Tuesday, June 24

Around 10pm Robin started to feel some pain in her abdomen. We'd learned in our birthing classes about false labor, and about how plenty of first-time mothers go to the hospital only to be sent home for a few hours. Robin had been feeling Braxton-Hicks contractions for months (tightening but no pain, as the uterus conducts drills for the Big Day), but these were a bit...twingy.

Over the next six hours, twingy turned into ouchy, and ouchy into OUCHY. Robin and I started to time the contractions, but didn't get the decrease in time from one contraction to the next indicating it was time to gas-and-charge up the Prius and head to the hospital. One of the symptoms of false labor is that walking around lessens the severity, and sure enough, walking helped.

But appeasement didn't work. Like all dictators, the uterus had plans of its own, and when the moving average of times between the contractions fell to about four and a half minutes, we called the OB and he told us to head on over. By this time it was 4am Wednesday.

Wednesday, June 25

We arrived at the hospital, and in Triage they confirmed that yep, our little tyke was about to find the egress, entitling us to a labor and delivery room.

At our birthing class, the nurse was proud of the fact that our hospital (Beth Israel Deaconess in Boston) had "labor and delivery" rooms, rather than having mothers labor in one room and requiring them to be transported, screaming, into another room for delivery. Beth Israel is a lavishly-endowed hospital. Every building is named after a different rich benefactor. Every wing is named, ditto. Every hall is named. Every conference room is named. A "plaza" consisting of twenty square feet of concrete in the parking lot is named. A shelf with some books on it is named and called a concierge desk, even though there is no concierge. Each elevator is named. Every time we took the elevator to the tenth floor, we gave thanks to a different rich guy that we didn't have to take the stairs.

Since Robin decided to go for an epidural, one of our first visits was from the anesthesiologist, a laid back surfer dude type. The sort of anesthesiologist who personally ensures that his anesthesia is primo Colombian-grade stuff. And indeed it was, as you can see from the picture. Robin's high on life!

Once she was hepped up on the epidural, Robin enjoyed the contractions. She could tell they were happening, but the pain just went away. Unfortunately, so did all feeling in her left leg -- the epidural was a bit off-center, favoring the left side.

From left to right, the machines pictured are:

1. White box with basket: blood pressure and heart rate machine
2. White dome at top: Spotlight! On! Birth Canal!
3. Green box in back: glorious glorious epidural (attached to Robin's spine)
4. Human in foreground: baby-making machine laughing her way through contractions thanks to machine #3
5. 1970s calculator on wheels: IV drip

The framed print in back of Robin is presumably there to fool the obstetrician into believing that instead of a hospital she's at a cheap motel, the sort of motel that decorates with pictures of places you'd rather be instead.

We relaxed and talked. Robin slept a bit (yes, through contractions -- epidurals are wonderful things) and I read more Cryptonomicon. There was a TV, and channel surfing brought us straight from The Baby Channel to Alien. Robin and I agreed that if only Kane had had an epidural, things would have gone far more smoothly for him.

At 2:50pm, the nurse decided it was time for Robin to push. Epidurals don't help here, and Robin was in a lot of pain. The nurse and OB encouraged Robin by telling her that she was almost there. Again and again, losing credibility each time. For about ten minutes, I was seconds away from getting to cut the cord, and Robin was seconds away from holding our baby girl to her chest.

At 4:24pm, we became very scared parents of a blue, unbreathing girl.

The OB cut the cord and hustled her over to a heated table, surrounded by a phalanx of doctors and nurses, with more arriving by the second as our OB called for backup. We heard them attempting resuscitation, and I saw them squeezing air into her mouth with an inflatable pouch.

The Apgar system is a way to quickly score the health of a newborn. An Apgar of 10 means the baby is perfectly healthy; an Apgar of 0 means no signs of life. Amelia's Apgar was 4. Here's how it's computed, with our assumptions about the components of Amelia's score in gray:

	0	1	2
Heart rate	absent	<100	≥100
Color	blue to pale	body pinking, feet and hands blue	pink
Breathing	absent	irregular	good rate, or baby crying
Muscle tone	absent/flaccid	some movement	active movement
Reflexes	no response to stimulation	grimace	sneeze or cough -- responds to stimulation

Amelia's Apgar of 4, coupled with Robin's temperature of 100.4 (suggesting susceptibility to infection from her waters having been broken for so long), meant an automatic trip to the NICU (Natal Intensive Care Unit -- don't choose a hospital without one).

