Neviah Katherine Seal (Nevi Kay)
born 3/6/9 - 6:58 a.m.
@ Boulder Community Hospital
weight 7 pounds
length 19.5 inches
cost: priceless!
I discovered our pregnancy near the end of June of last year (2008), when Kate woke me up to wave the stick in my face. We figured conception had occurred during our 4-day family vacation to Florida earlier that month, or shortly after we got home.
Aside from minor complications , the pregnancy proceeded very smoothly! Of course, from my point of view, that’s easy to say. I suffered none of the loss of energy, weight gain, fatigue, back pain, front pain, sleep difficulties, trouble moving about, emotional roller coasters, cravings, nausea or many other symptoms too numerous to count. Kate probably wouldn’t have complained much if these things had been severe or intense - because at times, I’m sure they were. She felt blessed to be spared many of the really bad things some expectant moms go through. Early on, her progesterone levels were low, requiring 12 weeks of prometrium, a progesterone supplement. She tested low on iron throughout the pregnancy, and took supplements every other day. And at 26 weeks a positive Group B Strep test indicated that she would require intravenous antibiotics during delivery.
At a high school football game in mid to late September, Kate asked me how I liked the name “Neviah.” Wow! It was the first name we’d discussed in a long time that we both heartily agreed on. At that time, we were speculating what the “bay-bay’s” gender would be, and (aside from about a week’s worth of time about 2 months into the pregnancy, when I was certain it was a boy), I was pretty sure we were going to have a little girl. In fact, I’m glad it wasn’t a boy, because we absolutely, positively could not agree on a name for one of those! Kate’s mom and I made a friendly wager on this issue, betting a cigar. At the first ultrasound, we discovered (through a very obvious “flash” from our little one on the sonogram), that we were, indeed, going to be blessed with a little girl, and our Nevi was from then on, unofficially named. We called her Nevi or Neviah amongst ourselves, and “the bay-bay” to everyone else. The middle name proved a lot more challenging...and it actually wasn’t determined until about 20 minutes after we gave birth. I thought her middle initial should be K, Neviah K. Seal, and we even considered giving her the letter “K” as a middle name. There was also my Grandma Cay, whose name was Catherine. And since Kate’s name is Katherine after her Grandma Eleanor’s middle name, we decided on that.
A major bright spot through the 9 & a half months that little Nevi Kay was growing inside her mama, was our decision to take natural childbirth classes. We decided on the Bradley method of Husband-coached childbirth, a class taught at the home of Amanda Hanson, who had, herself, completed 2 natural vaginal deliveries without medication (one of which had lasted over 40 hours, and the other resulting in her baby being born with the “bag of waters” (amniotic sac) completely intact, a statistic which occurs in less than 2 percent of child births). Plus, she lived just a few miles away in Superior.
The classes were amazing and informative. Eventually, we got to know each of the other couples a little bit better, and looked forward to the opportunity to meet all their babies after they’d been born. For me, it was very cool to know that there were 6 other fetuses (feti?) approximately Nevi’s age in the room with us during each class. Her first play group! But the great thing about the classes was the amount and scope of information that was covered. It ranged from pre-natal nutrition and relaxation exercises, labor and delivery preparation, how to deal with complications, how to interact with medical and support staff, and even neonatal care and breast-feeding. Very comprehensive in 12 weeks. For new parents, I highly recommend it! Another bonus was the resource material. Every week, we saw a video of at least one natural childbirth, and a whole library of related videos were available for us to check out and watch in between classes.
Kate planned to start her 3 months maternity leave at the end of February, even if the baby wasn’t born yet, and I was “on-call,” (explaining to each of my clients why I might need to answer my phone in the middle of a session) after February 1st.
