Wednesday, July 11, 2012

Happy birthday!

Dear Arjun and Anirudh,

Saturday, 9th June 2012. The day you will remember forever, your birthday. One of the longest days of my life. You probably wont feel anything different other than the taste of a nice birthday cake. But for me it is much more than the taste of that cake. It would be hard for me to forget the anxiety, fear, pain and that final smile on your mom's face on that long day.

The day started at 4:30AM for me. You mom was admitted to Royal Berks hospital due to the symptoms of pre-eclampsia. Majority of the pregnant women with twins apparently go through this tough phase. It is characterised by having very high blood pressure and some traces of protein in the urine. Also accompanied by blurred vision, headache and few other symptoms. She was admitted to hospital on Wednesday and counting the days for pre-scheduled c-section delivery on 22nd June. Our consultant Jill was on holiday and she had strictly instructed you to not create any trouble till she is back. But you didn't listen. I don't know what you have done, but you did something very nasty to the sack you were in and managed to break the water early in the morning. Your mom suddenly went into panic mode. She called me to pack all the things and come to hospital immediately. I got all the stuff and went to delivery suite at 7:30am. Don't ask what I was doing till 7:30. I had a nice two hour sleep in that time, dont really remember whether I just fell asleep or she asked me to come later. When I went there she was still in the shock, now water in eyes as well. She has a different set of search keys for google search and only finds the scary things from internet. So she had her own idea of how bad it is for you guys to be without much water left. I am quite selective in reading the online medical information and generally leaves it to experts in that area. So, theoriticaly it was hard for me to convince her due to lack of my subject matter, but somehow I managed to do that to certain extent.

As per the RBH policy, if the water breaks, they might wait for up to three days depending upon the circumstances. In our case it is bit trickier as it was identical twin pregnancy, which in itself carried greater risks. All the twin deliveries are handled in an operation theatre even for natural delivery. That is because the second delivery might create problems requiring emergency c-section in certain cases. So we had to be ready for the c-section as well, though they were trying for the normal delivery. Unfortunately Jill had clearly mentioned in her notes that they should try for normal delivery if there was any sign of labour before 22nd and as long as things are normal. So the duty doctors were diligently following her orders without showing any interest for c-section. We knew that the time was coming soon, but had no clue whether it was in minutes, hours or days. Strangely your mom was not allowed to take anything other than water till the delivery. It was already more than twelve hours without any food and she was starving. Finally she managed to get some toast after complaining several times.

At around twelve in the afternoon she started experiencing mild contractions. Contractions are circles of pain near abdomen area which we don't understand. I have only heard that is the worst pain one could ever have. I only have to believe it as there is no means for me to experience it. I think I witnessed that in next couple of hours. I had never seen your mom expressing the pain like she was on that day. The contraction started coming for every fifteen minutes and stayed for around forty seconds. Technically it is less than three minutes in an hour initially, which is only five percent of the time. But she felt really miserable in those forty seconds. My pain calculation mathematics didn't help her much as the contractions started coming more frequently. As per the midwife, they consider the contractions as labour pain only when they start coming every five minutes, for a minute each. The other approach was to look at the cervix opening, but they were against that as the water was already broken. Any such attempt had more risk of introducing infection making things even more complicated.

By 4:00PM the pain had reached beyond her control. I was finding it very hard to control her screaming. I was holding a watch and keeping the record of the contraction rate. After every contraction she was painfully asking me 'how long more'. 'You are doing really good, the contraction rate has come to every 8 minutes now, just few more hours'. My consolation was again based on the data. Actually it was coming every 9 minutes, but I had tweaked the data slightly hoping there might be some action soon. But I was scared to reduce that even further, Interestingly the contraction length was increased to 90 seconds, which was quite unusual looking at their data. She was constantly screaming for 'epidural', a pain relief injection which we thought we will opt for. We had been to a 12 hour NCT class to learn what we should be expecting as expectant parents. Out of many pain relief methods, epidural and spinal were thought to be the most efficient. So, we have forgotten all other measures of pain killers used during labour. Also, we were never mentally prepared for the labour pain, we always thought it would be a c-section and we have also got the c-section date scheduled. Looking at the way your mom was reacting to pain, the midwife changed her mind and took the risk by checking the cervix opening. She was only 2cm dilated at that time. So, they rejected 'epidural' as it can be given only after dilating 4cm. So she had to endure the pain for some more time. They suggested taking deep breath during the contraction, but the pain was too much to be controlled by these normal measures.

We were originally given a normal delivery room, which was supervised by a midwife and nurse along with two other similar rooms. So, they weren't able to give enough attention to us. At 6:00PM, another duty doctor came and prescribed two paracetamol and di-morphine for the pain killers. I didn't even remember whether it was good or not. But we were not able to take any decisions at that stage even if we knew, it was her pain taking all the decisions. After taking those 4 tablets, she went into sleepy mode.  We were also moved to another individual room where we had a dedicated midwife and nurse to take special care of us.

