In an attempt at not forgetting the details of how Arthur came to be, I am trying to write about the events that led up to his birth before too much time has passed.
Today's topic:
The C-Section
Everyone who has had a cesarean has had their own very personal experience with it. Some are positive, some totally sucked. I was extremely fortunate to have a positive experience. I attribute this to the amount of excellent communication I received from the whole surgery team throughout the day leading up to the procedure, during the procedure, and afterward.
I have noted in a past post that I'm really glad Arthur was breech on the day that he was born because it defaulted his birth plan to a cesarean section. Why was I so happy that I wasn't going to experience a vaginal birth? I don't have anything against a vaginal birth, I had been mentally preparing for and learning about them throughout my pregnancy so that if the time came, I would feel informed and as ready as I'd ever be to go for it. I know all the health benefits for mom and baby by doing a vaginal birth. I was all for that idea. The reason I was so glad he was a cesarean was because there was an 80% chance that inducing labor would lead to an emergency cesarean because Arthur wasn't tolerating the process or my body would stop progressing due to such an early induction and then we'd both be in limbo.
Everything I learned from the doctors about the lead up to an emergency cesarean was no fun at all. During the induction, Arthur's vitals could go haywire (no thank you) and then I'd be quickly wheeled into the operating room, knocked out fast (rather than getting to stay conscious), and Arthur may need more interventions upon his arrival than had he not been in distress. It's true that before you fully induce labor, the mother is given a small amount of the medication to see how baby reacts, but even if baby is fine with that at first, I couldn't get it out of my head the warning that the full dose could still put Arthur in a sticky situation. All of this due to his gestational age and size plus my crummy placenta not providing good blood flow. There are tons and tons of inductions that go flawlessly, it was Arthur's itty bitty stats that had me worried most.
TO CONCLUDE: For my own peace of mind, I'm really glad we didn't have to test that 80% chance.
I was penciled in for the procedure at 4pm. I was starving. I was impatient because I was so hungry. I didn't talk much in the last three hours of waiting because I was so hungry and it took all of my energy to not be snappy at people who were just doing their job or at Hunter who was just being a soon-to-be-father riding the same emotional rollercoaster. I didn't get a warning that I was going to have a "last meal" that day, so I never got to load up and make the most of breakfast.
The nurses came in at 3:45 to prep me and move me to the gurney. I was so relieved because it meant the show was on the road and all the apprehension could melt away as I just experienced the moment and took it all in...or so we all thought.
The moment they were wheeling the gurney out the door, one nurse's cell rang and on the other end was the operating room. My procedure had been bumped by up to two hours, an emergency had to go ahead of me. Everyone groaned at the timing. Me the most.
So I got back in bed, closed by eyes, held Hunter's hand, and tried not to puke from the hunger (and thirst, you also have to stop drinking water 4 hours ahead of time).
The nurses come back in an hour later. This time, it was for real! I sat up, ready to hop back on my chariot and, due to the movement and nausea, promptly barfed on my lap. Huzzah. Just what I needed. Quick change and I was on the gurney feeling even emptier than before.
Fun fact: While on the gurney, I was covered with a papery-plasticy blanket and a machine pumped warm air underneath it from down by my feet. It was a very cozy ride.
The trip was speedy. Hunter got to follow a couple minutes behind and also drop off our belongings in the recovery area. Then he had to wait and wait and wait for my full preparation to be over with before he could join me in the operating room. He says it was about twenty minutes that felt like two hours. He was also alone and feeling pretty bewildered sitting awkwardly in an empty side room somewhere.
The procedure preparation was fascinating. I put on my curiosity hat in order to take it all in. I certainly could have opted for a panicky fearful route, and I'm not saying I didn't have ANY nerves, but I was able to zen out enough to even, dare I say it, enjoy the process of watching and listening to the team prepping themselves and me for the procedure.
I am a nerd. I used to watch Animal Planet over all other kids channels. Emergency Vet was my JAM on weekday afternoons. All the podcasts I listen to today are science or social science based. So I was all for experiencing an operating room first hand. Weird. I know.
There were maybe 8 people in the room, not including myself. And the room wasn't very big. The ceiling was super high, that seemed oddly significant, and the room was absolutely packed with cupboards and equipment and bodies. The walls were bright white and the lighting bounced off of them sharply.