So, we waited. We made a checklist, packed our bags for the hospital, and reviewed the Bradley method information and techniques often. Kate did all the things she needed to do. She diligently practiced her exercises and pre-natal yoga, strived to eat her 100 grams of protein every day (to help keep the amniotic fluid “bag of waters” intact as long as possible), took her vitamins and iron, and eased off a bit from the high-intensity workouts she loves so much. She still made it to the gym or out on the trails nearly every day...just couldn’t get the heart rate up there with that belly in the way! : ) And I asked her if she was having contractions just about every time I saw a wince or a look of concentration on her face. Often, when she would call me from work, I would answer the phone, “how far apart are they?” or “has your water broke yet?” and these seemed to make for pleasant diversions.
Thursday, March 5, I had the day off work. I went to the gym, and did a trail run and some tai-chi. Kate took Dylan for a walk after checking her email. She was having back pain and feeling very intense, emotionally. We had an emotional heart-to-heart talk, about all kinds of stuff, including the upcoming responsibilities we would soon begin and interminably share. Then we decided to make it a light-hearted day and do a distinctly “Boulder” thing, the Celestial Seasonings tour. We grabbed some lunch at Gunbarrel Deli, and took it out to Twin Lakes, where the wind was a little strong for total comfort, but the sunshine and warmth were pleasant enough for early March. Kate sucked down 4 packs of oyster crackers while we waited for our sandwiches. She didn’t really want the crackers, she had just wanted to lick the salt off of them and put them back in their baggies, but she thought that might be a little bit socially unacceptable and decided against it. The tour of Celestial Seasonings was nice and they gave us some tea samples. Kate was especially sensitive to the odor of the “peppermint room;” she could hardly stand within 5 feet of it!
We headed back to the house for a little nap. I woke up at 5 PM, after about a half-hour lying down, and Kate reported that she had had her first contractions. I was sound asleep, but woke up to her saying “I think it’s starting!” After we woke up and started moving around, she reported that the contractions seemed to have stopped. They started going strong again, after about 20 minutes, and throughout “The Simpson’s,” we ate some pizza and some broccoli, as the contractions intensified, coming for almost a full minute each, about 5 & a half minutes apart.
I started getting nervous, thinking “this is it.” Being a professional massage therapist, I was fully prepared to bust out my deep tissue pressure on Kate’s low back, but her back was hurting so much, that every time I started to press on it, even with very gentle pressure, she would ask me to stop. That was my most challenging issue throughout labor...I’m a massage therapist and I can’t even touch my anguished wife! I later found out that it wasn’t the pressure that made her uncomfortable, it was the sensation of heat coming off my hands!
So, I suggested some various position changes for Kate, as we sat on the living room floor. The most “comfortable” for her seemed to be on all fours, leaning with her arms crossed on the couch. I say “comfortable,” but from her expression, that was certainly a stretch.
During the Bradley classes, it was suggested that we bake some cookies for the nursing and delivery staff during labor--partly to give the mother something to focus on between contractions, and partly to have something nice to offer the staff for their efforts. We had set aside the ingredients earlier, so I suggested to Kate that maybe it was time to start them. We “whipped up” some white chocolate macadamia nut cookies--me mixing up the cookie dough while Kate coached me from the living room, and Kate experiencing contractions while I coached her from the kitchen. It was a good partnership. Her contractions were now less than an average of 5 minutes apart, and all very intense.
We had most everything packed in our bags. I had a special bucket that I had packed and left by the door over two weeks ago. It contained all that I considered to be essential--massage lotions and tools, essential oils, towels and first aid supplies (in case we gave birth by the roadside, like our friends Nathan and Rena had done less than a year ago). The other things we’d need were clothes for ourselves and the baby, food, and various items that I could throw in a bag at the last minute, like the cameras, the iPod base station and “labor mix,” playlist and our cell phones & chargers. I figured I needed only about 5 minutes to complete this packing frenzy, throw it all in the Jeep & take Dylan out to poop before we’d need to head out.
