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Dawn of the Julian Era

Started: 2015-04-09 15:29:10

Submitted: 2015-04-09 17:58:57

Visibility: World-readable

In which the intrepid narrator attends the birth of his second son

I took the last Friday before Julian was born off work and went skiing at Copper Mountain, scoring almost-fresh snow in the morning (it snowed five or six inches on Wednesday and Thursday) and warm spring conditions in the afternoon. I spent the weekend running errands, tidying the house, repacking the hospital bags, and eating lunch with my sister and brother-in-law when they dropped by Boulder on their way to a late spring break skiing at Breckenridge and Vail. I stopped worrying that Kiesa would go into labor at any moment, figuring that Version 2.1 was perverse enough to wait until the scheduled c-section early Monday morning. (It wouldn't have surprised me if she had gone into labor on her own Monday morning, leaving us with the decision whether to go forward with a trial of labor or skip straight to the scheduled c-section.)

Kiesa, 37 weeks pregnant with Julian
Kiesa, 37 weeks pregnant with Julian

I spent Sunday night worrying about our decisions to date, especially whether the repeat c-section really was better than trying to induce labor. (Kiesa's OB wasn't interested in trying pitocin to induce labor, since Kiesa had had a prior c-section, but might have been willing to try breaking Kiesa's water.) I worried about Kiesa's mother's schedule -- she'd been at our house for a week and half and was leaving on Thursday, which might end up being before Kiesa and our baby were out of the hospital. I worried about my work schedule and whether I'd be able to make it for the big project coming up the following week, then worried whether I ought to work on the project at all so close to the baby's birth rather than letting one of my coworkers take care of it. I let these thoughts rummage around my head while I worked on a playlist to celebrate Julian's entry into the world. But there was nothing else we could do now, so I tapped the side of my imaginary helmet for luck and hoped for the best. I read the first few entries from Calvin's birth six years ago and remembered, once again, how to stop worrying and love modern medicine.

My alarm woke me up at 04:45 on Monday morning, 30 March 2015, giving us enough time to shower and toss the bags in the car and head to Boulder Community Foothills Hospital. (We left Kiesa's mother to take care of Calvin.) There was some traffic out before dawn; I wondered where everyone else was going so early. We reported to the birthing center on the third floor of the hospital at 05:30 and were escorted to the post-anesthesia care unit (PACU) where prep nurse Liz was waiting with a hospital bed for Kiesa, and our doula Kate was waiting for me with coffee and instant oatmeal. I ate breakfast and took pictures while Kiesa prepped for surgery by changing into an ugly hospital gown, watched 20 minutes of fetal monitoring, and tried to get an IV inserted (which proved more troublesome than Liz was expecting, because Kiesa was dehydrated because she followed the pre-operative instructions to not drink any water for six hours prior to surgery). We talked to Liz about the procedure, especially what the procedure would be if our baby were large (as we expected him to be). Liz said they'd want to do blood-sugar tests to make sure he wasn't diabetic (despite the fact that Kiesa passed two screenings for gestational diabetes while pregnant) but they'd wait to do the tests until after he'd tried to breast-feed (in stark contrast to our experience at Longmont, where they freaked out that Calvin was large and made us wait to get the results of the blood sugar test before trying to feed him).

Kiesa in BCH PACU, waiting to deliver Julian
Kiesa in BCH PACU, waiting to deliver Julian

Kiesa's OB dropped by to see us before the surgery and expressed some surprise that Kiesa hadn't gone into labor while she was out on spring break the prior week. (The baby did drop a little towards the end of the week, but it looked very much like we were going to have to come in and get him because he wasn't coming on his own.) We were told to show up two hours before the surgery scheduled at 07:30, and the hospital staff managed to fill in the time with paperwork and questionnaires and monitoring and other procedures performed at a languid pace, which was a far cry from the unscheduled c-section after two hours of pushing with Calvin.

We settled in to wait for the anesthesiologist; word was he was the last to show up, then that was attending to another woman in labor who needed an epidural. I put on the purple disposable scrubs I was given (but ended up with the mask up-side-down, so it wouldn't properly pinch onto my nose). At length the anesthesiologist showed up, and talked about the spinal he was planning on giving. He confirmed that he could only allow one additional person into the OR, so Kate would have to wait in the anteroom and take pictures through the large window in the door. (This was not his choice but the choice of his group of anesthesiologists. One thing I appreciated from when Calvin was born was that our doula Misha was able to be in the OR with us and take pictures, so I had a pictorial record without having to bother with taking pictures myself. This time I took my camera.)

Around 08:15 we shuffled from PACU through the anteroom (past the scrub room where the scrub tech was aggressively washing his hands up to his elbows) into the OR. Kiesa sat on the operating table while the anesthesiologist marked her back for the spinal. (I didn't watch -- my tolerance for needles is not as high as Kiesa's -- but for more than a week afterwards I could see the foot-wide crosshairs he used to mark the spot.) I didn't have anything to do yet but look around the OR, taking in the operating table, the large set of monitoring machines at the head of the bed that the anesthesiologist manned during the surgery (which, to my disappointment, didn't go "ping" even once), the cart of scary-looking surgical equipment, the warming table in the corner, the ritualized way the doctors and scrub tech handled the sterile equipment, and the big lights above the table (which tended to wreak havoc on my exposure, but at least had good white balance).