In the room was my doctor, the surgeon, her team of nurses, and the NICU nurse team as well as Nick, the anesthesiologist. He was the most involved with me during the whole process because his job was to make sure that A) I couldn't feel pain the whole time and B) My overall well-being was monitored constantly. He was chatty and dorky and loud. Exactly the kind of person who can disarm you in a stressful situation and keep you from getting stuck inside your own head. I noticed that Jack Johnson's In Between Dreams album was playing in the room and I asked who chose it. Nick, of course. My surgery prep was to the soundtrack of Banana Pancakes and Better Together and I will never forget that.
I was transferred to the operating table and sat upright with my legs over the edge of one side. I was given a pillow for my lap which would come in handy later. The room was freezing. I remember that about getting my tonsils out as a kid, the only other time I've had surgery. I was shaking with apprehension and real chills.
Suddenly, the entire room was brought to attention by the surgeon and it got very quiet. They all went over the details of the procedure and the roles of each group. The language was technical and clinical and precise. Their voices were loud and extremely clear so as to be understood by all. It was a like a pre surgery sound-off.
Once the procedure had been described, the room hopped back into action. Nick raised the operating table up to skyscraper heights as he stood behind me. He was getting my lower back to nearly his eye-level in order to do my spinal anaesthetic. A spinal is not an epidural and they are used in a C-section specifically because they work super fast, they last the right amount of time for the procedure and the time spent in the recovery room, and they are very, very effective at blocking sensation.
To quote a quick Google search to make sure I remembered the process correctly:
"A very fine needle is inserted into the middle of the lower back and local anaesthetic is injected through the needle into the fluid that surrounds the spinal cord. The local anaesthetic numbs the nerves that supply the tummy, hips, bottom and legs." -Patient.info
The anaesthetic acts on gravity to "fall" down the back through the spinal fluid and numb the nerves heading in all directions below the injection site.
While Nick was making sure he inserted the needle into the correct spot, I had to curl my body over the pillow in my lap to round my back as much as I could. I felt a sudden and intense "ZAP" in my right foot and nowhere else. "Woah!" I said. It didn't hurt. "Where did you feel that?" Nick asked as if that was his plan the whole time (I think it was all part of the spot-checking process) "My right foot." I responded. "Great!" Nick replied, made a small adjustment, and then in went the anaesthetic.
In a matter of seconds, my lower half felt warm and heavy. I couldn't feel by butt, but it felt like I was sitting on a seat warmer. I started to get prickles similar to when your foot falls asleep, but not nearly as AAAAAHHHH! inducing. It felt more like my lower body was turning into static energy...that is the weirdest sentence I have ever written. But if the static "snow" on a TV screen had a feeling, that's what everything from my tummy to my toes felt like. I was completely enthralled by this sensation. I think I said all manner of "Cool" "Weird" and "Woooaah" in the next two minutes as I was asked to lift my legs up onto the table (with help) and I began to lay down. It didn't feel *good*, it just felt different, and because I felt safe in the environment and everything was going smoothly, I could continue to approach the whole situation with curiosity and wonder rather than panic or discomfort.
Nick's job was now to make sure that the anaesthetic, which still worked by gravity, didn't travel too far up my spine and cause heaviness past my chest and into my neck and arms. The reason being that if it goes too high, it can affect breathing, so there's a sweet spot that is maintained by raising or lowering the patient's head and shoulders just a smidge by using the operating table's controls.
He also needed to make sure the anaesthetic was working completely before anyone did anything at all. He used an ice cube and ran if up and down my side to see if I could feel "pressure or cold?" The first time he did it, I could still feel a little bit of cold, so everyone waited a couple of minutes and prepped other items. Then he did it again and all I could feel was weird out-of-body pressure on my side. The team jumped into action.
A catheter, a thorough tummy wash and then covering the better part of my torso in an antiseptic, a big, super sticky sheet of something laid over my lower tummy and pelvis for what exact purpose during surgery I do not rightly know (but it left a rash behind afterward from being peeled off and taking all my peach fuzz tummy hairs with it), and then it was go-time.
At this point, Hunter was allowed into the room. He sat right up by my head. The curtain blocking our view of the goings-on had been raised and all we could do was hold hands, listen to the room, and wait.
I could feel tugging, jostling of my lower half, and pushing around, but nothing else. I focused a lot on my breathing, making sure I was paying attention to getting good, deep breaths instead of letting the adrenaline take over. My chest felt heavy from the anesthetic, but Nick had told me that this sensation wasn't going to prevent me from breathing, so I made sure to really feel my chest rise and fall, which prevented panic.
