A consumer reviews

Nashville may be Music City, but it also hospital central.  There are several large hospitals here, and several hospital corporations (that own hospitals nationwide) are based out of the area south of Nashville.  Vanderbilt is the academic medical center in Nashville.  It's where the most critical patients go, where the research happens, and is commonly where people go for advanced types of care.  But for things like childbirth, most women head to Baptist Hospital.  It's a newer hospital with more updated facilities.  Academic hospitals like Vanderbilt, which house the NICUs and handle the most complicated pregnancies, often treat every pregnancy as though it were a potential disaster rather than something normal, so a lot of women choose to go to a nearby private hospital that are more "childbirth friendly" for uncomplicated pregnancies.  In Charlottesville, many women -- even the wives of UVA doctors -- went to Martha Jefferson to have their babies.  Here, it's Baptist.  When I got pregnant, I talked to a lot of women who'd given birth in Nashville, and pretty much all of them had gone to Baptist.  The one woman who'd recently birthed at Vanderbilt wasn't happy about her experience.  But our insurance covers best at Vanderbilt, and given my history and the fact that I was using a midwife, Wes and I agreed that we would go to Vanderbilt.

And for anyone out there wondering about the same things, can I just say, Vanderbilt was great.  I have absolutely no complaints and actually found my experience there to be better than what I experienced at Prentice, which was brand new and beautiful when I gave birth to Oliver.  My midwives were supportive without being pushy the day of the birth.  I checked in with the midwife on call, Melissa, on Thursday morning to let her know I was laboring and to see when I should come in.  She reassured me that I could stay home as long as I felt comfortable, even with my GBS+ status.  When I called the triage nurse later that day, she offered for me to go to the hospital or come in to be checked, and really left the decision completely up to me.  And when I got the hospital, L&D was already expecting me and had a room ready for me to go to.  The nurses who took care of me were kind and thoughtful and respectful of the fact that I was yes, a laboring mom, but also an intelligent women who didn't need to be coddled.  We laughed about some of the questions they had to ask, and they praised my demeanor through the contractions (though I'm sure they do that with everyone).  When the anesthesiologist came in to talk to me about pain medications, she started by saying that she'd read my birth plan and knew I wanted to go natural, but explained that she needed to get a consent ahead of time in case there was an emergency.  And that was how pretty much everyone was -- informed and supportive but not pushy.  It seemed like everyone had actually read my birth plan, contrary to everything I'd ever heard about having a birth plan.  And people respected it but also made me aware of my options.  They knew I wanted no separation of care.  They paged our pediatrician so Wes could talk with her about treatment for the aplasia plus untreated Strep B.  They sent in a lactation consultant each day just to check on me since they knew I was breastfeeding.  No one pushed me to send her to the nursery so that I could sleep.  No one casually suggested I give her a bottle of formula.  They were very respectful of our wishes are parents.

I'm sure the reason some people don't go to Vanderbilt or hospitals like it is the presence of residents and medical students, but with a midwife I got to skip out on all that.  And in fairness, the rooms aren't nearly as nice as what Prentice had or what presumably Baptist has.  They're a little small for a bed, cot, bassinet and all the people who come and go.  The bathrooms are a little run down, the shower makes you claustrophobic, and the towels a dinky and well used.  But for the couple extra thousands dollars we would have paid to go to Baptist -- compared to the $0 we paid to deliver at Vanderbilt -- it hardly matters.  I truly felt like I had the birth I wanted to at Vanderbilt, and it was nice being "in house" at the place where Wes works and I study.  And hey, Emme had no complaints.

A speedier delivery

Emmeline's umbilical stump fell off yesterday, which meant she was able to get her first real bath.  It almost means she's been home for more than a few days, which means a recounting of her delivery is most certainly overdue.  So here's the story.

