Kahlilah’s Birth Story
The funny thing about the day Kahlilah decided to arrive was that we had agreed that morning that we were going to have a “lazy day.” We took the dogs to the Embassy to run in the morning. We lazed around the apartment in the afternoon. Then we walked down the hill from our apartment to the Plazas shopping center to have a coffee and alfajol. Afterwards, we ran into friends from the Embassy who offered to give us a ride back up the hill and subsequently invited us to an impromptu dinner at their apartment. We enjoyed their company and eggplant lasagna (Side note: Ironically, we’ve since read that—anecdotally—eggplant parmesan and basil can induce labor) until late in the evening. When we returned home, we got into bed and Albert tried to go to sleep right away while Chela read one of the numerous baby books we had—the Baby Book by Dr. Sears (which has come to be our “baby bible” since Kahlilah was born).
Suddenly, just like they say, Chela had a feeling like a balloon popping and soon there was water everywhere. Chela simply said to Albert “I think my water just broke” and stood up, while staring in disbelief at the rapidly forming pool of water at her feet. Ironically, we had just watched a video a few days before on what to do when a woman’s water breaks: mainly, it’s to have the woman sit down, note the time, note the color and smell and—if it is green—go to the doctor immediately. Albert remembered to do all of these, except to have Chela sit down. Luckily, the water was clear so that was one less worry. First there was some initial miscommunication about what to do/who to call (Chela kept on telling Albert to find the “card,” which Albert took to mean the business card for the doctor we had chosen that week—Dr. L—but which Chela meant to mean the card the Embassy gave her with emergency contact numbers). Then Albert called Dr. L, which turned out to be a wise choice. Albert talked with Dr. L for several minutes, explaining the situation and that Chela was only 34 weeks along (Side note: 37 weeks is considerd full term). Dr. L told Albert that we’d need to decide on which hospital to use, since we needed a hospital with an intensive care neonatal unit—with space available. That was the key since there are few NICUs in Caracas—or in the country for that matter—and they are often full, leaving parents to drive all over the city going to hospitals until they find a space. After Chela’s many repeated interruptions, saying “We have to go!,” Albert finally asked Dr. L if he could come to our apartment to help us through the situation.
While we were waiting for Dr. L to arrive, Chela attempted to relax—calling her mother to tell her what had happened and other FSOs to find someone to care for the dogs the next day. Meanwhile, Albert called the Embassy to inform them of the situation and quickly started packing for the hospital. It turned out that we should have discussed what to bring and in what bag beforehand, because Albert ended up bringing five pairs of socks, 2 t-shirts, no underwear, and a leisure suit—but he did remember to bring his Ipod and Bose speakers (which, by the way, Chela had requested so that she could have music she liked during the labor).
Dr. L arrived within 5 minutes (luckily he lives on the next hill to us). He did a quick assessment and told us that the baby would need to be born within 24 hours because of the premature state and the chance of infection due to the water breaking and that we’d need to get to a hospital for a C-section in the morning. Albert got out the medical binder the Embassy gave us with a list of recommended hospitals. We started by calling the nearest hospitals to us. Albert asked Dr. L to speak with the hospital staff to verify whether there was space available in their NICU. On the third try, with Hospital de Clinicas Caracas, we were lucky to hear that they had a space.
So, Albert grabbed the hastily packed bag, Chela wrapped herself in a towel, and we got into Dr. L’s minivan to ride to the hospital. (Side note: There are only paid ambulance services in Venezuela. We had planned on calling to set up membership with one later that week! Luckily, Dr. L was generous enough to drive us.) During the ride over, Dr. L attempted to distract Chela by telling her that this was her nighttime tour of Caracas—pointing out various landmarks such as the botanical gardens and a controversial mall being built. Chela tried to humor him, while taking deep breaths to calm herself.
Upon arriving at the hospital around 12:30, much to our surprise, we didn’t go into the Emergency entrance. Instead, Dr. L—who had worked at that hospital until the year prior—drove around back to park in the paid parking lot. While Dr. L found parking, Chela hopped into a wheel chair, per hospital policy, noting that she “felt silly” while Dr. L noted the faults in the policy saying that it reinforced the idea that a woman is powerless or an invalid during pregnancy.