Our classes recommended waiting to check in to the hospital until Kate was at least 5 cm dilated. “How do you know when that is?” you might ask. Well, it’s determined by a physician or nurse, through a pelvic exam. “Where do you get that done?” you might ask. Well, it’s done at the hospital! There are some things you CAN monitor to indicate what would reasonably be associated with 5 cm dilation--the timing of contractions, and the emotional signposts. You monitor the strength and length of the contractions, as well as the length in between contractions. Early labor can be slow and halting, even giving way to false labor where things just stop and then start up again at a later date. Early labor can also be sudden and intense. Many people suggest that it is common for first-time mothers to be more delayed, and they often give birth on or after their “due date.” Our due date was March 8, still 3 days away. Because of this, I theorized a slow start, and presumed (as our classes had suggested), that Kate would probably want to stand up, walk around, and go about her usual activities in between the contractions. However, three women that I had known or heard about had recently given birth within 3 hours following the onset of contractions...and they were all first-time mothers! Others, like our Bradley coach, had experienced marathon sessions of over two days. In short, there is no predictable pattern to the labor and birth process.
In addition to the timing of contractions, the other thing to look for are emotional signposts. The first stage of early labor is often paired with happiness, excitement, and an upbeat mood, corresponding to the realization that the birth (which has long been anticipated) is imminent, and more importantly the waiting (which has recently been resented) is nearing the end. The second emotional signpost is a very serious mood...deep difficulty with any physical or verbal effort. And though it was suggested that we could reasonably expect several hours of the first, and not to leave for the hospital until after a substantial duration of the second (paired with contractions lasting for a full minute, and 5 minutes apart or less, for over an hour), things were proceeding more rapidly than we might have expected. Bradley method seems to have the highest rate of natural, non-medicated births, and their students spend less time in the hospital and have shorter recoveries, including walking from the delivery room shortly after giving birth, and spending very little, if any, additional time in the hospital. This includes getting to the hospital as late as possible, so that the majority of labor can be done in a comfortable home environment. The other factor that we had to keep in mind was Kate’s Group B Strep positive test. Our doctor had recommended that we get to the hospital at least 8 hours before the birth, in order to receive 2 doses of I.V. antibiotics, 4 hours apart, with the 2nd dose coming at least 4 hours before the birth. At this stage, what Kate was experiencing would have prompted her to decide (regardless of Strep results) that as soon as I pulled the cookies from the oven, it was time to bolt!
As the cookies cooled off, I made my sandwiches, knowing that if labor lasted a long time, I would need to keep my strength up (important for coach), and knowing that I wouldn’t be able to leave and go get something to eat when her contractions were intense and shortly spaced. Between contractions, I would run downstairs, prepare a little food, and sprint back upstairs to be there for the next contraction. I took Dylan out to poop. Aunt Donna and Uncle Brent, who were on call to pick him up, had a spare key.
I loaded up the car, and promptly forgot to bring my labor bucket! I “loaded” Kate into the passenger side of the Jeep, and headed off toward the Boulder Community Foothills Hospital Birthing Center. On the way, I called Kate’s gynecologist and spoke with Dr. Jamroz, one of her regular Ob/Gyns, the on-call physician for that evening.
As of the most recent Ob/Gyn visit (the day before), Kate had been 1 cm dilated and her cervix was 50% effaced. There are 3 things to measure when determining progress--dilation, effacement, and station. Dilation is how far open the cervix is, measured as the diameter of the opening of the uterus. The cervix made up of circular (sphincter) muscles, which are normally closed. When labor begins, and as the uterus contracts, the longitudinal muscles of the uterine walls pull upward, opening the cervix. At the beginning of childbirth, the cervix is 0 cm dilated. At the end, it is 10 cm dilated (roughly 4 inches). Effacement is essentially how deep the cervix is. It starts off snug, like a turtleneck sweater, and gradually gets shallower as it softens and the uterine muscles contract. Effacement is measured in percentage. At the beginning of childbirth, the cervix is 0 % effaced, and at the end, it is 100% effaced. Station is the position of the head of the baby, in relation to the opening of the pubic arch in the mother’s pelvis. Zero station is when the baby’s head is level with the pubic arch. A negative station is indicative of early labor, when the baby’s head has not progressed very far down the birth canal. A positive station is when the baby’s head has progressed past the pubic arch. The stations range from -4 to +4.
