| Date and Time |
Event |
Wednesday
January 7th, 2004 |
Nellia was scheduled to be born on
or about December 31st, but there was minimal progress with the cervix
ripening and dilating. Typically, there will be some dilation and
softening of the cervix well before labor even begins -- sometimes up to two
weeks before. |
| 10:00 am |
We arrived at the US Naval
Hospital and checked in to our room. We had originally planned on
arrived at about 7:00 am, but we had a hard time contacting the right person
because of an inaccurate phone list.
 The
nurse began the standard series of exams and connected the fetal monitor.
The fetal monitor shows mother's heart rate, baby's heart rate, baby's
movements, and any contractions all in graphical format over time.
|
| 12:35 pm |
The doctor checked the cervical
dilation and found it to be only 1 cm with about 50% softening. Note
that the percentage of softening is only a subjective estimate from the
doctor based on experience. This is a manual exam. The doctor
decided to use misoprostal (also known under the trade name Cytotec®).
Misoprostal comes in tablet form and is inserted next to the cervix in order
to "ripen" it (i.e., thin it out and dilate it in preparation for uterine
contractions)..
Go to
http://www.gentlebirth.org/archives/cytotec.html for all the technical
details on how this chemical works.
|
| 12:50 pm |
The doctor administered a 25
microgram dose of misoprostal initially and said that we could wait until
the following morning before receiving Pitocin® (the trade name for a
synthetic form of oxytocin) to start uterine contractions. Since we
had arrived late in the day, there was no need to start an aggressive
program and have Gwen with contractions all night. |
| 1:45 pm |
 The
monitor showed that the uterus had contracted, although Gwen had not felt
it. The misoprostal had apparently caused contractions to begin on
their own. This is perfectly normal, but was not expected since the
cervix was so small to begin with. |
| 4:05 pm |
Administered a second dose of
misoprostal (25 micrograms). |
| 6:30 pm to 7:00 pm |
Several contractions felt.
Not painful, but definitely stronger than the Braxton-Hicks contractions
felt throughout pregnancy. |
| 8:45 pm |
The baby's head has dropped.
The measurement, known as "station", was approximately -1. Note that
"Zero Station" means that the baby is engaged in the pelvis. Negative
numbers mean the head is above the ischial spine; positive means below.
Cervix softened a little more -- approximately 55% effacement. |
Thursday
January 8th, 2004 |
Contractions continued through the
remainder of the night and into Thursday morning. |
| 12:20 am |
Right after midnight, Gwen said
that she thought she felt her water break. We had the duty nurse to
check, but she said that is was probably just the mucous plug, or part of
it, passing. She estimated Station still at -1. |
| 1:40 am |
Contractions are much stronger and
are happening more frequently. They have become very uncomfortable
over the past hour. |
| 2:15 am |
Much more fluid has leaked out --
red and greenish-yellow tint. The nurse confirmed that it was
definitely amniotic fluid and that it had meconium in it.
Meconium is the first stool from the intestines and is green and tar-like
in consistency. This is sometimes passed before birth and stains the
amniotic fluid. It is usually not a problem in small quantities since
it is sterile and the baby is not exposed to it for very long. |
| 2:20 am |
Contractions have increased in
frequency to 2-4 minutes apart. Baby has moved to Zero Station. |
| 2:40 am |
The nurse attempted to check the
cervix, but could not determine dilation. She called Dr. Schweitzer,
who happened to be at the hospital already. He determined that the
baby was now at Zero Station (confirming what the nurse had said),
effacement was at approximately 90%, and that dilation was 3 cm. |
| 2:55 am |
Fentanyl, a narcotic analgesic
safe for use during pregnancy, was administered for pain relief. |
| 4:30 am |
The effects of the fentanyl, which
has a short duration, wore off. Gwen could feel very strong
contractions and could not sleep. |
| 5:50 am |
Another cervical check: 4cm
dilation, -1 Station (unknown why the measurement indicated the baby had
move back up), and complete (100%) effacement. |
| 6:10 am |
Discussed pain control options and
called the anesthesiologist. We decided on an epidural since the
catheter is left in and medication can be continually administered
throughout the procedure, regardless of duration. |
| 8:00 am |
The anesthesiologist arrived and
went over the risks/benefits of each type of pain control technique.
Gwen signed the consent form. |
| 9:00 am |
The epidural was placed, but the
catheter went into the cerebro-spinal fluid (CSF), which is where
interthecals are placed. Epidurals should go between the membranes.
Since the catheter was already in place, the anesthesiologist left it there
and administered the drugs manually rather than through infusion via
machine. The disadvantage of an interthecal is that it is a one-time
injection (except in this case) that lasts about 4 hours. |
| 10:15 am |
The doctor started the Pitocin®
(synthetic oxytocin), which is the drug that induces uterine contractions.
