Robert Heaton

Software Engineer /
One-track lover / Down a two-way lane

Childbirth: a father's-eye view

17 Jun 2019

“I have no idea who he is. He feels like a random baby lying on my chest,” said Gaby, my wife, ten minutes after the birth of our first child. I agreed with the sentiment, if not the specifics, but we still decided to give Oscar a bit longer before giving up and dumping him on his grandparents.

This is the story of the twenty-four hours leading up to this moment. It contains very little advice per se, since nothing scares me more than blithe overgeneralization. But it is a case study of one way amongst many in which you can have a baby.

Oscar’s birth was like his gestation - mostly straightforward with a few episodes of mild peril.

Oscar was due on a Friday. The date came and went, as is common for Heatons, Marxs, and indeed most first-time mothers. Stacy, Gaby’s OBGYN, suggested inducing Oscar on his due date - I seem to remember her saying that prompt inductions can reduce the rate of C-sections by a few percent because the baby is slightly smaller and therefore more likely to fit easily down the birth canal. This was of particular concern for Oscar, because we knew from his ultrasounds that he had inherited my signature enormous head.

Nonetheless, we wanted to wait a few extra days, for at least three reasons. First, we thought that the hospital’s assessment of Oscar’s date of conception was a little early, and that they were therefore overestimating his age. Second, it felt like a good idea to give him more time to develop in the womb; I’m not sure about the science of this one, but it’s a very hard idea to get away from once you have it in your head. Finally, and perhaps most importantly, it’s always easier to delay than deal with big events. We agreed to schedule the start of Oscar’s induction for the following Tuesday, because Stacy was going to be on-call on Wednesday and it seemed sensible to for Oscar to be delivered by a friendly face. Then we pushed the date back to Thursday, because what difference does two days make to anything really?

In some ways I quite liked the idea of an induction because it would mean that we could walk to the hospital. Gaby definitely wouldn’t accidentally give birth in the back of a Lyft, and I wouldn’t have to feel guilty about having never got my US driver’s license. Gaby detested the idea of an induction because once she had begun to take pictosin (the drug that induces contractions), she wouldn’t be allowed to eat anything until she had squeezed out our baby. Apparently this policy is standard for all hospitals, and is in place to prevent you from choking on your own vomit like a pregnant Jimi Hendrix if they need to put you under general anesthetic. The total time from first dose to final push can easily be twenty-four hours or more. Anecdotally most women report completely losing their appetite whilst giving birth, but Gaby was quite certain that she would die of hunger instead.

Gaby did some research and concluded that the entire policy was just insurance bullshit, and that nowadays almost no women have to go under general anesthetic during labor. She began scheming. The hospital will allow you to drink “clear liquids”, so Gaby started arguing to me that thick white milkshakes should be classified as “clear”. She pondered whether any kinds of fish could be blended into a clear-ish paste. Eventually she decided that she would load me up with nuts and carrot sticks and that I would covertly slip them to her when no one was looking. In the unlikely event that she did have to go under general anesthetic, I would be responsible for telling the surgeon that she had engaged in clandestine eating that I had aided and abetted and that we were both very sorry. I was not thrilled with this plan, but begrudgingly agreed that it seemed like a reasonable risk-reward tradeoff.

It turned out that we never actually reached the full induction, and Gaby’s food embargo was relatively short. She still reported feeling very hungry whilst pushing.

Gaby had a checkup scheduled for 10 am on Wednesday, the day before our scheduled induction. At 6am she came into my room and told me that she was leaking a little and was going to go in early to get checked out. She told me that I should stay in bed, so I did.

At 9:30am Gaby called to say that the hospital thought her bag of waters probably had a slight puncture, and that they were going to induce her into full labor immediately. I should therefore call myself a taxi. We had a go-bag mostly packed, and all I had to do was add our toothbrushes and some stimulating reading matter. I felt about as nervous as when I have a flight to catch early the next morning, which I think indicates both my relative nonchalance at having a baby and relative terror at having to make sure I’m at SFO by 5am.

I took a Lyft to the hospital, driven by a European man who had recently had a baby of his own. He offered cocksure and forceful parenting advice. He thought our plan for taking parental leave was foolish, and was horrified by our lack of certainty about our future childcare arrangements. He ran several traffic lights that were a good few seconds beyond green and made it to the hospital 3 minutes ahead of Lyft’s prediction. I guess we can call it even. When I arrived in Gaby’s room she had just had her first half-pill of misoprostol and was having occasional, regularish contractions. So far they seemed like mild inconveniences at most. We discussed the day so far, and I went to Whole Foods to get lunch. I had a big day ahead of me so I treated myself to a smoothie. I ate and drank my lunch on the outdoor patio that overlooks the car park at Franklin and California.