When we arrived at the birthing center, Kate was about 3 cm dilated, about 90% effaced, and the baby was at a -1 station. But she was having so much trouble moving and in so much back pain, we both thought it was a good idea to go ahead and check in (ignoring the recommendation of 5 cm dilation), rather than drive back home and go through the moving of stuff and the car ride all over again. After going over our birth plan with the nurse, and discussing options regarding fetal monitoring and the administration of the I.V. antibiotic, I made the trip out to the car to get our bags. Along the way, I made 4 calls- one to Kate’s mom, one to my sister, with the instructions to inform both sets of parents on my side, one to the clinic where I work, letting them know that “I think this is it, cancel my clients!” and one to Donna & Brent, letting them know their dog-sitting shift had started.
Back in the hospital room it was serious business. Our nurse, Diane, hooked up the external fetal monitor, informing us that continuous fetal monitoring was not necessary; she would merely need to hold the monitor to Kate’s belly for 3 minutes every half-hour. As of now the contractions were coming about every 3 minutes. Later in the night, Diane said she was so impressed by Kate’s relaxation, that she couldn’t even tell when Kate was having a contraction. Dr. Jamroz came in about an hour after we arrived, and proceeded to briefly monitor the situation, and discuss with Kate how she was feeling. She was wearing a Texas Longhorns sweatshirt, which made me cringe a little, because I know how Kate feels about the state of Texas, including the universities that are associated with it. She talked to Kate soothingly, got a grasp of the situation, and then disappeared to take care of a caesarean surgery.
The most profound medical intervention we had agreed to engage in were 2 courses of intravenous antibiotics to counteract the presence of Group B Strep bacteria that had been found in Kate’s birth canal. While just a few years ago, GBS was not even known about, let alone tested or treated for, it has now become routine to test at about 36 weeks. Showing very few, if any, symptoms in the expectant mother, GBS can have devastating, and even deadly consequences for the rare fetus who contracts it during vaginal birth. There is no definite contributing factor, and the presence of GBS seems (for the most part) to be completely random. Because it takes several weeks for the “infection” to run its course, the recommended treatment is 2 courses of intravenous antibiotic, four hours apart, with the second one at least 4 hours before birth. Given the potential consequences, and the fact that my cousin Chris had recently lost an infant to complications from GBS, we decided on the treatment.
Bradley principles suggest that the mother take a sip of water after every contraction in order to avoid dehydration, and as her coach, I was solely responsible for seeing to it that this happened. Of course, the water bottles and bendy straws I had packed from home were in my labor bucket by the front door, but we got a water cup for Kate from the nurse, and I tried to remember to at least offer her a sip after every visible contraction. I didn’t do a perfect job reminding Kate to drink, often because I couldn’t tell exactly when her contractions were happening, and she wasn’t verbalizing anything. Every time she asked for water, I was there in a flash, and I don’t think I ever let more than three contractions go by without offering her another sip and swish.
I really wanted to document a reasonable amount of this process on video. Kate and I had discussed it previously, and I concluded that as long as I didn’t interfere with her concentration, or sense of relaxation, that I would take short clips during times when I wasn’t able to do anything else useful. I think of Kate as being a little camera shy even in normal circumstances, so with the privacy and intimacy of this situation, I was hesitant to “break the seal” and start filming, for fear it could trigger self-consciousness or discomfort on her part. She later told me that Channel 9 news could have been in the room, reporting on the whole thing, and she wouldn’t even have noticed they were there.
We had taken a tour of the birthing center a few months before, and discovered all the modern amenities the labor & delivery rooms provided. The private rooms were equipped with jacuzzi bathtubs, birthing balls, a couch for coaches & support staff to rest on, a fridge for personal food items, an optional squatting bar that could attach to the bed to provide alternate positional support during the crucial “pushing” phase, and a gorgeous view of the Flatirons that were (for now) pitch black outside our window. I had bought a few battery operated “candles” and placed those around the room when we first arrived, put our food in the fridge, including the celebratory orange juice that Kate was supposed to have at the end of her labor. Then, I had plugged in the iPod base station and began to play our pre-recorded “labor mix,” on random shuffle. The “labor mix,” all 237 songs worth, was for the hospital segment of labor. From gentle instrumental massage music to Paul Simon, Van Morrison, Hem, various jazz and classical, the total play time was 17.4 hours, so we figured we weren’t likely to have to repeat anything. Occasionally, throughout the night, I would hear a song that had special meaning. A few that come to mind were “Crazy Love,” by Van Morrison, which is the song we danced to first at our wedding, “Calico Skies” by Paul McCartney (which Kate walked down the aisle to), and two by eastmountainsouth which we played during the processional. The other notable ones I remembered were “Mother and Child Reunion,” by Paul Simon, and “Daughters” by John Mayer, which played shortly after delivery.
