Monday, April 10, 2006

William Kengo Kroboth
(The insane birth story as told by Angela)

Warning! This post may contain crazy labor and delivery descriptions. Read at your own risk.
If you would rather, just go back to the posts with the cute pictures.

Largest Baby in Japan
Yes, I gave birth to what may be the largest “newborn” in Japan. Every time I would go to the doctor for a pre-natal check-up, they would tell me how big my baby was. However, I dismissed this as simply a Japanese perspective on my Western-sized baby. Boy was I wrong. I can’t believe how big Will ended up. He is huge by Western standards! I really thought I would have a baby around 9lbs, the size that I was when I was born.

Summary of the Experience
Since Will was more than 10 days late, the plan was to try to induce labor on Monday by taking some prostaglandin pills. When my water “broke,” or rather, kind of started leaking, on Sunday, this seemed reasonable since it seemed that my body was getting ready for labor. However, my body wasn’t really ready. My cervix had dilated about 2cm by that point, but wasn’t thinking about going anywhere yet. Dan and I have a theory that the placenta was too healthy and was still doing its job quite well. It never released the hormones to start labor. Therefore we spent the week trying to convince my cervix to open up and start labor. Finally it was forced open and I gave birth on Thursday.

The Gory Details

Sunday morning
when I woke up, I noticed that my water may have sprung a leak. I wasn’t sure, but since we had an 11am midwife appointment that morning, we thought we would ask then. It was confirmed. This made us feel a little anxious, but hopeful that labor would start and we wouldn’t have to start the inducing with the prostaglandin pills the next day. Since the water leaking indicated that I could get an infection, I was admitted to the midwife clinic a little later in the day after we got some stuff together and did some walking.

Odd Note 1: As Dan and I sat in the exam room at the midwife clinic, we discussed one of the devices on the counter. Dan determined that it was a device that sterilized equipment. It was turned on. Much to our surprise, when it finished its cycle of sterilization, it then played a tune, “It’s a Small World After All.” We know that Disney is big here in Japan, but until that moment, we didn’t realize just how big. We now understand that “It’s a Small Sterile World After All.” After checking in we went to make tea. The hot water tea maker informed us that it was ready by playing “M-I-C-K-E-Y M-O-U-S-E.”

Monday Morning – Still no labor. Time to go to the OB doctor’s clinic. The way it works typically with midwife clinics is that normal, non-risky births can be handled there. If a complication occurs or an induction is needed, we have to go to the OB. Additionally there is also a backup hospital in case of a severe emergency.

After an exam by the OB, there is a discussion about the size of my baby and the size of my pelvis. The doctor recommends we be sure that the baby can fit before we start induction. Otherwise bad things happen as we try to force the baby out of too small a space. So, we went off to the hospital for a pelvic x-ray. When we see the x-ray doctor prior to the x-ray, he immediately commented on my height. I think he was mildly amused at the x-ray order. But we went ahead. What did the x-ray show? I basically have the perfect pelvis for delivery. There was tons of space for the baby to make it out and I am even shaped the proper way. The baby was facing the correct direction. The x-ray doctor drew lines between my pelvis and the baby’s head, putting up measurements on the x-ray. Everything was perfect. However, my body had still not decided to go into labor.

Monday Afternoon – Time for starting induction. In the United States induction can be started by applying prostaglandin gel to the cervix. That is not the route that we took. We started with prostaglandin pills, one per hour.

Odd Note 2: One of the great things about my husband is his ability to make me laugh. During the whole labor experience, he did a good job of keeping my spirits up even though everything we tried failed. For example, we had to check the baby’s heart beat frequently to make sure he was ok even with the water breaking. During one such instance Dan had the opportunity to say, “I don’t think curry beeps.” This totally cracked me up. I don’t think anyone has ever said those words together before. You see, we had curry for lunch and then the midwife put the doppler on my stomach. We heard “beat-beat-beat-beep.” Turns out it was just the doppler’s battery dying, but we were confused at first.