Once everything was ready, just before 08:45, Liz stopped everything and went through a big checklist on the whiteboard on the wall next to the door. (During surgery she floated around the room making sure everyone else had everything they needed.) Once she was confident everyone was on the same page, Dr. Bright Hoffmeyer started the surgery by cutting through the skin at the base of Kiesa's abdomen with a scalpel, then went back to remove a strip of scar tissue from her prior c-section. (Kiesa was disappointed that BCH didn't have clear drapes so she could watch what was going on -- as the child of doctors she has a high tolerance for medical procedures, even on herself.) I watched intermittently as they cut deeper, pried her abs open with a variety of surgical instruments, and presently pulled a giant head, covered in wet black hair doused liberally with amniotic fluid and blood, out of the incision. (I think I forgot to narrate before too long.)

Julian started crying even before he was completely born, once his face was exposed. The doctors pulled Julian the rest of the way out of the incision; his official time of birth was 08:55 MDT. They clamped his umbilical cord, then transfered him to the pair of nurses waiting in the OR for this very purpose. They carried him to the warming station in my corner of the room, where they wiped him off, calculated his Apgar scores (8 and 9), let me trim his umbilical cord, and weighed and measured him. Everyone knew he was big, but his official measurements left no doubt: his official birth weight was 4700 grams, or about 10 pounds, six ounces -- placing him somewhere above the 97th percentile.

I used the Version 2.1 Twitter feed to post Julian's first tweet as an actual baby on the outside: "Hello World!"

Kiesa and Julian immediately after he was born
Kiesa and Julian immediately after he was born

Within ten minutes of birth, the nurses moved Julian from the warmer to place him directly onto Kiesa's chest. BCH prides itself as being a "baby-friendly hospital", and one of those "baby-friendly" things is skin-to-skin contact between baby and mother after baby is born. Kiesa held Julian there while they put her back together, which included several different layers of stitches under her abdominal wall, and only a series of adhesive sutures on the skin above the incision.

Jaeger, Kiesa, and Julian, immediately after Julian was born
Jaeger, Kiesa, and Julian, immediately after Julian was born

At some point I carried Julian out of the OR back into PACU, and Kiesa followed on the hospital bed. Kiesa attempted to breast-feed, which seemed to work better than with Calvin, then one of the nurses took Julian's blood sugar and concluded that he passed. (He continued to pass the blood-sugar screenings for the next twenty-four hours, with his blood sugar climbing each time, giving us some confidence that he was actually getting some amount of colostrum (the first stage of breast milk) while nursing.) On Version 2.1's Twitter feed, I quipped that "This interface is not as intuitive as I was led to believe", referencing the claim in user-interface circles that "the only intuitive interface is the nipple", which is not actually true, as babies (especially premies) often need to be taught how to suck properly. I had Kate call our mothers to tell them the news first-hand.

Kiesa and Julian in BCH PACU
Kiesa and Julian in BCH PACU

To exit PACU, Kiesa had two criteria: increase her body temperature to ward off infection, and be able to wiggle her feet. They had a blower that pushed heated air into an air mattress that sat on top of Kiesa under her blankets in an attempt to increase her temperature. She passed the tests late in the morning, a little before 11:00, and the nurses wheeled her into the postpartum wing, into a bright room overlooking the hospital courtyard with a great view of the Flatirons. It was the first time I'd seen sun all day long; it was well before dawn when we checked into PACU, and both PACU and the OR were dreary windowless rooms in the middle of the building.

Courtyard, labryinth, and Flatirons from BCH Foothills
Courtyard, labryinth, and Flatirons from BCH Foothills

Kiesa called her mother, who arrived just before noon to see her second grandchild. I stepped out to my favorite sandwich shop Snarf's just down the street, whose location convenient to the hospital explains why I often see people in scrubs eating lunch there.

Grandma holds Julian
Grandma holds Julian

Kiesa's mother departed during the designated "quiet time" from 14:00 to 16:00 to pick up Calvin, then returned after the end of quiet time with Calvin, giving him his first chance to meet his baby brother.

Calvin meets Julian for the first time
Calvin meets Julian for the first time

Calvin was not quite sure what to make of the infant who stared back at him with big steel-gray eyes, but he seemed pleased to adopt his new role as big brother.

Grandma holds Julian for Calvin while Kiesa rests
Grandma holds Julian for Calvin while Kiesa rests

Kiesa's mother took Calvin home, and I headed to Chipotle for supper. Kiesa got to try a light meal of easily-digestible foods including (regrettably unsalted) mashed potatoes. The nurse helped her stand up and take a few steps before heading back to bed. I took more pictures and sent out an e-mail to the list of people we wanted to announce Julian's birth to (but only after posting the link to my blog post on Twitter, rewarding my own followers first). We put Julian to bed in the bassinet next to Kiesa's bed, and settled in to bed ourselves, with me sharing the queen-sized hospital bed and promising to help her up in the night when Julian needed assistance.

We went to bed on the first day of Julian's life tired but happy that he was born and healthy, and ready to begin our new role as parents of not one but two children, at very different stages in their lives.

For Kiesa's parallel account of Julian's birth, see Julian's Birth Story. For more photos from the day of his birth, see Photos on 2015-03-30.

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