I'd been having contractions, cervical pressure, even some rectal pressure for weeks leading up to delivery day.  I honestly began expecting an imminent delivery around 37 weeks, which is probably why it seemed like I was so late, when in reality Emme was born pretty much right on time.  So when I spent Wednesday afternoon feeling more uncomfortable than usual, I thought it was just another stage in the wait-and-see game.  By Wednesday night, though, the contractions, as I finally recognized them to be, were consistent enough that I started noting the time.  They were 15 minutes or more apart, irregular, and nothing that had me completely convinced.  I tried to sleep, but the contractions kept waking me up, so I moved upstairs to the nursery so that I wouldn't both Wes.  I tracked the contractions on and off with a timer on my iTouch.  Sometimes they were 10 minutes apart, sometimes more than 20.  I rested between then, but I didn't really get any sleep.  Many of them were painful, not just uncomfortable, and I was breathing, even groaning, through them.  By morning, they were 6-8 minutes apart.  Wes got up, got ready, and in my short time alone with Oliver, we decided he should go to daycare as I was going to get no downtime if he were to stay home.  I called the midwife, who assured me I could wait awhile to come in, and my mother, whom we asked to travel up if the roads were safe enough.  In the time I was up with Oliver and making phone calls, I got worried that the contractions seemed to drop off.  I would still have a painful one every once in  awhile, but some seemed really far apart.  It's like my labor was stalling.

I tried to go to sleep after Wes took Oliver to daycare, but once again, things were consistent enough to keep me awake.  I finally gave up and got in the bathtub, hoping it would give me some relief and either stop things all together or speed them up.  After I got out, I finished packing my hospital bag (which I'd gotten out the night before) and sat down in the rocking chair in the living room and started watching Anne of Green Gables (from which Emmeline's name comes).  My mom arrived.  Wes went in to work for a meeting, then came home and took a conference call.  The labor continued on as previously -- sometimes close together, sometimes a long time between them.  I was getting frustrated, feeling like nothing was as I expected or had experienced with Oliver.  I felt like I didn't know what to do.  Around 2pm, Wes pushed me to go to the hospital.  I was hesitant but knew I couldn't spent another 12 to 24 hours in this state and still have the energy to push a baby out.  So I called the midwife on call and instead got the triage nurse in the office.  She said I could go to the hospital or I could go to the office and get checked.  I didn't want to go home from the hospital because I wasn't far enough progressed, so I elected to go get checked in the clinic.

Wes and I got out of the house around 3pm.  I had one contraction in the waiting room (and was worried I was scaring the other very pregnant, but not laboring, woman there), then sat on the monitor for awhile with none.  I figured the midwife was going to think I was nuts, insisting I was in labor or even uncomfortable with so few contractions.  She talked about my options if I wasn't ready to head to the hospital -- including some "therapeutic rest" (which I think means some narcotics so I could sleep).  But then she checked me -- and I was 8cm, 0 station, 100% effaced with a bulging bag of waters.  She said as soon as my water broke, I would be ready to push.  And so we were off.

When I got to the check-in desk at the hospital, the woman behind the desk seemed in disbelief that I was there to have a baby.  I assured her that labor and delivery was expecting me, and she sent me back.  The nurses in L&D laughed when they saw me coming in.  They said, "We sure are impressed with Miss Elizabeth, walking in here like that at an 8."  They made me feel good about my progress, after such a strange labor.  I got changed into a gown, hooked up to a monitor, and had an IV put in so that I could receive the antibiotics for my GBS.  They asked me lots of questions -- "Highest level of education?"  Umm, still going.  The midwife came and saw me.  They weren't going to move along my labor -- by breaking my water, for example -- because they wanted me to get at least some antibiotic first.  There were no other laboring patients from the clinic, so the midwife sat with me for parts of the next hour.  She was very encouraging, told me I made it all look easy.  The contractions got slightly more regular and a little more painful.  I groaned through each contraction.  After about 6-8 of them, I started to feel pressure.  After a few more, the midwife offered for me to move, and I said I wanted off my back.  They laid the table down, and I immediately felt an overwhelming urge to push.  And so it was time.