After taking a few prostaglandins, we went for a walk. This only caused slight contractions. We spent the rest of the afternoon hanging out, playing Scrabble, and other such things. Given that we are techno-geeks, Dan even demonstrated his techno-superiority by using his IPAQ to connect to our TiVo in Virginia and display a TV show. This all while we were still at the clinic. Later that night we decided to go to walk stairs. We headed over to Iidabashi train station where I could walk up stairs, then take the escalator down. (Down is less safe to do because I was large and had pregnancy balance issues.) Dan ran home to get a few things and everything went terribly, terribly wrong. I was ok, it’s just he lost me for 2 hours. Our friend Carissa put it best, “How can you lose a 5’10” pregnant white woman!?” I WAS IN THE RIGHT PLACE! We said Oedo line. That’s where I was. As I had climbed stairs for 20 minutes, I was resting right near the platform. However, Dan never made it that deeply into the Oedo line station, so I was lost. The only bonus to the evening was that Dan lived his dream of making an announcement on the Tokyo Subway announcement system. Everyone heard him tell Angela Kroboth to check in with the nearest station manager. Everyone, that is except for me, since I was at the Oedo line and the announcement went everywhere except there. In the end he called our midwife who was able to find me at the Oedo line. After our traumatic reunion, we went back to the OB clinic to sleep. Unfortunately this stress did not help to induce labor or cause contractions.

Tuesday Morning – I woke up at 6am. After sitting around and relaxing for a little while, I started having regular, but light contractions 5 minutes apart. To help these contractions along we took a walk at the Ueno Zoo (see previous post). Not even the ice cream break helped them along.

Tuesday Afternoon – Time for a more serious approach. Since the prostaglandins didn’t do their job to help the cervix to efface and cause labor, we took the next step: cervical dialators made from seaweed. You may be thinking, what?! That sounds crazy. They are called laminaria. They look like small black twigs. You put them into the cervix, they absorb fluid, they expand, this forces the cervix open. At this point I was 4cm dilated. We started with 15 sticks of laminaria. During the afternoon, I actually had contractions. I guess I really didn’t have a choice. We were doing things a little backwards. Normally during labor a contraction happens, it opens the cervix. We were doing the opposite, but the same things all happened. These were not severe contractions, but enough to distract me from my activities.

One great thing about Tuesday afternoon is that Carissa stopped by. And, she brought snacks. American snacks. Pepperidge Farm cookies...mmm. And she brought a ham sandwhich. Not normally a fan of ham sandwhiches, I was suspicious. But I tried it. IT WAS THE BEST HAM SANDWHICH EVER!

After Carissa left, we spent more time playing Scrabble. You see, normally Dan does not play Scrabble with me. He thinks I play dirty. It makes him annoyed when I crush him. But, he did promise to play while I was in labor. So what does he do? He starts out the game by playing all 7 letters! Then, for his next turn, he does it again! This was most unusual. We knew then that all was not well with the world. Here are our final Scrabble results:

Odd Note 3: One thing about Japanese clinics. They serve traditional, home-style, Japanese food. Dan has been enjoying many of my meals. I have been trying to eat what I can. For example, the other morning I saw scrambled eggs on my plate. I figured that they had some edible stuff in them, so I went to eat them. This was a bad idea. You know those sort of translucent fish that end up on sushi conveyer belts, watching you with their beady little eyes as they go around and around? Turns out there is a smaller version that can end up in scrambled eggs. I have circled some in this picture to help you identify them in their smallness.

By the end of my stay, the poor cook was doing all she could to get me to eat the food. And she was successful. Here is my last meal at the midwife clinic:

Mmmm... Salad, potatoes, brocolli, lasagna, strawberries and pineapple. I ate everything! It was great. And colorful.

Wednesday Morning - I woke up on Wednesday with weak contractions, 5 minutes apart, for 3 hours. I thought, "Yea! This is actually the start of labor. The contractions will get stronger, then I will give birth." Dan even entertained me through the contractions by attempting card tricks. However, after I had the cervical seaweed dialators removed, we went for a walk, but the contractions stopped.

