Editing Pregnancy (section)

== Delivery ==

Because of Julie's Gestational Hypertension, delivering as early as possible once she hits term is [[Pregnancy#Eighth_Consultation|apparently a good idea as we found out at a previous consultation]]. So we had a scheduled induced delivery as soon as she hit term on Mar 7.

From a convenience standpoint this was much better. No rushing to the hospital at a random time and so on. However, it does mean a longer stay in the hospital.

Here was our anticipated delivery process

{| class="wikitable sortable"
|+ Delivery Timeline
|-
! Date Time !! Event
|-
| 2025-03-07 0700 || Arrive at hospital
|-
| 2025-03-07 0745 || Get to room
|-
| 2025-03-07 0830 || Finish onboarding process
|-
| 2025-03-07 1800 || Insert foley<ref name=foley-balloon/> device
|-
| 2025-03-08 0800 || Start Pitocin (synthetic oxytocin)
|-
| 2025-03-08 1600 || Deliver baby
|-
|}


[[File:CPMC Van Ness Delivery Room - Playing Dominion.webp|thumb|It's best to bring some entertainment if you're being induced. It may take some time.]]

Obviously nothing but our arrival could be precise so we had no expectation for anything but the start, plus we expected that any branching would change everything completely.

=== Things to Take ===

Once you've registered with the hospital they'll send you a checklist to take with you. The bare minimum of things to take with you are:

# Car seat
# Photo ID
# Insurance card

All other things are for comfort, but you need the Photo ID to check in, the insurance card if they ever need to check it, and the car seat to actually take the baby home in your car.

Things we packed in addition were:

* Games to pass the time
** Dominion and Milles Bornes
* An iPad and laptops
** We downloaded a show Julie wanted to watch on Netflix on the iPad
** I wrote some of this post while waiting
* Bedding
** The pillow Julie got me is far better than theirs
** The blanket I had has served me well since when I was a Masters student at NCSU
* Snacks
** A few chocolates, some peanut butter cups, some popcorn
** A few coke zeros and coconut water and Julie's favourite Hint water
* Toiletries and change of clothes
** In theory we'd swap to sleep in and shower there and so on
** In practice, I changed once and didn't shower but it was nice to brush my teeth
** It was nice to get out of the shoes and into slippers
* The stroller that the car seat fits into
** This was primo. She fell asleep as we rolled her around and then we slotted her out and into the car without a change in her demeanour.

Overall, considering we had the Subaru parked downstairs and they gave us a cart to transport stuff between Floor 5 and Floor 8, I think bringing these supplies was quite useful. There is lots of room to store them and it was very convenient.

=== Arrival ===

This was a straightforward process because we were delivering at the same place we did ante-natal monitoring. The parking lot gets full quickly but it being seven in the morning gave us a chance on P3 of the CPMC Hospital building.

CPMC security varies quite a bit. Some are particular about going through security without setting anything off and others are happy to look at what you've got. A laptop will trigger it. A hydroflask will trigger it. There's no real hurry at this point if you're being induced, however.

We had a wait until about 0740 while they prepared their room and our nurse came out. Unfortunately, we did miss our obstetrician as she was just finishing her rounds and hand-off before going home after finishing her on-call shift.

=== The Room ===

[[File:CPMC Van Ness Delivery Room.jpeg|thumb|It's quite spacious. Maybe 400 square feet or so.]]

The room at CPMC was quite spacious. It's got all the hospital equipment on one side and then a table on wheels and a chair you can move to be by the mother. There's a couch next to the windows to sleep on, though it's only about 5 ft long which makes it hard to fit in.

[[File:View from CPMC Van Ness Delivery Room.webp|thumb]]

There's a pretty nice view from the windows (which do have shades because of the bright sunshine). The bathroom is also quite large and there was a birthing ball in it.

There were two biohazard bins and one linen bin in the room, but no general trash.