With Oliver, I never felt the urge to push.  I got to the hospital, they told me I was complete, and they encourage me to start pushing because the situation seemed emergent.  I had to get myself to push.  This time, there was no way I could have not pushed.  The urge was so strong.  Melissa, the midwife, checked me with the next contraction and told me I could start.  And then, I couldn't stop.  I pushed so hard and couldn't get myself to stop between contractions.  I held tight to Wes's hand and just pushed and pushed.  There was a little screaming, a swear word, and a lot of self-help talk -- "We can do this.  We can do this."  (I think the "we" was me and the baby.  I don't know.)  I knew it was only going to last so long, but this pain was definitely more than I had with Oliver.  It was just all coming so fast.  There is no possible way to describe the feeling of pushing a baby out.  It feels like your body just can't possibly fit this thing out.  It hurts.  And then it's amazing.  Her head came out, and everyone told me to look down.  And strangely enough -- there was a baby there.  One I didn't recognize but that clearly was mine -- since about half of her was still inside of me.  They pulled her out and put her on my chest.  They left the cord attached until it stopped pulsing and then cut the cord.  Wes and I immediately started looking her over, both at her head, and laughed at each other for doing it.  He spotted the aplasia before I did, and though we both feared the possibility, we weren't worried when we saw it.  We knew what it was, and it clearly wasn't as serious as Oliver's case (only one spot, and almost filling in).  They let her sit with me for a little while before taking her to be examined.  Wes went with her as there were other concerns, including some skin abnormalities, and midwife tried to give me some time before putting in a few stitches.  They had some trouble getting me to stop bleeding.  I ultimately got Pitocin, Cytotec, and Methergine all to help with that.  My uterus was firm, but I was loosing large clots of blood even into the next day.  They brought Emme back to me so that I could nurse.  We had to stay in the delivery room until my bleeding was under control.  The nurse got me out of bed eventually so that I could go to the bathroom (an experience that made me very sympathetic for the my potty-training toddler, who is constantly watched to make sure he pees).  I got woozy on my way back to the bed, so they got me some applejuice.

We finally made it post-partum around 8pm.  Wes went with Emme to the nursery to get weighed and measured and have a pediatrician check her out.  They were gone awhile, and it was after 9pm by the time they got back.  Wes ended up staying the night at the hospital so that he could help me if I got woozy again, but I ended up being fine that night.  Emme slept okay, and it was mostly the endless parade of nurses, care providers, and other people checking on us that kept me from really resting.  The rest of the stay was largely uneventful.  I saw Emme's pediatrician, the lactation consultant, and the midwife the next day.  My mom and Oliver came over in the morning to meet the baby.  Wes spent Friday evening with us and then went home to sleep and came back for us the next day.

Wes asked me Thursday night if I would do it without pain medication again for the next baby, if I had to make the choice right in that moment.  And I said I would, if I were able to.  My labor this time was very, very bearable because the contractions were spaced so far apart.  But for the duration -- about 18 hours before delivery -- I never had a moment when I thought, "I wish I'd gotten an epidural."  And by the time the pain of delivery was there, it was way too late to consider that option.  And as intense as it is, there's a brief recognition of -- "Hey, that thing that really, really hurts down there is my kid coming out." And that's just cool.  

Emmeline's birth, a pictorial

Oliver visiting with me while Wes was in the shower.  His last morning to be the "baby" in the family.  I had been up laboring all night and was in no shape to be dealing with a toddler's morning antics!

At the hospital getting checked in.  I was getting penicillin and being monitored.

In her bassinet once we moved to post-partum.

Oliver meeting Emmeline.  He brought the sheep and blanket as a gift to her, but he wasn't willing to part with them once he got there.  

Having trouble with her hospital hat.

Looking at the world from inside her bassinet.

My girl

Emmeline Mae was born Thursday, January 13, 2011, 89 years after her paternal great-grandmother, Elizabeth.  She was 7 lbs., 4 oz., and 19.75".  She has dark brown hair, dark eyes, and long, skinny fingers with manicure-ready fingernails.  So far, she is very alert, likes to nurse, and loves to be held.  Welcome, dear daughter.