By the time I got back to the hospital, the ambience was starting to turn. Apparently the first dose of misoprostol had pushed Gaby into labor on its own, and the show was fully underway. Now whenever Gaby had a contraction she had to stop talking to concentrate on breathing. I rubbed her back; she said that this helped. A nurse offered some fentanyl, which Gaby decided would be quite pleasant, given the circumstances. I panicked a little. No one had said anything about fentanyl before, and I had only ever heard of it on documentaries about the nationwide opioid crisis. A quick Google suggested - obviously - that the World Health Organization thought it was OK.

The first hit of fentanyl was straight and true; now Gaby could walk and talk and grimace slightly less. She reported feeling “really fucking high”. We went for several slow walks round the hospital garden, interrupted every few minutes by contractions that were now only moderately crippling.

An hour passed. We had made little progress, and the fentanyl was wearing off fast. Gaby was offered and accepted a second hit. It was much less effective than the first. Now she couldn’t talk and didn’t even want me to touch her. She had been deep yoga breathing her way through contractions so far, but there weren’t enough oms in the world to get through the convulsions battering her now.

This part of the labor, and indeed all the rest of it, was quite harrowing for me. Yes I know that it was worse for Gaby, but you knew that already, and anyway this is my blog. Earnest men on the internet, as well as many friends and relatives, had all said that watching their partner go through the excruciating pain of labor without being able to do anything to help was extremely difficult. I assumed that they were all being dramatic and irrational. Everything will be OK in a few hours, and if there’s nothing you can do then what’s the point in being empathetic?

I suspected that I would probably want to disown this opinion after the experience, so I didn’t tell anyone about it.

Some time later: “Do you want the epidural?” “Yes I do.”

Gaby had decided several months ago that it would be ideal if she didn’t have an epidural. “Expecting Better” by Emily Oster had told us that epidurals increase the risk of having a C-section, and increase the mother’s postpartum recovery time. However, they are also extremely effective at preventing pain at a time when pain is in something of an oversupply. Gaby therefore also decided (and I agreed) that it would also be completely fine if she did end up having an epidural. The differences in outcome are small, and whatever happened we would almost certainly end up with a healthy baby and mother at the end of it.

Despite being very into science and very scornful of the idea of wanting a “natural” birth for the sake of the word “natural”, I still felt a small pang of misplaced sadness when Gaby said yes to the epidural. It felt like we had lost our shot at a perfect birth scorecard. For people who do place a lot of weight on the idea of a “natural” birth (as far as I can tell, mistakenly), this step must be absolutely horrible. Gaby later said that what she really wanted by this point was to be Caesarian-ed there and then, extended recovery time and probable slight decrease in infant health be damned.

Before the epidural went in, Gaby asked the nurse to check her dilation. 6cm. All the way back at the start of the morning she had been at 4cm. She needed to be at 10cm in order to even start pushing. It looked like we were going to be here a while.

The anesthetist showed up a few minutes later. She was a little on the slow and methodical side, but I would say that the epidural was in within twenty minutes. Gaby swears that it can’t have been a second under eight thousand years. It helped a little. Then a machine started beeping and nurses and doctors started mumbling to each other.

A few minutes later Stacy, Gaby’s OBGYN, appeared. She said hello; I said hello; Gaby swore into a pillow. Stacy explained to us why her colleagues were mumbling; when the epidural went in, Oscar’s heart rate had suddenly dropped. We could see this on the heart rate monitor next to the bed. If you were feeling optimistic, you might say that he was oscillating around the lower end of normal. If you were feeling scared for the safety of your unborn child, you might say that he was frequently dipping into the realm of concerning. A baby’s heart rate tends to drop even further when it’s being squeezed through the birth canal, out from the womb and into the world. Spending too long with a low heart rate can be very bad. It was now critically important to get Oscar out as soon as possible.

But remember, the last time that anyone had checked, Gaby was still 4cm of dilation short of being able to push. Stacy checked Gaby’s dilation again, out of hope as much as anything else. After poking around for a few seconds Stacy popped her head up.

“Actually now you’re fully dilated, time to start pushing.”

For me this was the second most surreal moment of the day. Teams of nurses swarmed into the room, pushing trolleys piled with tweezers gloves forceps needles buckets for blood and babies. Within thirty seconds Gaby’s feet were in stirrups.

In order to push, the woman strains very hard with each contraction for three bursts of ten seconds. Stacy told Gaby that she should push “like you’re taking a really big poop.” I expected an addendum along the lines of “except instead of tensing your colon you engage your pelvic floor,” but none was addended. Squeezing out a baby is like taking an hours-long dump, no caveats required. Stacy yelled “come on Gaby, poop it out” several times throughout the course of the labor.