Newborns have their Apgars calculated at 1 minute and 5 minutes after birth. Amelia's 5-minute Apgar was 7. This isn't completely out of the woods, but perhaps it's as good an improvement as can be expected; a baby born blue isn't likely to be pink four minutes later.

They kicked me out of the NICU once Amelia arrived. I think this was because the hospital has a policy of not letting parents see their newborns stuck with needles. When I got to see her about half an hour, I took this picture.

From left to right:

1. Tube coming out of her head: IV (Why the head? Because it's least likely to get torn out when the baby thrashes.)
2. White wire: respiration sensor?
3. Black wire: heart rate sensor
4. Red wire: blood oxygen sensor?
5. Small yellow clip on her bellybutton: umbilical cord clamp
6. Big yellow clip on her diaper: ?
7. Bands on feet: ID bracelets with code identifying her as our baby (we had matching bracelets)
8. Cuff on left foot: blood pressure?

We finally got Amelia Wednesday night at about 9pm for our first restless night with her.

Thursday, June 26

On our first full day with Amelia, she got a bath:

and enjoyed the company of her parents:

and tried to breastfeed. Modesty dictated that Robin breastfeed through her shirt:

...with less than ideal results. But it wasn't long before Amelia was feeding like a champ.

Friday, June 27 (Robin's birthday)

Like Amelia, we fed ourselves silly at the hospital. Robin drank a lot of milk in particular. Mothers are machines for converting cow milk into human milk. Babies are machines for converting human milk into vile excreta. Thus the mother and child together constitute a two-body system for converting cow milk into vile excreta.

The hospital photog took Amelia's picture for the web nursery and we were discharged. The discharging nurse said that she looked a little yellow, which we should monitor once we got home.

Saturday, June 28

Unfortunately, the yellowing progressed. Amelia had jaundice.

When old red blood cells break down, they produce bilirubin. It's the liver's job to remove it. Newborn livers haven't cranked into full gear yet, so bilirubin stays in the bloodstream and tinges it yellow. The yellowing begins at the head and proceeds down to the toes. The whites of the eyes can turn yellow (Amelia's did).

Jaundice is common in newborns, but the yellow should stay above the bellybutton. Amelia's didn't, and so we headed back to the hospital on Saturday for a bilirubin test, which takes two nerve-racking hours. Her bilirubin count was 17.1 mg/dl, enough to merit phototherapy.

Phototherapy is conducted with a device that is essentially a tanning booth. Intense UV light breaks down the bilirubins. Baby wears opaque goggles to protect her eyes. When the baby needs to be fed by the mother, she's removed from the tanning booth and swaddled with a UV pad nicknamed a "biliblanket":

I wish I'd remembered to take a picture of Amelia wearing this inside her clothes. It made her entire body glow with a bright greenish light, making her the cutest 1950s science fiction monster you've ever seen.

We spent a nervous Saturday night in the hospital, where a unenthusiastic nursing assistant fed our baby from a bottle. Hospital bottles all use nipples that are horrible for your baby if you intend to breastfeed. They're high-flow nipples, designed to ensure that the baby can ingest milk as quickly as possible. Babies who become accustomed to a firehose of milk from a high-flow nipple are less likely to settle for the trickle of milk that breasts produce immediately following labor. Why do hospitals use nipples that sabotage breastfeeding? Cost. They get them for free from the formula companies. This was problem number one.

Problem number two was that the selfsame assistant fed our baby as much as she possibly could from the bottle, and then brought her to Robin for breastfeeding an hour later when she wasn't hungry.

The result was that Amelia had two types of feeding experiences. The first type, bottle feeding, resulted in lots of milk, delivered efficiently, and when she most wanted it. The second type, breast feeding, resulted in little milk, delivered inefficiently, and when she was already full.

Is it any surprise which Amelia preferred? Overnight she turned from a fantastic breastfeeder into a baby who hated breasts more than Ashcroft. We had to feed her through a syringe taped to our fingers:

Sunday, June 29

On Sunday, after a night on the tanning bed and three bilirubin tests, we were discharged from the hospital for a second (and hopefully final) time, with a baby that was neither blue nor yellow and newly fearful of breasts. Now she's home, happy...

...and doing the tango!

Lessons learned

Overall, we were pleased with the care we got at Beth Israel. The doctors and nurses are superb, as far as we can tell. There are some things we'd do differently, like insisting that the staff not bottle-feed except in dire circumstances.