Dr. L brought us up to the sixth floor, where the doctor-on-call met us. She had just graduated in December but seemed very open to Dr. L’s presence and our desire for as natural a childbirth as possible given the situation. Chela was asked to lie down on a hospital bed and was hooked up to a fetal monitor. It showed that there were virtually no contractions and the fetal heartbeat was good. (In between fetal monitoring and waiting for test results to come back, Dr. L proselytized to the on-call doctor the virtues of natural birth and commented on the horrendous pay that new OBGYN make, which ranges from US$300-600 per month.) Based on the results, it was decided that Chela would undergo a C-section in the morning and, in preparation for the birth, she would be given an antibiotic to help the baby and some medicine to help the baby’s lungs. Once the plan was set, Albert and Dr. L went downstairs to get Chela admitted. During that time, Chela was left alone in the hospital room—this was one of the scariest periods for Chela. The full weight of what had happened finally sunk in and, in the solitude, it was almost overwhelming. Chela almost cried out for someone but, instead, she tried to practice the deep breathing techniques that she had learned in Bradley classes that she and Albert took in DC. When Albert returned, Chela told him never to leave her side again.
We were moved to a private suite around 2:00 am—a room much nicer than either of us expected. It had a very clean private bathroom, a plasma TV, lazy boy and a quasi-sofabed. We were left alone, so Albert set up the Bose/Ipod soundsystem. Chela requested Joni Mitchell’s Ladies of the Canyon album and Amos Lee’s Supply and Demand album. (Side note: Albert would come to associate Joni Mitchell’s “Morning Morgantown” song with the entire birth experience, given how many times it played over the next week.)
Around 3:00 am, Chela started to have what she came to find out were contractions. Since she never gave birth before, she didn’t know what she was feeling at first. Basically, it just felt like really bad menstrual cramps—pain low in the belly and lower back. Albert started timing them. At first, they were irregular so Albert thought they might be Braxton-Hicks contractions. But, after 30 minutes, they became more regular (4 minutes apart, 1 minute duration) and stronger. After some convincing of the on-call doctor, Chela was again placed on a fetal monitor. The monitor confirmed that they were in fact contractions. Upon seeing the results, the on-call doctor called Dr. G—who Dr. L had arranged to attend the birth since Dr. L did not have privileges at the hospital—who subsequently proposed that the on-call doctor do a vaginal exam. The exam revealed that Chela was 4 centimeters dilated, that the baby was in position but that her hand was over her head. The on-call doctor suggested various pain medications, which Albert had to try to make sense of via his “birthing bible”—the Birth Partner book by Penny Simkin. We ended up forgoing any pain meds for the time being.
Around 4:00 am, they moved Chela to the birthing area. About this same time, they informed us that—because of the speed at which Chela was progressing—there would no be time to prep for a C section. So instead the plan was for a vaginal birth. This was reassuring and frightening to us, at the same time. On one hand, we were happy that our desire for a vaginal birth would be met. On the other hand, Chela was in a lot of pain and we knew that a vaginal birth would not necessarily mean it would be a natural birth. In the Bradley classes, we had prepared mentally and physically for a natural birth, with various birthing positions, relaxation exercises, and ideally limited or no medications. We quickly realized that the birth would be vaginal, but far from natural. The doctor insisted on an epidural to prevent undue stress on the baby. Due to the preterm nature of the birth, we capitulated to the doctor’s suggestions for an epidural, pitocin (which they administered without our knowledge or approval) and a small episiotomy. They also strapped Chela’s right arm down in order to give her the medications, which prevented her from getting into an optimal pushing position, and kept her flat on the exam table (which the nurses had extreme difficulties positioning, much to Chela’s discomfort and frustration).
