Today marks two years since I made my first middle of the night drive 90 miles up the 101 freeway to respond to disaster in Ventura County. The Thomas Fire ignited near Santa Paula December 4, 2017 and within hours had forced evacuations 15 miles to the west in the City of Ventura. It would grow to become the largest wildfire in California history at that time. In 2018 I had the pleasure of presenting Ventura County OES with a California Emergency Services Association Exceptional Service Award for emergency management best practices in response to the Thomas Fire. There were so many lessons learned and so many emotional moments during the response that I can’t even begin to capture them all in one article.
The most critical function that was coordinated out of the
Ventura EOC was the crafting and dissemination of emergency evacuation
messages. This was the action that undoubtedly saved lives during the fast
moving fire that started at night and threw people off guard when they realized
‘that brush fire in Santa Paula’ was lapping at backyards in Ventura. So today I
am focusing just on the stellar emergency notification process that Ventura
County OES honed during the fire. I’ll break down their EOC structure and processes
into several parts so you can see how the system functioned.
Methods of Notification
In addition to traditional door to door notices by officers, news media partnerships and social media, the Ventura EOC primarily handled two methods: an opt-in system called ‘VC Alert’ that was coordinated through EverBridge software and the Wireless Emergency Alert through FEMA’s Integrated Public Alert & Warning System (aka the technology that gives us Amber Alerts). The EOC heavily used VC Alert with detailed information about who was being evacuated, since this information could be shared with very targeted geographic areas and everyone receiving it had already indicated their interest by signing up for the system. They could also receive notifications through email, voice call and text message. This method is great but since it relies on sign ups, they knew that it only reached a small fraction of the county’s population. On that fateful night, the Ventura EOC Director made the decision to ‘push the big red button’ and utilize WEA for their first time ever when they realized how dire the situation was and needed to get the word out far and wide as quickly as possible. The WEA alerted everyone with a cell phone in that part of the county about the fast moving fire and directed them to seek emergency information on the VC Emergency website. The number of characters that can be included in a WEA is limited so they had to be very concise and could not share evacuation area specifics.
Alert & Warning Coordinator
Both the WEA and VCAlert messages were crafted from an Alert
and Warning position within the EOC’s Planning Section. This person was
knowledgeable in EverBridge and IPAWS. it was definitely a highly skilled
position that needed to be filled by highly trained VCOES staff. The position
coordinated directly with an EOC liaison at the Incident Command Post in order
to obtain the latest evacuation orders coming from Law and Fire. This position
also provided the intel from the field to the Website Coordinators in the
Situation Unit and to the Planning Section Coordinator and the EOC Director. He
or she was always a very popular and busy person during the activation. If you
wanted the latest and greatest information on what the fire was doing, you went
to this person.
The EOC Liaison at the ICP
The EOC Liaison was physically stationed at the ICP although
he/she was an actual Emergency Manager who was part of the VCOES team. I think
this is a great practice because this person’s sole responsibility was to watch
out for information about evacuations and immediately relay it to the EOC. When
this responsibility is tacked onto the already full plate of fire and law
personnel it may slip through the cracks. A physical presence is also important
so that Incident Command will have that constant reminder of emergency
management needs and resources that can be coordinated through the EOC. It is
also great for building strong relationships with law and fire partners—standing
side by side in the smoke together solidifies a bond that can never be
replicated over the phone.
The Website Coordinator(s)
Within the situation unit, there was one person entirely dedicated to making sure that the VC Emergency website was kept up to date with all the current details of the incident. Most importantly this was evacuation information, but it grew to include information on shelters, school closures, air quality information, road closures, and more. It included a detailed, interactive map that was kept up to date with real time evacuation information through the assistance of a GIS specialist also working within the planning section. The website was such a critical mechanism for the public to maintain information about the response that it actually temporarily crashed due to high volume on the first night. It was certainly a lesson learned for future responses to ensure that your website can handle a sudden increase in traffic during an emergency situation. As the fire continued to burn and keep community members out of their homes for two weeks, the need for providing better real-time information in Spanish became apparent. They were originally using Google Translate to provide the information in Spanish, however the system was imperfect as ‘brushfire’ was translated into ‘hairbrush’ along with other unintentional translation mishaps. Ventura eventually expanded the team to add a bilingual website position that was responsible for keeping a Spanish version of the site up to date whenever the English version was updated.