I wonder what Amelia's fate would have been had she been born a hundred years ago. It's possible that a smack on the bottom would have gotten her pink and breathing, and it's likely that the jaundice would have cleared up on its own. Beth Israel (and the associated doctors) were erring on the conservative side when they kept her in the NICU for observation, and when they had her return to the hospital for the overnight bilirubin tanning. But it's possible that the jaundice treatment did more overall harm than good -- not because of a poor medical decision, but because of that one dimwitted nursing assistant.

Our top ten nonobvious tips for expecting parents:

1. When choosing an OB, ask whether their hospital has a NICU. Their answer will either be "yes" or "if we need a NICU, we just go to this other hospital". If their answer isn't yes, get a different OB.

2. Doctors know a lot. Nurses know a lot. Assume everyone else is a dimwit until proven otherwise.

3. Do not give birth in the last week of June. That is when new residents and nurses are learning the ropes, and the experienced staff has just rotated elsewhere or gone on vacation. (However, our residents and nurses were fine, even if our resident was clearly inexperienced; this warning comes from our pediatrician.) This may apply only to teaching hospitals like Beth Israel.

4. If you're planning to breastfeed, say yes when you're offered a lactation consultant. Even if you're having no trouble breastfeeding. There's no substitute for an expert watching the mother breastfeed and fine-tuning the (surprisingly intricate!) process. I thought it was puffery at first; mammals have breastfed for millions of years without lactation consultants. But those mammals didn't have pacifiers, bottles, and formula, all of which can taint an infant (pacifiers encourage babies to chew; bottle nipples get babies accustomed to faster milk flow than a breast can provide; formula tastes better than breast milk). If you're having trouble breastfeeding, you can go to a private lactation consultant once you've left the hospital ($70 if you visit them, $100 to $200 for house calls).

5. Buy baby furniture early. Baby furniture = crib + nursing chair + changing dresser. The crib is essential, the nursing chair is darn nice, and the changing dresser is merely convenient. Buy them in the second trimester, since if you want anything not in stock, it can take 10-12 weeks to arrive.

6. Buy a "Diaper Genie", a mechanically interesting $30 chunk of plastic that makes diaper disposal easy and odorless.

7. Tips about breathing and walking around and taking showers during active labor are harmless and useless. They're comforting, but if you've got a good epidural, you won't need any of that.

8. That said, you should still take a birthing class. Parenting isn't rocket science, but you'll be so sleep-deprived that you'll have trouble remembering what you learned in the hospital. A birthing class drills the information into you, making it easier to remember later. A good birthing class will tell you all the right brand names to get as well (diapers, nipples, pumps). We took three birthing classes: parenting (excellent), breastfeeding (excellent), and baby CPR (OK).

9. When packing clothes for the hospital stay, be aware that moms don't instantly shrink after giving birth. The uterus takes a long time to contract (breastfeeding helps, by triggering the release of oxytocin). And mom's feet can swell, too: bring loose-fitting shoes.

10. Bring Playtex Slow Flow nipples to the hospital. In the event that your baby needs to be fed from a bottle, make sure that the hospital uses slow flow nipples and not the firehose flow nipples that the formula companies give them.

Wednesday, July 2

Amelia's eyes are now brown. All babies are born with blue-gray eyes and only later change into their final color. I had no idea it could happen this soon.

Babyvision

From parenthood.com:

• One Month: Eyes haven't yet focused, which means your baby will have trouble seeing anything beyond 12 inches or so. Still, he'll study intently anything within this range, especially your face. In terms of color vision, your baby will prefer bold patterns in sharply contrasting colors, much like a black-and-white chessboard design. Contrary to popular belief, newborns are not stimulated or soothed by the soft pastels adorning most nurseries. In fact, they cannot see the full spectrum of colors and their many shades until about four months.

• Two Months: Eyes work together to move and focus at the same time. This allows your little one to track the movement of objects, like a swinging hand toy or swaying mobile. He'll also begin to develop depth perception.

• Three Months: Distance vision begins to develop. You may notice your baby staring at you from halfway across the room or examining objects that are several feet away.

• Four Months: Distance vision develops fully. Your baby will test his newfound gift by staring at a distant television screen or looking out the window. His response to color is greater, too, as he begins to decipher a full range of colors and shades.

• Five Months: Your baby can now distinguish subtle shades of reds, blues and yellow. You'll find him stare intently at objects as he examines their color, shape and size. Infants this age, for some inexplicable reason, tend to prefer red or blue to other colors -- something to keep in mind when buying clothes or picture books. Bold patterns, such as polka dots and checkerboards, are also a favorite with babies.

Monday, July 28

Amelia had her one-month checkup today. 10 pounds. She's tall, but with babies this young, height is mostly a function of how much the nurse stretches them out before measuring.