The next step was one I had been dreading (weren't they all). Time for pitocin. Whenever you watch the birth stories on TV, pitocin always causes severe contractions. Our experience was a little different. We started off with one of my most feared experiences - the IV line. Of course, the first try for a vein didn't work, so I ended up with a bruise. The second try worked, but it was uncomfortable and hurt the entire time the IV was in. It also hurt and bruised after the IV was take out. My wrist actually still kind of hurts at the point of entry. It seems that my fear of IVs was actually founded. (Is that the opposite of unfounded?)

After the trauma of IV insertion, the pitocin was hooked up and the monitoring began. We watched the monitor. It showed contractions. As the pitocin dosage was increased, the contractions came closer together. However there was one problem. I couldn't feel any of them. This meant that they weren't doing anything.

Wednesday Afternoon / Evening – Since the cervical dialators did open my cervix to about 5/6 centimeters, the doctor determined to add some more. This time there were 20 sticks of seaweed. They immediately caused painful (finally), regular contractions (to help the cervix to efface more). However, after a few hours of this, it was late, so I decided to go to sleep. The contractions calmed down.

Thursday – I woke up Thursday expecting the contractions to start up again. They didn't really. The doctor removed the cervical dilators, said I was at 7cm. This was not enough. The next step was to force the cervix open in another way. I guess even seaweed has its limitations. So what do you do next to force the cervix open? That's right, they inserted a balloon into the cervix. They added water. We went upstairs, started some more pitocin, and they attached weights to the balloon to force the cervix open more. It was barely in for 15 minutes when I threw up all over the place, and the balloon popped out. Then we had some strong, kind of irregular contractions for another 3 hours. After that, they checked me and determined that the baby had still not dropped enough. They wanted to stick a vacuum extractor all the way up to my cervix and pull him out. However, I just couldn't deal with that kind of stimulation and pain so I insisted that if we were to go that way (risky to the baby's head/neck/spine/etc), that I HAD to have an epidural. After everything, it wasn't the contractions that bothered me the most, but the stuff they kept doing to my cervix. So there was a stage of Japanese negotiations. Dan held steady and said that if they couldn't accommodate us, we needed to go to the hospital for a c-section (which I agreed with).

They decided that they could wait on the vacuum-extraction-all-the-way-down procedure. Therefore, I didn't need the epidural. They ended up letting me try pushing. It actually worked. Will moved out of the uterus into the birth canal. I did laying down pushing, standing pushing, squatting pushing, laying on my side pushing. This lasted for an hour. Then he kind of got stuck behind the pubic bone. Fortunately the vacuum extraction at this point was a whole lot safer and less involved than the procedure proposed earlier. So they sucked him down, gave me an episiotomy, and pulled him out.

Obviously the experience of the labor and delivery (8 hours 38 minutes) was quite the short part of the entire experience. Pushing was easy compared to the stress of the rest of the week. I am sorry that I couldn't quite push enough to get him past the pubic bone. He has a scab on his head from the vacuum extraction. In any case, he is healthy, strong, and seemed glad to be in the outside world. He often expresses his appreciation for the outside world at 4am.

Here are the vital statistics about the labor:

Yes, the placenta weighed 858 grams. It was huge. I was so much smaller when everything was over. In fact, I am now 3 lbs less than my pre-pregnancy weight. I hope to join Curves again in a few weeks and find my pre-pregnancy shape too.

What about Will? As you know, he weighed 4766 grams. That's more than 1/1000th the size of the elephant we saw at the Ueno Zoo on Tuesday.

Will: 4766 grams

Elephant: 4150 kilograms

And, of course, for your reference, here are Will's footprints next to a standard US quarter:

Was it an insane experience? Yes. But, I had the best care and the most attention possible from my midwife and my doctor. Things didn't go as I had hoped, but during each step of the process, I knew that my health and Will's health were the most important things during the decision making.

My Doctor

My Midwife

Happy Family:


Liz said...

AHHH! The translucent fish strike again! You just can't away from those in Japan...

Wow, it sounds like you had quite the ordeal. I am so glad everything worked out in the end, and both you and Will are safe and healthy. :)

Angela said...

The translucent fish are creepy. I am glad to be back in the US where they can't find me!