=== Onboarding ===

This is a fairly standard process with the blood pressure checks, blood sugar checks, sticking the mother on the monitor, and all that.

For the blood sugar check, it's apparently nicer if you use the needle you've always been using. Julie had hers which saved her one from the bigger jabber in the room. They still use their devices to check you.

There were a couple of questions that seemed unusual to me. One was about 'goals' which was apparently an avenue for those who want their make-up artist to show up at a time or their delivery photographer to be present and so on. We had none here.

Another was about the erythromycin, Hepatitis B, and Vitamin K shots the baby was to get. They all do what they say on the tin and we'd have to get them from the paediatrician anyway if we didn't get them at the hospital so we opted in.

Ater that it was about settling in for a few hours.

=== Support Person ===

[[File:CPMC Van Ness Delivery Room Couch-Bed.webp|thumb|I slept quite well here]]

[[File:Julie Selfie With Roshan Sleeping in the Delivery Room.webp|thumb|As you can see]]

For this delivery, I was the support person.  Most delivery rooms here have the wider couches. These are convenient because when the back comes down you get a bed that's about 5'8" or 170 cm long. This is sufficient for me to curl up and sleep in.

=== Actual Timeline ===

The reality, as everyone is well aware, is less likely to land precisely on schedule. I am writing this from memory in a moment of quietude so the times are non-exact. They may vary by an hour.

{| class="wikitable sortable"
|+ Delivery Timeline
|-
! Date Time !! Event
|-
| 2025-03-07 0700 || Arrive at hospital
|-
| 2025-03-07 0745 || Get to room
|-
| 2025-03-07 0830 || Finish onboarding process
|-
| 2025-03-07 2130 || Insert foley device<ref name=foley-balloon/>
|-
| 2025-03-08 0530 || Balloon comes out, dilation at 4 cm, start Pitocin
|-
| 2025-03-08 1230 || Dilation to 6 cm
|-
| 2025-03-08 1345 || Epidural attached
|-
| 2025-03-08 1615 || Prep for pushing
|-
| 2025-03-08 1655 || Start pushing
|-
| 2025-03-08 1730 || Delivered
|-
| 2025-03-08 1755 || Stitching complete, surgical stuff removed
|-
| 2025-03-08 1810 || Breastfeeding begins etc.
|-
|}

=== Delivery Itself ===
[[File:{{#setmainimage:Julie and Astra.webp}}|thumb|Everything went well, as you can see]]

The actual process itself was quite quick once it started. Julie gave it a few pushes and before we knew, out came our daughter. They clamped the cord and I cut it. They handed our daughter to Julie who held her and then breastfed her while the doc stitched Julie up. And that was it.

=== Breastfeeding ===

We had a plan for feeding the baby that went breastfeeding > stored milk > formula. But we didn't have any expectations as to how likely it would be that she'd be able to feed. As it turns out, things went quite smoothly here.

There are lactation consultants at the hospital but the nurses are the first line. They showed Julie how to express milk: press downward on the breast to the nipple. And then they verified the presence of some [[wikipedia:Colostrum|colostrum]].

=== Post Delivery ===

At the beginning of the process, they asked us if we had any objection to the initial treatments the baby will be given. We consented to all of them:

* Erythromycin on the eyes
* Vitamin-K shot to the thigh
* Hepatitis-B shot to the thigh

They suggested and I was eager to put the little band-aids on her at the injection sites.
[[File:CPMC Van Ness Newborn Room.webp|thumb|Quite a bit smaller but still spacious]]
[[File:CPMC Van Ness Newborn Room Couch.webp|thumb|Much smaller, but it does expand out to about the same length as the delivery room one]]
[[File:View from CPMC Van Ness Newborn Room.webp|thumb|I like cityscapes as does Julie so this was quite pleasant. I especially loved the depth to the city.]]

