried to finish their medical notes while Taras held Caleb so I could get dressed. Taras and I paused together to say a quick prayer before the ambulance arrived.

We texted our families to update them. At that point we expected that I would have a quick surgery repair and that Caleb would cough up the fluid and soon get the okay to be released, then we'd head home in a matter of hours just as we would have gone quickly home from the birth center.

Just an hour after Caleb was born, he and I were riding in the ambulance - all of this happened so fast. Along with the ambulance, a police officer and a fire truck showed up. It seemed like so much commotion! I just kept thinking... we're fine! Look at my beautiful boy - he's healthy! Look at me - I'm walking to the ambulance. I knew that we both needed hospital care but all the emergency vehicles seemed so excessive. But, you know, protocol. So I got on the ambulance bed, and held Caleb in my arms, as we rode to the hospital. Taras followed behind in our car. One of the midwives stayed with me in the ambulance, and another followed behind.

At the hospital, they wheeled Caleb and I through the emergency entrance and into the trauma room. I remember looking up and seeing "trauma" above the double doors and I continued to think about how much commotion we were making. Our situation was hardly of the trauma caliber. But, again, I realize it's just protocol and it's the room where they bring in ambulance patients to have them checked. I was thankful that Taras arrived right behind us. I knew I wouldn't feel comfortable letting them take Caleb until Taras was there to go with him.

I had to have surgery for my tear so it wasn't an option to stay with Caleb. Believe me, I tried. I couldn't believe that just an hour after birth we were being separated. My plea with the OB surgeon was that I was hardly bleeding, so there was no urgent need to repair me. She agreed that I wasn't losing much blood, but she disagreed that I could wait. So, right then my boy and I were separated. As much as I hated being separated - talk about being so far from what we imagined birth would be like! - I remember feeling calm and confident. I knew Taras would be able to stay with Caleb the whole time and the midwives had put us completely at ease about his wellness.

I was taken to a room and repaired, and the midwives stayed with me. It took probably 45 minutes. I closed my eyes the whole time because the couple times I squinted my eyes to survey the room, all I saw was blood. I don't do blood... so, eyes closed. I felt sad for a minute that Taras wasn't with me. Not because I needed him there - he was doing the most important thing by being with Caleb - but that guy loves blood and surgery and medical tools. He would have loved to watch them repair me. Once I was all stitched up, I texted Taras for an update on Caleb, and I started to get a few updates from the nurses.

During the time I was in surgery they had weighed and measured Caleb - 7lbs 6oz and 19.5 inches - and were monitoring his respiratory rate, and otherwise assessing him. They moved him from the trauma room over to the nursery, where he got put under a supplemental oxygen hood. A nurse mentioned to me that Caleb was on oxygen and I remember that moment being the first time during all of this that I wasn't calm. When I left Caleb, he was breathing fine - why was he on oxygen? Taras had yet to call or text me back and the nurses didn't seem to have any complete information to give me. After what felt like an eternity - but was probably less than ten minutes - Taras got back to me. Caleb was on oxygen because his blood oxygen level was a bit too low, and he was still breathing fast to make up for that. Now it was a waiting game to wait for him to spit up the fluids he swallowed and for him to get his respiratory rate down below 60.

At that point we realized that neither Caleb nor I would be released that night. We texted our family to come join us at the hospital.

Once Caleb was settled in the nursery, I was able to waddle over to see him. We were probably separated for an hour and a half. Seeing him, I was completely confident again that everything would be perfectly fine. Other than the minutes of concern when I first learned he was on oxygen, I generally felt calm and confident of his wellness all the way through this process. I remember taking mental note of how surprisingly calm I was and how I mostly wasn't phased about the turn our “ideal birth” had taken.

The pediatrician in the nursery let me hold him skin to skin as soon as I arrived in the nursery. He coughed up some fluid. His respiratory rate quickly went down to 60. It looked like, if all stayed this way, he would be in our room later that evening and then we could all go home together the next morning. For the next couple hours I stayed in the nursery, skin to skin with my boy. This was the first time I really got to stare him over, but it wasn't a private or intimate moment by any means - he was hooked up to monitors and doctors and nurses were all around. I was upset that I wasn't allowed to nurse him, but that seemed like a minor detail considering I was able to hold him in my arms.

Our families joined us at the hospital and came into the nursery two-by-two to meet Caleb. I didn't let anyone hold him. He stayed right in my arms, held tight against my chest.