Speedy Delivery

Note: The following is a posting about Oliver's delivery. It contains certain details that might freak out, say, a guy. You have been forewarned.

I frequently said going into Ollie's delivery that I didn't know what it was going to be like, and I was prepared for that. And I didn't know exactly how it would unfold, but I found that I was prepared for it. I was worried at times that not taking a class would mean I wasn't really ready to handle labor without meds, but since I wasn't 100% committed to being unmedicated, I tried to embrace that. As it turns out, I think I just knew my own "learning style." All the books and fore-flection (as opposed to reflection) on what could happen left me open to whatever, but knowledgeable enough to feel calm about the situation.

Contractions started around 3am on Friday the 12th. I woke up to use the restroom and notice cramping that felt similar to what I'd heard described as contractions. They weren't terribly uncomfortable and were pretty sporadic. When Wes got up for work, I told him, "I may or may not be having contractions." After he left I fell back to sleep for about another hour before the alarm went off for me, too. When I used the bathroom, I passed my mucus plug and knew then that I was within 24 hours of meeting my son. It was exciting, though I was nervous about what lay ahead.

I called Wes, who nixed my idea of going to work for as long as possible, and then the midwife (at Wes's behest), who confirmed that I was fine to stay home for as long as I wanted (unless my water broke). I talked briefly with my mom. Wes was already on a 6-3 shift, and since things were moving seemingly slowly, there was no real reason for him to use sick call and come home. I'd always believed I would labor better by myself early on, without him watching and worrying, and I think that was in fact the case. Not that he didn't know what to do, but that there wasn't really much, in my mind, that could be done.

I did, in fact, go to school for an hour to drop off some materials and talk to the teacher who would be taking over my classes on Monday. I saw some neighbors and then a bunch of teachers at school who couldn't believe I was up and about. I don't know what it's like for other women, but for me, those first few hours were just like intense menstrual cramps. I had to stop and stand still for some of them, but there was no need to breathe through them or anything like that.

When I got home from school, the nesting instinct everyone talks about really kicked in. I decided, as was only reasonable, that I needed to clean before the baby came. I took all the linens off the bed and started cleaning the bathroom between contractions, which by 9am were a little more uncomfortable and regular. I talked to my sister once or twice, who, when I had two on the phone with her (and that I had to stop talking for), forewarned me that labor was picking up. Wes called to update me on when he would be home and make sure I was okay. I rocked in the rocking chair, tried to get comfortable on the couch (the rocking chair made my lower back ache), and walked some. Kneeling didn't seem to do much for me. I think in that period of labor, I felt okay about being without drugs. I was still nervous about how much had to still happen (and I didn't know if I would be able to feel if I was dilating), but I was mostly focusing on the next contraction. I didn't really time them except for two 10-15 minute periods. I had a general sense of how often they were coming, but mostly I was thinking about the pain level.

Wes got home at 3am, took Lucy to the vet, and jumped in the shower. While he was in there I called the midwife, thinking it might be close to time to go in. I was getting to the point where I couldn't find any relief from the pain. She told me, though, that it sounded like I was doing well, and she would encourage me to stay home another hour or two if I wanted, maybe try the shower, and call her back. I did get in the shower for 30 to 45 minutes, which helped me get some relief before the contractions picked up even more. When I got out, I threw up pretty hard, which made me a little nervous and confirmed my desire to head to the hospital. It took at least another 30 minutes, though, for me to get dressed, to talk to the midwife again, and to get downstairs with our stuff.

By this point, I was groaning through the contractions. I was in our lobby for at least 5 minutes on my knees on the couch moaning while Wes tried to hail a cab -- during rush hour -- on Friday -- while it was raining. The cab driver seemed pretty calm, even with me moaning and groaning in the back seat, though Wes said he was clearly looking nervous when traffic was totally stopped on Lakeshore Drive. It took over 20 minutes to reach the hospital, which is 1 1/2 miles from our apartment. I could feel my water break and leak with each contraction in the cab (which, fortunately, I had foreseen and taken precaution to manage without damage to the cab). When we got out, I had 3 contractions between the taxi and the door of triage, a total distance of maybe 200 feet.