There were warm towels in the steamer, and I gave Kate one when she got out of the hot tub. Her back pain was tremendous now, increasing as time passed, and interfering with her ability to rest and relax in between contractions. The jets didn’t feel “good” per se, but they did make her feel a little better. The nurse hooked up the first I.V. to administer antibiotic shortly before 11 PM, checked her progress around midnight: 5-6 centimeters, fully effaced, with the baby now hovering at around “zero” station.
“Transition” was a big buzzword in the Bradley classes. The “event” takes place during the last 3 or so centimeters of cervical dilation. The emotional signpost involved here is called “self-doubt,” and it’s during this period of time when many women who have worked so hard to labor naturally will ask for an epidural. The pain is very intense, but even more overwhelming is the conglomeration of emotions and thoughts, paired with the physical turmoil that is going on within her body. The laboring mother can hardly move, cannot articulate what she wants to say, and may not even have coherent thoughts. This is when many women report wanting to give up and go home, just decide (against all rationality) that it’s really not that important to even have this baby, or scream obscenities at their husbands for doing this to them! They say this usually lasts anywhere from about a half an hour on up to two full hours! I figured Kate’s transition stage took place some time between about 1 and 4 AM, but there was nothing to distinguish between appearance now, and the period of time just after the beginning of her labor! From the textbooks, I might have expected her to be going through periods of intense pain (during contractions), and periods of relatively less pain and more rest (in between contractions), but because of the constant pain and pressure on her back, she never really got a break in between contractions. What normally makes transition so difficult is that contractions are coming “one on top of the other,” so that there is no rest from the work, and no break from the pain of contractions. In back labor, one might say that “transition” seems to last the entire time!
Kate was still characteristically quiet, and seemed to sink into even more deeply subterranean states of relaxation. I got a couple quick clips of video footage from this time. When I would ask her a question, she would often have no response whatsoever. When I would attempt to touch her, or adjust pillows, or make a suggestion, she would often shake her head quickly to one side, with no additional movements, obviously to say “stop whatever you think you’re getting ready to do, because I’m not going to like it!
At about 4:20 AM, Diane checked for dilation and station once more, and discovered that Kate was 9.5 cm--almost fully dilated! She had what the nurse referred to as an “anterior lip” of cervix left over the front of the baby’s head. I remembered the “stomp, stomp, squat technique” from classes, and Kate did that a few times. The nurse told her that getting into the bathtub might do the trick. Kate tried on her back, and on all fours. From time to time, I would stroke her upper back and neck lightly, and was learning the nonverbal cues that indicated whether she liked or disliked what I was doing. During our previous Dr. appointments, our physicians had checked the baby’s position in the womb. Nevi was most definitely head down (which is of course, a good thing), but it seemed as though she was “posterior presentation,” which means occiput posterior, or sunny-side up. It’s apparently much more difficult to labor with a child in that position, and often results in severe back pain. Nurse Diane and Dr. Jamroz agreed that there was still plenty of time for the baby to turn on the way out.
Although Dr. Bradley had often cautioned us not to adhere to any time clock expectations of when the delivery would be final, Diane made a second directive that she wanted to “see this baby before I go home,” which meant the end of her shift at 7:00 AM. We were in no position to (or had no desire) to argue! Kate got out of the tub at about 5 AM, I gradually got her dried off with a steamed towel, and put back into bed.