After a couple hours, we decided to leave the nursery. I hadn't eaten all day and we knew Caleb would be in the nursery for a while longer, and we'd go visit again a little later. We got some food in us. Our families left. Then we took a few brief moment to talk, just Taras and I - filling each other in on what we had missed while we were separated, recapping in awe everything that had happened, and basically catching our breath after the marathon of events. Then, it was back to the nursery to check on Caleb.

When we got back to the nursery, we were shocked to learn that Caleb's respiratory rate was back up and he was back on the oxygen. He wouldn't be allowed to join us in our room that evening. We were bummed, but still confident that he'd be completely fine. After a short visit, I went back to our room for some rest, while Taras stayed behind. Soon after, Taras was joined by the pediatrician. She recommended that since it seemed there was still fluid in Caleb, and since it had already been a number of hours, the best course of action would be to take a culture to ensure there was no bacteria. If Caleb got an infection from the fluid, it would turn into a whole different situation, even presenting the risk of pneumonia. The one catch to taking the culture was that it'd take 48 hours for the results. And until the results were in, Caleb would need to go on antibiotics just in case there was already an infection.

There was no question that this was the best choice for Caleb's well-being. Taras and I both took it all in stride and in good spirits, considering we went from our ideal birth of no hospital and no medical intervention to an extended hospital stay and the first substance going into Caleb's body being antibiotics. Once the plan of action was decided, Caleb was hooked up to an IV of sugar water and antibiotics. I felt so sad for my little boy being connected to so many things! But mostly I was thankful because I knew it was all precautionary and that he'd be okay.

The nurse in the nursery suggested we go back to our room and get some rest. They'd let us know if anything changed with Caleb's status. Early in the morning we were back in the nursery and got a mixed report: he had a slightly scary episode early in the morning when a lot of fluid came back up, but the good news was that it seemed to be the last of the fluid. They were tapering him off the oxygen and he'd soon be joining us in our room. I finally got to nurse him for the first time, while we waited for him to be released to our room. A bit later, around 2pm in the afternoon, they brought him to our room, where he was able to stay with us for the rest of the 48 hour monitoring period to wait for the culture results.

After that, it was smooth sailing. We relished having Caleb in our room, where we could hold him as much as we wanted. Our families came back to visit and they were all able to hold him. We were finally getting those moments of new parenthood and celebration with family that I had been longing for.

Friday evening, what would be our last night in the hospital, Taras and I sat there and recounted the events of the last couple days. It was late and the halls of the maternity floor were nearly silent. I held Caleb in my arms with Taras sitting by my bedside. We stared him down. We re-hashed what a blur the two previous days had been. I processed through my emotions of all the things that didn't go according to plan - that when he was born, we missed out on the feeling of pure joy and merriment, in favor of being on guard to make sure he was safe; how we were all separated for a couple hours, especially that I was separated from Caleb; how I wasn't able to nurse Caleb for almost a full day; how we weren't able to just go home after he was born at the birth center; and how our little boy was hooked up to IVs and had antibiotics running through him. I think to some degree women need to mourn the parts of their birth story that didn't go according to plan, and that's what I did that night. It felt good to finally have a chance, together, to sort through the feelings and emotions of the past days. Above all else, we were just so thankful that Caleb was healthy. I knew it didn't matter that things didn't happen as we had planned. But it was an important step for me to talk through it all. We felt so blessed that he was ours. As we talked, we both just stared over him, soaking him in, tears of joy streaming down our faces. We finally had that moment that we never experienced when Caleb was born.

Saturday morning we were released. It felt so good to come home. Our family had decorated the house to welcome us back and stuffed our fridge with food. In the days that followed, we got used to a new normal.

Because of my bad tear, my recovery was longer and more difficult than I ever imagined. That's one thing about using midwives: they're known for easing that baby out and for using warm oil to help alleviate tears. But the reality was that Caleb came out fast, and there was no amount of oil that could have fixed that. I wasn't prepared to be bed-ridden for nearly two weeks. Taras had to take more time off work than we had planned, so he could continue to care for both Caleb and me. It wore on me that I couldn't get up to care for my baby - all I could do was lay in bed and nurse him. It was especially hard to watch on facebook as friends who had their babies in the same week as me had their first family outings, while I was stuck in my bed. It was not at all how I imagined those first days with my son would be.

Now that I'm writing this six weeks later, it's all good. I'm feeling great. I've gotten over the disappointment of how long it took me to heal and to be able to fully care for my son. I've moved on from the frustration that it took a long while before we had our first family outing. I look back at it all with nothing but happiness and thankfulness. I'm even ready to do it all over again. Someday. But first, I'm excited to spend the next days, months, and years getting to know this little man we call Caleb.

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