The EOC Hotline
The Ventura EOC also housed a hotline call center with a minimum of 2 staff at all times to answer any inquiries from the public. The hotline number was shared far and wide on social and traditional media. The call volume would have put a burden on an emergency dispatch center and would have been overwhelming for a single public information position. Call center staff answered phones and mainly utilized the website to share information with the public about what was going on in the fire. Even though people could’ve just looked at the website on their own, many felt better about interacting with an actual human being. They were also able to request additional information or get messages into the EOC if needed. I believe this function is vital within or directly adjacent to an EOC and it is often overlooked with the assumption that dispatch will be able to handle it. Within the org chart, the call center fell under the Public Information function, and the Call Center Supervisor reported to the PIO for questions and connected the calls for media interviews to him.
The EOC Collateral Program
You might wonder how Ventura was able to staff all these positions using their emergency management team and the answer is that they didn’t. They created an optional program called the ‘EOC Collateral Program’ where staff from other county departments could volunteer to undergo training to augment EOC functions and earn overtime during emergency activations. This program is truly a best practice because everyone participating applied, interviewed, and underwent significant training. These staff viewed the experience as a privilege rather than as an unfortunate ‘other duty as assigned.’ The way this program was framed by OES as competitive and selective created a culture of people who actually wanted to help out in the EOC. People in this program staffed the website, situation status, call center, and logistics support functions.
Public Information Officer(s)
Both Fire and Law provided PIOs to the EOC. These PIOs were
primarily responsible for giving media interviews, drafting press releases, and
coordinating EOC visits for media or dignitaries. Social media for this
response was handled by field personnel for fire and law. The EOC did not
utilize its own Twitter Account for emergency notifications since they had not
built up a following or trained on that method.
Emergency notification is an extremely critical function that should be coordinated through the EOC rather than at the field level whenever possible. Ventura had learned from the mistakes of Sonoma County just two months earlier during the wine country fires of October 2017 when 44 lives were lost as the fire swept through neighborhoods in the middle of the night. Their decision not to use WEA limited the spread of life saving information, and I believe that Ventura’s decision to send its first WEA absolutely reduced the loss of life in the Thomas Fire. There is much that can be learned from the response and recovery from such a major disaster, but I believe these are the most salient emergency management lessons to be shared on this day of remembrance.
I was very lucky in my pregnancy because it was relatively easy. I was happy, I was pain-free, I didn’t get morning sickness and I was able to go on long daily walks right up until the day of my induction. By far the hardest part of the whole parenting experience for me so far has been the so-called ‘fourth trimester’ or post-partum period. Particularly the very first 3-4 weeks was the most difficult and the main reason was breastfeeding. As special, important, and beautiful that breastfeeding can be, it can also be an incredibly painful, anxiety inducting, emotion laden imprisonment. I am happy to say that Scarlett and I have a great breastfeeding relationship now, but there were definitely dark, difficult times in the beginning when I often questioned how others could find it so amazing and whether it was for me.
I had heard from many sources that breastfeeding can be ‘hard’ or ‘frustrating’ or ‘challenging’ while I was pregnant. I took a 90 minute class at Kaiser where the instructor basically told us we had no excuse to not breastfeed. It wasn’t very helpful. I really didn’t know what, if anything, I could do to prepare for breastfeeding before Scarlett was born. I focused all my energy on preparing for the labor and delivery because breastfeeding was a big unknown and I assumed we would naturally find our way. I still don’t think there is much you can do to physically prepare for it, but I do think that really understanding what those first few weeks might be like could help you prepare mentally.
In this post I want to share the nitty gritty of my experience in hopes it might help someone. I know my experience wasn’t the easiest that could be had, but I also know that it wasn’t the most challenging. I am not a lactation expert of any kind, all I can do is genuinely convey what my world was like for the first few weeks, explain what makes it ‘hard’ and solutions that I used to cope.