Hunter and I were excited but we also felt a very healthy dose of worry about who was about to be pulled out of me. We didn't know what our tiny guy would look like, but we knew he wouldn't look quite "right" as a newborn. We didn't know if he would come out crying or silent but we wished for a loud entrance. We didn't know if he would be in a state in which we would be allowed to see him lifted up before the NICU team grabbed him.
All of these questions were answered very, very quickly. Lightning fast, it seemed. What felt like two minutes, but was probably more like 10, passed by before the surgeon called out "Baby's out!" To the room and it was echoed by other voices around us. They dropped the blue curtain to reveal a clear curtain and Arthur was hoisted into my eyeline, screeching his protestation, so, so small, red with good oxygenation, goopy, his full head of dark hair on display, his skeletal, skinny arms and legs splayed out. Then he was whisked to the isolette and the NICU team to our immediate left and Hunter was my eyes and ears for the rest of the experience.
Hunter turned so that he had his eyes on the NICU team and an ear on me. I asked him to tell me everything he heard and saw because I couldn't see past the team's backs. I could only hear clips of sentences but mostly everything was garbled by the activity. My abdomen was being stitched back up and the voices of the two different teams in the room were competing for my focus. When you have a c-section, the surgeon goes through seven layers to get the baby out, the last one being the amniotic sac, which is removed after the baby is removed. Then you have to have six layers stitched back up. It's shockingly fast, but very annoying to wait through as all I wanted to do was absorb what the NICU team was doing.
Thankfully, Hunter is a great play-by-play reporter and knew what information would be most important to me. He relayed everything he could as quickly as he could. "He's breathing. They say he looks good! They wrapped him in plastic for heat. They are giving him an oxygen mask." All manner of things. I heard someone call out his Apgar scores "8 and 9!" And it was echoed by other voices. I remember thinking "This tiny baby got an 8 and 9?!"
The NICU team addressed Hunter directly about what they were doing and invited him over to trim Arthur's cord, which had been cut pretty long just to get him out. Apparently the cord was very beefy. My body made an excellent umbilical cord paired with a placenta that didn't want to do its job. The nerve.
The team stood out of the way to let me see the weight reading on the isolette's display screen. 2 lbs, 10oz. The number was shockingly small to me. I cried two times during the procedure, once when they popped Arthur's body over the screen to show him to us and once when I saw his weight. Both times I felt many things very quickly, but I distinctly remember feeling a wave of dismay wash over me as I thought "He's too small, this can't be!"
Arthur was ready to be wheeled away to the NICU and I was still being stitched up. I told Hunter to follow him and see how he was set up in his new spot and come back to see me in the recovery room, so he did. The room was markedly less exciting once the team had left. Nick kept checking in with me, lots of cleaning up was going on as the surgeon finished her work. The sticky mystery sheet was peeled off of my stomach, I was transferred back to the gurney, and away I was wheeled to the recovery "room". Which was really just a row of curtained off stations where a nurse monitored my blood pressure every ten minutes, I chewed on gum and ice chips to get my digestive system jump started again (the anaesthetic puts everything on hold), and we waited for me to be able to wiggle my toes, then move my feet, then bend my knees and so on.
I began to feel super itchy in my face and chest. It's a common side effect of the anaesthetic. Good golly, it was soooo itchy. I couldn't stop scratching the tip of my nose or my chin or my neck. I was still running on adrenaline and I remember not being too put off by it, but WOW. So itchy. Constant. No relief.
Hunter stayed for quite some time in the NICU watching Arthur get situated and gathering all the information that he could to bring back to me. He was gone for maybe 30-45 minutes. When he did come back, he told me what he knew. I can hardly remember the conversation now and he would probably be a better reporter about it. I know I asked about what his setup was like. I know he told me as much as he could, but of course, all those details are already escaping me. What I did know was that our baby was stable and he hadn't needed to be intubated (when a machine takes over breathing completely). These were two pieces of information that I clung to as positives.
Eventually, after a total of maybe two hours in the recovery area, my blood pressure having been taken a total of one bazillion times, my ice chips depleted, my gum losing flavor, I was wheeled to our room where we would stay for the next four days as I recovered from my c-section and we absorbed all the newness of being dumped into parenthood with a very small, extra dependent baby.