They gave the child these injections while she was being weighed and so on in the newborn warming bed. One interesting about the entire process was the emphasis on metric units throughout (degrees Celsius and grams and so on). In fact, much later as we were checking out there was a trainee nurse who the nurse in charge asked for temperature who responded in Fahrenheit. The experienced nurse said "Metric, please" so the data are all written down in metric, which is unusual to me in the US.

We were then given some time and a cart to pack up and move to Floor 8 of CPMC for Newborn Care. The room there is much smaller, but still quite large. I'd say about 150 sq. ft. with a nice view out the window.

There was a small two-seater couch by the window which extends into the same length as the couch in Labor & Delivery. The back comes off but isn't the same height as the seat so I had to augment with some pillows to be comfortable.

There's also a folder with a few infographics and some questionnaires.

=== Security ===
[[File:CPMC Child Security Tag.webp|thumb]]
[[File:CPMC Parent-Child Identification Tag.webp|thumb|These are the tags that the parent and child have]]
[[File:CPMC Parent Identification Tag.webp|thumb|And this is the tag on me showing the number that nurses match against]]
Security of the child seemed to be an important thing to the hospital. The child was taken out of our sight only once (to check her [[wikipedia:Meconium|meconium]]) but they were still quite careful. The security measures were:

# A radio tag on her ankle that would shut off elevators on the floor and fire an alarm when she passed any of the doors exiting the ward
# A printed tag with a number that matched tags on our wrists
# A teddy bear icon on people with badges who were allowed to handle a child

According to a nurse who had been there a few years she'd never seen any real trouble with these, so I must assume that this is standard in the US. I get why they did these things [[wikipedia:Babies switched at birth#21st_century|since baby mixups do occur even today]] though the examples there from the last decade are from El Salvador, India, and the Philippines.

=== Day One ===

The next day was when we had a couple of visits:

# The birth certificate and SSN recorder
# The audio technician
# The paediatrician

==== Birth Recording ====

The thing they give you is a birth certificate worksheet with a pencil. They also give you a big warning that once you agree to the birth certificate it's final and it can't be changed. Any changes must be recorded via an amendment document that's attached. Having this be an append-only store makes sense to me.

The worksheet itself isn't the birth certificate so mistakes on it are tolerated. The hospital's recorded takes the worksheet, types it into the computer, and then gives you the actual certificate to sign. Once signed, it's done.

Our daughter's last name is not either the mother's or the father's so the recorder had to attach an explanation for why it was so.

==== Audio Technician ====

Mid-day the next day, the audio technician came by and checked whether our daughter could hear. Avoiding a problem here was the principal motivation for lots of things that we did, so we waited with bated breath.

The service itself is provided by [https://www.pediatrix.com/our-services/pediatric-care/newborn-hearing-screen Pediatrix] and uses a [https://natus.com/sensory/algo-5/ Natus Algo 5] which uses automated [[wikipedia:Auditory brainstem response|auditory brainstem response]] to detect if the baby can hear. The short version of things is that they place a bunch of sensors on the baby's body, then a pair of headphones that deliver some sounds, and then measure the brain's response to these.

The test took about 91 seconds to report a PASS result. The alternative is a REFER result.

==== Paediatrician ====

From [[Preparing for a Newborn#Conclusion|our search for a paediatrician]], you know we selected Pacific Paediatrics. There was a tiny mixup here at the hospital and we were assigned a doctor who used to be there and had now moved elsewhere. She wasn't available so her partner came by. We got a bit of a short consultation with him before he realized the mixup and we were sent the right one.

A few interesting things that he said were:

* Use the rooting reflex<ref name=rooting-reflex-1/> to feed the baby
* Hold the baby as much as possible
* In the absence of the pacifier, the tip of your pinky will trigger sucking and soothe the baby

The rooting reflex thing was unusual because I thought that was an involuntary thing that occurs always. But it does seem like it is primarily a hunger thing<ref name=rooting-reflex-2/>.