The first big surprise to me was how time consuming it was. I don’t think that I really realized how often newborns need to feed before I had one. The rule of thumb is pretty much every two hours and this includes through the night. If you are breastfeeding ‘on demand’ though you watch for feeding cues from the infant and feed them more often if they desire it. Some newborns will ‘cluster feed’ which basically means feeding nearly constantly or with very short breaks between sessions. So be prepared to literally not have time for anything else in the beginning. The frequency is counted from the beginning of the feed, so if you feed at 8AM expect to do so again at 10AM, 12PM, 2PM, etc. In the beginning, my baby wanted her feeding sessions to be extremely lengthy. It was not uncommon for her to go 30-40 minutes on one side before even switching to the next. My sessions sometimes lasted more than an hour, they were regularly 40 minutes. That’s what I planned for every time. So if I needed to feed her in public, it meant excusing myself from the activity to go to the car and feed her for 40 minutes. If we had visitors, I excused myself to her room for a 40 minute feeding. If you do the math, you also realize that it leaves very little time to do much else before the next feeding commences. You get used to living basically an hour on, an hour off, for weeks. And if you are trying to also pump after each feed to increase your supply, expect to spend an additional 15 minutes or so doing that afterward. The pace was grueling, the emotions ran high, I was struggling to nourish this precarious new life and set my motherhood on the right course.
Time itself seemed to transform. It was no longer a marker for my working hours, meeting up with a friend or when the game started. It was a tracking device for my every movement—for a while I was instructed to feed 15 minutes on each side—no more, no less. I then needed to pump for 15 more minutes. I would have gone insane without a clock to time this, to give myself pep talks—just five more minutes to go. When we changed her, we took note of the time. The clock measured my life in a way that I never knew it could. I was “off work” and freed from any time dictated obligations, yet I was more bound to the minutes that passed than ever before. I tracked the time in small increments, without much thought at all to whole days passing or what the date was.
I also didn’t realize that I would need both hands to feed
her. One hand to guide my breast toward her mouth and cup it into a ‘sandwich’
and the other to guide / hold her head so that she correctly faced the breast
and give us the best chances of getting a good latch on one of the first few
tries. This meant that I wasn’t able to read, scroll through my phone, get a
drink of water, blow my nose or anything that I might have wanted to do to
occupy my mind for 40-60 minutes each session. This is why having some shows
lined up to binge watch hands free can be such a lifesaver while breastfeeding!
As much as I had been told that breastfeeding might hurt, I was unprepared for the true physical pain of it. Somehow between leaving the hospital on Friday afternoon and visiting the lactation consultant Saturday morning Scarlett managed to shred my nipples. They were scabbed over, but the thin scabs ripped and oozed fresh blood each time my hungry baby attempted to feed. I inhaled sharply and yelped ‘ouch’ and other obscenities each time she tried to latch on. I think she could sense my negative energy and instinctively knew that the metallic taste of blood was not the sweet milk her body craved. That Friday night became the night of hell as our baby screamed, wailed, and lashed out at us inconsolably as her face scrunched redder, angrier and hungrier as the hours wore on sleeplessly. When the lactation consultant saw my nipples, scabbed over and adorned with hickey-type purple ridges she knew that I needed a break. I had expected some version of ‘power through it’ which I had heard from countless friends and stories on the Birth Hour podcast. When I pumped only a few drops of colostrum after 15 minutes, she told us firmly that we needed to supplement with formula so that she could get her weight back up after losing 10% of her birth weight. She assured me that it was just a rest for a few days for my nipples to heal and I could still pump to stimulate milk production. I cried raw, unrestrained tears there in the office, trying to come to terms with my failure yet thankful that she had granted me some respite from my torturous endeavor. I also felt ashamed and embarrassed because I had wanted so badly to be a part of the ‘exclusive breastfeeding’ club. While we were able to resume direct breastfeeding after a few days and it became easier when my milk came in it was definitely not pain free until the next month. The latch would send searing pain rippling through my chest and I would have to gear up and brace myself for it when she began feeding. I would exhale slowly and count in my head, using some of the same strategies that had gotten me through her labor. I also felt the strangest tingling and burning sensation throughout my breasts after each feed. It was as if the milk was being regenerated and I could feel that sensation as they refilled slowly. It was uncomfortable and each time I longed for the relief of warm water or a compress. This was every day, 8-10 times per day. It only got better incrementally, so slowly that you could barely notice improvement but by eight weeks nursing was pain free.