This is done through an IV solution. |
| 11:50 am |
A cervical check revealed 4-5 cm
dilation with some swelling. This is one of the risks involved with
Pitocin® since the contractions can be too strong for the cervix. During
this cervical check, the baby's heart rate dropped to a dangerously low
level as indicated on the monitor. The doctor and staff administered
oxygen and rolled Gwen on her side in order to alleviate any pressure on the
umbilical cord. When the amniotic fluid is low, the risk for pinching
or compressing the umbilical cord is much greater. Since the two
arteries in the cord are so small, any pressure results in a significant
oxygen loss to the baby. It is also possible to compress the arteries
in the uterus by lying flat (also the reason why pregnant women should
not sleep on their backs).
Note from Kevin: This episode absolutely scared the hell out of
me. I was making the journal entry above regarding the cervical check
and then without warning the staff was rolling Gwen on her side and was
scrambling around her bed. Since they knew what they were supposed to
do, they just did it. Unfortunately for me, I heard no warnings or
indications that something was happening. Rather than disturb them and
possibly complicate the situation, I sat there watching the fetal heart rate
drop to around 60 beats-per-minute (normal range is around 140). No
one can possibly imaging what thoughts went through my head at that time.
Although this was very upsetting, it actually is a quite common
occurrence which means the staff knows exactly what to do. Everything
was over in just a matter of seconds... not even a minute had passed.
The baby's heart rate went back to normal.
The doctor stopped the Pitocin®. |
| 12:20 pm |
The doctor discovered that the
baby's head had not moved into the correct position. Usually the
baby's head is either facing up (not ideal) or facing down (the correct
position for birth -- vertex delivery). It was neither in our case.
The baby's head was sideways, making it almost impossible to pass through
the pelvis. This is probably the cause of the swollen cervix since the
baby's head was pushing against it, but could not move further into the
correct position. The obstetrician was called to further evaluate the
situation. |
| 1:25 pm |
While the obstetrician was
performing her exams, the fetal heart rate dropped again (variable
decelerations). The doctor did an amnio-infusion (added saline to the
amniotic sac).
At this time, we discussed the possibility of having a cesarean section.
It was actually a short conversation. We decided that whatever was
best for the baby is what we'd do. A cesarean section was the best
option in this case since no progress had been made from using Pitocin®.
By this time, the interthecal medication had completely worn off and Gwen
was in pain. They had not given her a re-dose since it appeared that a
c-section was a possibility. |
| 1:31 pm |
Gwen was prepped for surgery.
The anesthesiologist administered a strong medication into the interthecal
that would allow Gwen to remain awake throughout the procedure. This
would not have been possible if she would have given a re-dose earlier.
Gwen was taken the operating room. |
| 1:47 pm |
Kevin scrubbed in and waited
outside the OR.
From Kevin: This was the longest wait of my life. After
reviewing my journal, I now realize that it was only a few minutes, but it
seemed much longer. One of the nurses at the hospital was out there
with me and she also scrubbed in to accompany Gwen and I during the
procedure. Thanks Brooke. |
| 1:48 pm |
Kevin entered the OR where Gwen
and the surgical staff was waiting. He sat down on a stool with Gwen
behind the barrier that blocked the view where the surgeons were working.
One of the surgeons said something like, "Let's go."
 From
Kevin: Brooke asked me if I wanted to watch the procedure. I
initially said "no". Had it been anyone else on the table, I would
have watched, but I felt very uneasy about seeing surgery performed on my
wife. She then coaxed me to at least watch the baby be delivered and I
agreed. At literally seconds before 2:14 pm, I stood up and looked
over the barrier -- just in time to see our baby's head emerge from the
uterus. They pulled her up and announced "It's a girl" (which we
already knew) and called out the time of 1414 hrs (military time). |
| 2:14 pm Central
European Time |
Our baby girl, Nellia Dae, is
born. One and five-minute Apgar scores were both "9" (out of possible
ten). She weighed 7 pounds, 9 ounces. From Kevin: The
doctor held up Nellia for Gwen to see (picture above). I got brave and
watched them remove the placenta. That lasted about 30 seconds and I'd
had enough. I then went over to watch the doctors check Nellia -- eye
drops, footprints, etc. We then went to the nursery while Gwen went to
the recovery room. I helped give Nellia her first bath.
Some trivia that no one else except us would care about:
First sneeze (Nellia): 5:15 pm
First diaper change (by Kevin): 6:37 pm
First real sleep (Nellia): 8:30 pm
Second diaper change (by Kevin): 10:00 pm
Third diaper change (by Kevin): 12:19 am Jan. 9th |