All along there were two heartbeat monitors and a contraction monitor attached to her tummy to observe how you are behaving. I could see the contraction graph getting bigger and bigger and more frequent. But due to the pain killers, Ashwini wasn't feeling any of those. She was in some kind of trans mode and we were trying to keep her awake. She was able to answer all the questions but didn't show any sign of having contraction pain. It continued till 8:30 and then the pain started taking over the pain killers. It became hard to control her again and she started screaming for 'epidural'. Midwife called for the anaesthetic doctor for advice. In the meantime she examined her cervix again and surprised to see that she was completely dilated. Anaesthetic and another doctor came in the meantime, but they weren't sure whether to give the 'epidural' or not. Epidural takes around 20 minutes to kick in and they were worried she might already get delivered by that time. Also her blood report hasn't arrived yet which was needed to take the decision as well. So, they ended up deciding not to go with the epidural and instead opted for 'spinal' after moving to operation theatre. Spinal is also very similar to epidural, but given directly to the close proximity of spinal chord through injection and the effect is immediate. But it was hard to control her till that point. So they tried with entonox, basically inhaling laughing gas, which didn't help much. So, they ended up giving morphine injection this time as Spinal would still take some more time. They had to do some more preparations before moving us to operation theatre. Both of us are given special dresses and shoes to be worn at OT. And there was a long list of questionnaire to fill in. Ashwini was still in trans state, not really sure how she managed to answer all those questions. Apparently they had to get the answers from the patient herself.

We were moved to OT at around 9:30. There were more than 7 people including 3 doctors and a paediatrician. Ashwini seemed to be in a better state and was able to bear the pain now. She has started pushing now which actually helped her to overcome the pain. The natures way of giving birth really looked amazing to me. A strong push during the contraction not only pushes the baby through the cervix passage but also helps to overcome the pain. Ashwini quite liked the push part, so she was even ready to go ahead without taking 'Spinal'. She said the same thing to doctors as well, they looked bit startled but allowed her to push. 'Spinal' completely makes the nerves numb making it difficult to feel the contraction. Without feeling the contraction it is hard to push against it. So, these pain killers in a way doesn't go that well with the natural delivery. Doctor decided that the 'push exercise' will only continue for 20 minutes and after that they planned to give the 'Spinal'. 'Spinal' procedure takes close to 15 minutes and it is hard to do that if there is any emergency during the delivery. We agreed and stopped pushing at 10:15PM. Anaesthetic took a bag full of syringes with different types of chemicals and carried on with his work. It had to be done very precisely as any minor mistake would result in serious long term issues. It took complete 15 minutes and they did final testing to make sure it actually worked. 'Spinal' severely reduces the blood pressure, so they had to make sure BP doesn't fall below the threshold. 

Within minutes the OT was completely ready for the delivery. Based on the contraction monitor she was allowed to push for some more time. Both of you were quite low, still it wasn't enough for the easy delivery. After pushing for five minutes, the doctors decided to use the forceps. That was the first time I saw delivery forceps and the look itself really startled me. The determined doctor put two forceps inside the cervix and tightened the grip on head, within seconds she decided the opening isn't sufficient and did a quick episotomy. And in next few seconds I could see Arjun's head coming out! The wall clock was showing 10:51. In the next second I could hear his cry, but believe me, that wasn't really how I imagined my boy would look like! He was immediately given to the paediatrician and they checked several things along with a clean wash. I was quite confused whether to take another look at Arjun or see how Anirudh would be coming out. After the first delivery, the doctor looked relaxed so she let Ashwini to do the push again and go for normal delivery without the use of forceps. But as soon as Arjun escaped out, the shape of her tummy changed dramatically and the monitors looked like misplaced. The heartbeat started dropping suddenly, so everyone became panic again. I am still not quite sure whether the heartbeat really dropped or it is the changed position of those monitors that gave the wrong readings. Anyways, doctors never take risk, so forceps went in again and came out with Anirudh this time. Anirudh cried as well within seconds. I thought I might cry at that stage earlier, but surprisingly I didn't feel like crying. The moment we have been waiting for from last several months had just passed, but I was still not in a position to admit that. You both were given to us for a closer look. Not sure what soap did paediatrician used, you both looked amazing side by side!

Slowly the moment of pride, happiness, excitement started to sink in. But, I am sorry to say, it was not you, who stole your birthday for me, it was your mom. The courage, that she has shown on that day was truly beyond the words. 


Destiny's Child said...


Giri RP said...

Good one dude.. 1st half resembles my experience in labor room.

Jagadish said...

Amazing man .

Sunil said...

Wow! well narrated. Congrats to you both :)