It took a while before Kate got the urge to push. Diane did another pelvic exam at this point, and determined that the baby’s head needed help clearing the pubic arch. It was excruciating, but when it came time for Kate to start pushing, the nurse helped as much as she could. It wasn’t until the first push, that Nevi’s bag of waters broke, signifying the healthy membranes Kate had strived for with her prenatal nutrition. After a couple rounds of pushing, I suggested we insert the squat bar, so Kate was alternately able to hold onto that during the squatting pushes, and press her feet on it during the “stirrups pushes” (for lack of a better term.) Kate pushed for about an hour, using the simple “deep breath in, deep breath out, repeat, deep breath in, hold it, push as hard and as long as you can, comfortably,” deep breath out, repeating that up to 2 more times during each contraction. I couldn’t see any part of the baby externally yet, but she was obviously in there, and obviously on her way out.
About this time, Dr. Jamroz, called the nurse, and having just finished her surgery. Diane told her that it was time. She arrived around 6 AM, this time wearing the surgical scrubs that I considered to be a more appropriate uniform than the Texas Longhorns sweatshirt, at least for our labor and delivery room.
As 6 AM gradually moved toward 7 AM, and the sunlight started to glow upon the Flatirons outside our room, I began to see the baby’s head during the height of each push. She was still pretty far up in there, and continued to slide back after each contraction. Dr. Jamroz was working to avoid an episiotomy, kneading and massaging the tissue around Kate’s labia and perineum. The contractions were still coming about 3-4 minutes apart. During the pushing stage, she had taken to remaining in the stirrups position, and with each push, she grasped my neck and shoulders with all her strength, pulling me towards her. I gradually figured out how to push/resist/assist, and eventually, I think I was helping somewhat with each push. As the baby’s head got more and more pronounced, Dr. Jamroz was applying ointment and massage, and giving her instructions about how hard and how often to push. Kate apologized numerous times after the fact for hurting my neck and pulling my hair out, but I never once felt discomfort. I just breathed with the same pattern she was breathing with, tucked my chin down, and focused on the upside-down Flatirons growing orange out the window behind me.
When the baby started to crown, the energy in the room got even more tense and excited. I saw her head start to slide out, and Dr. Jamroz was quick to coach Kate in modified pushes, sometimes for short duration, other times for less intense effort. Nevi’s head was plastered with matted, dark hair. A couple times, I thought I spied the occiput at the base of her posterior skull, which assured me that she had made the turn and was coming out the correct way. I kept looking toward the bottom, to see if I could see ears, forehead, facial features. But everywhere I expected to see face was still just head. Due to the natural malformation of the bones of the skull (which are pliable and bounce back to their more permanent shape shortly after birth), Nevi was being born with a cone-head! I realized this as she finally started to slide out, as her face was located about 80% closer to her neck than what I thought possible. Dr. Jamroz told Kate to ease off the pushing once again, Neviah’s left arm popped out, and less than 20 seconds later, our first born daughter was lying on Kate’s belly, wide eyed, crying, and ready to nurse.
Dr. Jamroz handed me the scissors and asked if I wanted to cut the cord. We had wanted the cord blood to pulse so the baby could get as much of it into her system as possible, but the Dr. said she had already clamped the cord in 2 places, and mentioned that it was very short and would hinder breast-feeding if we kept it connected for too much longer. I got out the video camera and was furiously taking shots, as Kate began to suffer oxytocin afterglow, and verbally illustrated it with Nevi, me, the Dr. and nurses on staff, gleefully sharing her enthusiasm at having become mother to the most beautiful thing on earth.
I had the celebratory orange juice all ready, and I gave Kate her bottle while I drank mine down. It burned her throat because of all the verbal pushing she had done at the end! We made calls to the grandparents in between Nevi getting weighed and measured and foot-printed, and when she was finally and fully an official “person,” according to hospital records, I gathered up our stuff, re-packed our bags and chucked them on the hospital cart, and carried my daughter down the hall to the recovery wing. Kate walked (leaning on the cart) less than 2 hours after giving birth to our little baby girl!
Nevi around 6 weeks old...