The triage people got me to see a nurse right away. I passed something else (more mucous plus, amniotic fluid, I don't know), and then she examined me between contractions. At that point, I thought I was maybe 7 or 8 cm dilated and had decided that, if so, I was going to get an epidural. I couldn't imagine another 2-3 hours or more in the state I was in. Fortunately, I was 9cm and baby was +2 station. We moved quickly up to labor and delivery, but, for reasons unclear to me, the midwife was not there. Instead, I was greeted by one of Wes's and my good friends who is a 4th-year OB/GYN resident. I had joked with her prior to the delivery that if she was in the delivery room, we could never be friends again. After she checked me, too, I looked at Wes and said, "Brook and I will never have the same relationship." There was some concern by the triage nurse and Brook that the baby was presenting weird, so an attending came in to have a feel, too. I begged to get off my back, which was horribly uncomfortable, and they let me squat on the bed. The contractions were at their most painful and most frequent at this point, and I was 100% dilated and effaced. They broke what was left of my water and encouraged me to start pushing. I tried, but there was no urge to push and it was horribly painful. People kept telling me not to make any noise and hold my breath, but it just didn't feel right.

At this point, I was offered an epidural. I was skeptical that it would work fast enough, but I couldn't fathom pushing through what I was feeling, so I said okay. A nurse got my IV going, which I needed for the penicillin (for Strep B) anyway, and the anesthesiologist did a fast run-down with me. Just about that time my midwife came in. She wanted to check me, too, and got me more on my side to do so. After she looked, she told me I didn't need an epidural, I was ready to push and doing great, and she cleared the room but for two nurses.

And then it just happened. I finally felt the urge to push, I was able to get a bit of rest in between contractions, and the midwife and nurses just encouraged and coached me through it. It's amazing how much difference it makes just to have someone there say, "Hey, you can do this. You're doing great." Wes stood by the bed and held my hand and let me pull against him while I pushed. I could feel the baby's head and the aptly named "Ring of fire." There was almost some comfort, literally and figuratively, in the realization that I was just going to have to do it, regardless of how I felt. That baby was going to come out. Wes asked if I wanted to see or feel his head come out, but I was doing much better just focusing on the pushing without associating it with any product. I know that sounds weird, but I didn't care if I was birthing a watermelon at that point -- I was going to push it out!

If there's one thing that recommends going without an epidural, it's the last 10 seconds of the delivery. I don't know what you can feel if you've had meds, so maybe it's not much different, but feeling that baby come of you is totally unbelievable. That was the moment when it all came together and I realized what had just happened. They put him on my chest, and I just smiled and laughed and rubbed his back. He was yelling up a storm (working for that 9 on his Apgar) and, save for the spots on his head, looked great. About 10 seconds out, he pooped meconium all over my chest, but I seriously could not care. They let me be with him for a minute before taking him to weigh and measure him and inspect his head. I passed the placenta with one easy push, and the midwife got me some meds before putting in a few stitches. It took a few minutes for me to be able to relax my pelvis, and I miraculously felt pretty good. I guess that hormone rush really does happen.

The nurses let us both hold him for a few minutes before taking him to the NICU to see a neurologist for the aplasia. I wanted to be with him, but I felt good knowing he was going to get seen.

The recovery has, thus far, been very good. Wes has been really cute about everything -- he seems so proud of my "performance," if you will, and tells everyone about it. I was in the door of triage around 6:45pm, baby was born 7:30pm, with about 20 minutes of pushing, and I was up and walking within a few hours of that. I know full well that most of what happened is just nature -- some women labor longer, suffer more painful or frequent contractions, deal with complications, etc. I'd like to think that my activeness during the pregnancy and labor helped some, and I am proud of myself for trusting that I could make it through, but mostly I'm just so grateful that things went the way they did, knowing that I owe it to biology and luck.

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