We had at least three doctors or nurses with us throughout Gaby’s labor, sometimes more. I’m sure they all had well-defined medical roles, but I also wonder whether how much of their job was to be an invaluable cheerleading squad. A nurse called Caitlin was on counting-to-ten duty. “One! Two! Three! Four!” I tried to join in but felt very self-conscious. “One! Two! … Four! … Actually it looks like Caitlin has got this, no need for me to step on her toes.”

An epidural numbs your lower body. This is good, because it means you can’t feel the eight pound person that you are squeezing out of your previously pristine vagina, or the agonizingly painful contractions that make sure you’re paying attention. However, not being able to feel the contractions means that you don’t know how to line up your pushes with them. This can lead to labor stalling out, which can lead to complications and C-sections. To help with this, Gaby was hooked up to a machine that measured her contractions. The nurses used its output as a substitute for the pain in order to tell her when to push. It later transpired that Gaby had picked up a small hernia during the first half of her labor. This hernia was compressed during each contraction, and for whatever reason didn’t seem to have been numbed by the epidural. Gaby’s friendly hernia served as a direct yet subtle indicator of when she should push.

After the initial adrenaline rush of the nurse-swarm had worn off, I started to get anxious again. It didn’t seem like we were getting anywhere. Gaby kept asking “how are we doing?” in between pushes, and Stacy was running out of ways to say “we aren’t making any progress but don’t worry you’re doing great.” Oscar’s heart rate was still low, on the border between good-but-bad and just-plain-bad. Nurses and doctors were mumbling to each other again, which I always find very distressing, although I’m not sure what they should do instead. I don’t think they should keep everything completely secret from you, but I also don’t think that they should offer unfiltered streams of consciousness that presumably sometimes contain disconcertingly high estimated probabilities of your semi-born child being dead or doomed.

Stacy explained that they might have to use forceps or a vacuum to gently yank Oscar out. She explained that both of these techniques were perfectly safe, apart from the rare occasions when they caused minor cosmetic damage or killed your baby (I added to myself). She was going to ask a colleague to help and double-check her work.

An older doctor with salt-and-pepper hair came in. Her name badge was green and said “ALL ACCESS”. She had a root around, and agreed with Stacy’s assessment. I seem to remember that they decided that forceps would be the best approach, although even they would be awkward because Oscar’s head was coming out a little crooked. As they were scrubbing up, Oscar’s heart rate jumped, right back into the middle of normal. No one was quite sure why, but equally no one wanted to look a gift horse in the vagina. Salt-and-pepper doctor left, and Gaby started pushing again.

This felt like the home stretch. I started getting excited and enthusiastically joined in with Caitlin’s counting to ten. Eventually Caitlin dropped out and left me to it. I started my counting from two because starting from one felt cruel. Gaby politely asked me to turn down the volume a little because I was screaming in her ear.

My other responsibilities were raising Gaby’s head while she was pushing and passing her an oxygen mask while she was resting in between contractions. I was concerned that she wasn’t resting enough, and was pushing for a second or two extra after I had clearly finished counting. This didn’t feel like a helpful conversation to start, so I didn’t say anything. I figured that the hernia was guiding her, or maybe she had noticed that I was starting my counting from two. Gaby doesn’t remember.

Throughout the pushing, Stacy would periodically rummage around in Gaby’s vagina, trying to help things along. After a while Gaby asked Stacy what she was trying to do and whether it was working. Stacy said that she was trying to give Oscar a hand, but probably wasn’t really achieving much. Gaby politely asked her to refrain from rummaging around in her vagina unless it was strictly necessary.

I had thought that I wouldn’t be able to look into the bloody, distended business end during the birth. I’m very squeamish, and feel queasy whenever I see anything remotely bloody or uncomfortable. However, many people had told me that on this occasion I had no choice but to look, and that if I didn’t then I was a big loser. I’d heard unwoke stories of men scarred by the sight of vaginas and boobs being used for anything other than boning. This didn’t feel like the reaction of the modern man I aspire to be. I was torn.

It turned out that I actually had no problem looking as Oscar inched towards the world. I have no idea why. When Gaby asked “is he getting closer?” the doctors and nurses were mostly honest and objective. “Sort of!” “Maybe a bit!” “I’m not sure!” I, however, was trying to convince myself that he was almost out. I’m still not sure whether I thought I was being truthful or not when I shouted over them “He’s almost here!” “Definitely!” “Yes!” Gaby was also very concerned with whether Oscar had hair or not. I have no idea why. “I think he has brown hair!” someone said. “Hmm, I suppose that’s plausible,” I said. Everyone thought that was very funny. It wasn’t a joke, but I suppose it’s also not what normal people say when seeing the crown of their firstborn son’s head for the first time.