Failure and Rejection
Breastfeeding is the natural way for us mammals to feed our offspring. That is why so many people assume it will be easy or that they can just figure it out. It is also why failing at it feels like the ultimate, deepest, most personal failure. What is wrong with me if I can’t even feed my baby? Am I just not cut out for motherhood? How can some people enjoy this? These types of thoughts ran through my head and tears sprung from my eyes when Scarlett turned her head away from my breast, howling from hunger but unwilling to suckle. She was frustrated with failing to latch too and horribly hungry. I wanted to help her but I felt powerless to force my breast into her mouth in the correct position and stimulate her to suck to extract milk. As we continued to try I swatted away the help or advice my mother and mother in law tried to provide. I wallowed in feeling a deep, personal rejection by my daughter when she would not feed from my breast. I felt so small, like I wasn’t fit to perform this function that should be instinctual. My own child did not want anything to do with momma’s milk and I was miserable. My husband can attest that on more than one occasion I screamed out of despair, pain and frustration, “I hate breastfeeding!” I felt inadequate as a mother and ultimately a human being. How could the wail and turned cheek of a baby reduce me to a worthless, sobbing pile of nothingness the way that it did? Somehow feeding my daughter was more mentally challenging than responding to a disaster, crafting an emergency plan, battling cancer, or any other obstacle I had yet faced in my life.
I did not expect the hunger and the exhaustion.
Breastfeeding is draining as the calories and nourishment from your own body is
literally sucked into another. I have read that you burn an extra 500 calories
a day. I thought I was eating for two while pregnant, but I felt the most ravenous
hunger of my life while breastfeeding. I needed to eat immediately in the morning
and I couldn’t last from one meal to the next without significant snacking in
between. The compounding factor was that I was in the heat of surgery recovery
while learning to do this. Physically, I was not at my best to take on this
most difficult journey. I was still on pain medication around the clock and
there was just so much to keep track of. I had to document my pill schedule as
well as every feeding, how long she fed directly on breast, how many ounces we
supplemented, whether it was breastmilk or formula, every time she had a wet
diaper, a dirty diaper, and even her naps. I felt like I was going mad trying
to document all this while it was happening. I was totally sleep deprived and
absolutely running on empty. I still couldn’t get up and down from a seating
position without assistance. My brain was racing around writing checks my body couldn’t
begin to cash. I needed to eat and I needed to sleep, but feeding her was my life’s
purpose and I was the only one that could do it. It was incredibly taxing.
Another mental and emotional challenge was the pressure of being
the only one that could feed her. As many people that surrounded us offering
help and support it still came down to me as the mother to be able to
breastfeed her. It was my sole responsibility and I felt that I could never truly
get a break. Even when we supplemented with formula I would have to be pumping
simultaneously to make sure my supply kept up. Even if my husband or mom offered
to take over one of the nighttime feeds, I couldn’t really rest because I knew
I needed to be pumping so that my body would know what her demand really was. I
had been educated on how critical those first few weeks would be to shape the
future of our breastfeeding journey. It was an immense amount of pressure that
I had not anticipated. I also did not want to give up. I didn’t want to fail at
giving her what had been ingrained into my head as the most wonderful gift a
mother could bestow. I had heard and read so much about all the benefits of
breastfeeding, the way your body adapts to give the infant exactly what she
needs based on a feedback mechanism through her saliva while attached to the
nipple. I didn’t want to deprive her of this because I was too weak or
exhausted. I felt an incredible amount of social pressure to keep going from
the constant dialogue on how superior breastmilk is to formula. Though every
day I felt that switching to a bottle would be such a mental and emotional relief.
Finally we could share the responsibility of feeding her and some of my burden
could be alleviated. But I endured, hoping that I would find a light in the end
of the tunnel. And I did.
Here are some things that helped me, by no means is this a
definitive guide or am I suggesting that all of these things will help every
person. But I know I wouldn’t have made it through my own journey without some
of these external factors.