The next two hours passed extremely quickly, as Chela was either in the throes of a contraction or trying to recover from a contraction. Since the contractions were so frequent and strong, Chela barely had time to recover from one before the next one was upon her. Chela struggled to use the breathing techniques she had learned to fuel the pushing. Due to the epidural, though, it was hard for her tell if she was pushing effectively. Periodically the doctor would do a vaginal exam and urge Chela to push through her pelvis, rather than through her neck. At which point, Chela would scream back in English that she “couldn’t push effectively because you numbed my entire body with your f-ing shot!” (Side note: When the doctor wasn’t examining Chela, she could hear him out in the hallway casually talking to the nurses. She wondered how he could have normal conversation while she was in second-stage labor. Meanwhile, Albert was constantly frustrated with the nurses. In Venezuela, nurses are there to assist doctors and that’s it—they are not there to care for the patient. And they let you know it.)
Finally, around 6:15 am, the doctor’s exam revealed that the baby was finally ready to come out. After 15 minutes of extremely hard pushing, assisted by nurses kneading Chela’s belly and the doctor pulling the baby out, Kahlilah was born. She was a “Frank breech” birth, meaning she came out rear-end first in a V-shaped position. She also came out with her right hand trapped underneath her posterior. People from the neonatal unit quickly took Kahlilah away to examine her for the Apgar test. After the test, the doctor let them put Kahlilah on Chela’s chest for a few seconds before they took her upstairs to the NICU.
After all the drama, Chela had to wait for the birth of the placenta and to be stitched up. The doctor actually went in and removed the placenta himself, which is very different than what we had prepared for or what is the norm in the US. It was also pretty painful for Chela as he stitched up the episiotomy. In fact, it seemed like an eternity but, since there were only 6 stitches, it probably wasn’t that long. (A funny anecdote: While Chela was getting stitched up, she kept on asking Albert in English to find out how many stitches she needed. Albert then asked the doctor in Spanish about the number of stitches, which made him seem very insensitive. The doctor just told him that everything would be exactly as he found it. The doctor even asked whether Albert wanted to observe the stitching, which was the furthest thing from Albert’s mind. Chela was obsessed with knowing how many stitches she had in order to see whether she would beat the number of stitches one of her friends had. Finally Chela—frustrated with Albert’s and the doctor’s lack of a specific number—launched in Spanish into explaining her friend’s story. After which, the doctor finally told her the number of stitches: 6. It turns out that Chela wasn’t even close to her friend’s number. Chela has no memory of this at all! So two days later, when she and Albert ran into the doctor at the hospital, she again asked how many stitches she had received.)
After Chela was taken out of the birthing area to the recovery room, Albert started to make a series of very expensive calls on his cell phone to family in the US. Chela tried to sleep but uncontrollable trembling in her legs and thoughts of Kahlilah kept her awake. Albert was only with Chela in the recovery room for a few minutes before they told him that he had to go downstairs and fill out paperwork to admit Kahlilah to the hospital. This seemed—and still seems—asinine to Albert. After he returned, both of us were taken to our private suite. There we anxiously awaited news about Kahlilah…and the arrival of a mythical breast pump from the lactation unit so that Chela could pump her colostrum to give to Kahlilah. After Albert was told that there would be no news about Kahlilah until noon and Chela went to sleep, he quickly returned to the apartment to take out the dogs, make arrangements for them to be boarded for the next few days, and pick up more appropriate clothing for Chela. He returned to find Chela in the NICU, singing a Winnie the Pooh song—which Chela’s mother had sung to her—to Kahlilah.
Over the next 5 days, Kahlilah grew stronger in the NICU—surpassing all expectations. During the same time, we came to find out some things that made us feel even luckier (and some things that we were glad to find out after the fact). Dr. L, who checked in with us daily in the hospital, informed us this was one of the few vaginal births Dr. G had ever attended. (Side note: The C section rate in Venezuela is over 90%. They are the norm, not vaginal births.) Also, talking to our Bradley class instructor, doula, and midwives from the US, we came to find out that Chela would have never had the chance to have a vaginal birth in the US with Kahlilah in the Frank breech position. And finally, we realized that Kahlilah was born at 34 weeks to the day—the exact day at which Chela would have left to go back to the US for a “medevac” delivery if our visas had arrived on time and thus we would have had that option. “Medevac” is when the government pays for your repatriation for medical purposes. In that case, Chela would have been alone—without Albert—with her water even possibly breaking in flight.
So, in the end, it was a wild and sudden labor but Kahlilah joined us as a relatively healthy and happy baby. The End