We spent a few hours getting nowhere, as far as I could tell. Then suddenly Stacy said that he was almost out, and would Gaby like a mirror so she could to survey the scene for herself. Gaby said yes, which I at first thought was a gauche reflection of our self-obsessed, vagina-gazing Instagram culture. But it turned out that the mirror gave Gaby extremely useful, rapid feedback on what types of pushes were and weren’t working. With hindsight she wished she’d had it much earlier. Two contractions later the nurses retracted the bottom half of the bed. Stacy asked if I wanted to catch the baby. I explained that I wasn’t a doctor and so that was a nice but deeply stupid idea. Next push Oscar’s head was out; one final push later he was lying on Gaby’s chest covered in blood and crap and crying his eyes out.

I assessed how pointy Oscar’s head was; Gaby later admitted to doing the same. We had agreed that we would love our son, even if for the first few days of his life he had a freakishly pointy head like some of the babies on the internet. We were nonetheless relieved when his head came out relatively round. Oscar was beautiful and only mildly resemblant of an Alien from Alien vs Predator.

I was offered some scissors and the chance to cut the umbilical chord. I initially demurred, but everyone was quite insistent, including my darling, exhausted wife holding our five-minute-old son. I figured that I had gazed into the abyss and so I could probably do this too. The chord was very rubbery and required several good hacks to get through.

Then the placenta flopped out. As with so much else during the birth and presumably the next twenty years, I had read that this would happen but was entirely unprepared for it. It was placed tastefully in a bowl for us to have a poke at later. I learned that I really am less squeamish than I had previously believed.

We hugged Stacy goodbye and she left to deliver another baby. What an insane job. Our nurses went on their dinner break. We thanked them profusely and they introduced us to their replacement.

All of the “Dude’s Guide to Childbirth” articles I had read and people I had spoken to had emphasized the importance of bringing snacks. “You won’t want to leave her side, man,” they said, “make sure you bring some quinoa salad and trail mix.” This sounded like emotional posturing to me, so I had defiantly not brought any snacks. There was a Starbucks downstairs, and Gaby could survive without me for a few minutes every now and then. This was foolish. The markup on Starbucks food is insane; a dollar fifty for a banana that would have been twenty cents at Trader Joes. Having children is expensive enough without overpaying for fruit, although hopefully the children are positive ROI when you factor in the care during old age and allow for the net present value of a sense of deep, cosmic fulfillment at reasonable exchange and discount rates.

On top of the financial considerations, it also really would have been impossible for me to nip out for a croissant whilst Gaby was in so much pain she couldn’t speak, and when our son could easily have been born while I was choosing between chocolate and almond.

Ten minutes after the birth it still felt improper to leave and go in search of even a quick curry. An hour or so seemed like a sufficiently reverential waiting period. I found an adequate-looking pizzeria on Van Ness, and ordered a 14 inch Veggie Supreme. It took about fifteen minutes to come. While I was waiting I watched the Oakland As against the LA Angels. The As were down 7-5 in the bottom of the ninth, but hit a homer and a double who the next man drove home. When my pizza came the As had batters on first and third with one out left. I don’t know how it ended.

The whole experience made me much more appreciative of technological advancement. I live in Silicon Valley, which to everyone on the inside means audacious, life-enriching innovation, and to everyone on the outside means so many ways to erode workers rights and accidentally give up personal data. It is of course all of these things, often in the same social network. It can be easy to make fun of and air-quote the word “progress” sometimes.

But during Oscar’s birth I was made acutely aware of progress that made both my and my loved ones lives unarguably better in unarguably meaningful ways. Yes it’s always been cool that I can play beautiful games on my relatively inexpensive PlayStation and can book a taxi from my phone two minutes before I need it, but it sucks that the games rely so much on micropayments and Skinner boxes and that many of the people driving the taxis feel like they’re getting economically screwed without any alternatives. But it’s unambiguously great that Gaby was able to give birth to our son in a big, clean hospital with extremely effective medical equipment; highly trained medical staff; and safe, powerful drugs. I suppose that the story of the rare earth metals in the scanners is probably a little hair-raising, and maybe our treatment was only so great because of the US’s two-tier medical system that makes so many other people’s treatment extremely shitty (the bill to our insurance at the end was an eyebrow-raising $35k). But there’s definitely something good happening, on balance.

When I returned with our pizza we were moved up to the postpartum ward. We alternated holding our baby and eating slices. We Skyped my parents in London - I had phoned them when we went into the hospital, and they had been up all British night in childish excitement. Everyone was very happy.

We decided that I would go home to sleep and come back the next morning. Oscar would go into the nursery. Gaby couldn’t really walk so she would stay where she was. We’d play the rest of our lives by ear.

(Part 2)

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