I must give a huge shout out to Kaiser Permanente’s South Bay Lactation Center. We met with two different lactation consultants there and both were extremely helpful. It was amazing to already have the appointment set up for the day after we were released for the hospital. Even though we were struggling so much I feel like I still would’ve hesitated to reach out for help, too stubborn to accept that I needed assistance. They always set follow up appointments for us, taking the questioning of whether to go back out of the equation. They made it seem normal to struggle. They were able to hook me up with two free months of a hospital grade breast pump for home usage, which was oh so helpful. They have a super precise scale that will weigh baby before and after a feeding so that you can actually know how many ounces (or milliliters) he or she is transferring. This was extremely helpful, validating that we were making progress and giving me peace of mind that she wasn’t going hungry after I fed her directly on the breast since we had no way to measure at home. They also would observe the latch and make sure you were getting it right. I felt like I had the opportunity to ask questions and better understand what was happening. They gave us a detailed print out of instructions after each visit, which was so crucial since my mind was literally mush at that time—trying to keep track of all the tiny details of Scarlett’s life made it hard to remember what was said during conversations.
There are a few things I would recommend for those of you embarking on your first breastfeeding journey. Gel soothing pads were a huge, huge help for me in the first few weeks. My nipples were always some degree of sore around the clock and these really helped to take the edge off. I would put them in the refrigerator during each feed / pumping session and then they’d provide instant cool relief as soon as I was done. Nipple butters were also a regimen that I indulged in, I had two different kinds and I kept one in the bathroom and one next to my nursing station so that I could apply as needed. It may seem basic but showering was huge. I always hear moms say that they go days without showering while taking care of little ones, but I seriously don’t think I could’ve functioned without it. Each day it was the one activity that allowed me to feel human again, the warm water rinsing over my body and reminding me that I existed for more than just to feed a newborn. It felt amazing on my sore breasts and it was the one time of day they were free from a bra. I seriously would not skip this, it was the highlight of so many of those early days. I also had gel compression pads that could be heated or cooled for relief, I didn’t use these as much as I wanted to frankly because I was so exhausted at the end of each feed it seemed like too much to even get up and microwave them. The few times I did use them it was with assistance from one of my supporters and they felt awesome! While you’re pregnant, download a baby tracker app and get prepared to track away—at the lactation consultant and the doctor’s offices they would always ask how many feedings, how many wet & dry diapers in the last 24 hours. I literally don’t think I could have remembered this if I hadn’t been meticulously tracking it in my app. The Brestfriend pillow has also been my most prized possession. We still use it and I highly recommend it, it’s the perfect level for baby and it buckles around you so that it stays in place. The pouch that it has is also perfect for storing your essentials—I have nipple butter, headphones, my Kindle and her nail file in there. I also highly recommend making sure you get all your essentials together before settling in for a session, since you never know how long she’ll want to nurse for or if baby will want to fall asleep on you right after! Cell phone & charger, water bottle, Kindle / ipad, the TV remote, a burp cloth for baby, a snack if you need it…
I can’t stress enough how important it was to have my husband there to help me. I really don’t know how single mothers do it and I am so incredibly thankful for his support. I also had my parents come visit for a week in the beginning and they were amazing. So seriously, don’t be shy! Enlist friends and family. The most helpful things they can do are help with cooking, cleaning dishes, washing your breast pump parts, refilling your water bottle, doing laundry, even feeding you directly! There were so many times I was grateful for my mom to literally put food in my mouth while I was starving but using both hands to feed the baby. Your helpers might not be able to help with directly breastfeeding, but they can help with everything else. It really does consume your whole life, so any help you can get with your other normal functions is going to work wonders for your sanity.
Alternatives to Direct Breastfeeding
Knowing when to take a break from breastfeeding (with the
help of a lactation consultant) really saved our long term breastfeeding
relationship. I thought that it might be ruined when we fed Scarlett formula.
But it was absolutely crucial for my mental health and to let my breasts heal. I
was able to pump during this time to continue stimulating my breasts and help
my milk come in. We bought formula and my husband being able to feed her
formula with a syringe was a lifesaver. I felt like a weight was lifted. I
would recommend researching and even purchasing a small store of formula to
have on hand for after birth even if you plan to exclusively breastfeed. We had
to frantically go to the store and procure some, and I found myself falling
asleep out of pure exhaustion while trying to figure out which brand was best
to feed her.
Light at the End of the Tunnel
Gradually, these difficulties got easier. I got stronger I guess, or we just learned together through practice how to make the symbiotic process work. I became accustomed to the routine and learned what to expect. I am so thankful now that I stuck through those very dark, very low days. Breastfeeding now seems like it is actually the easier way to feed her—no bottle or pumping accessories to worry about washing multiple times a day, no mental inventory on formula that I have to keep up and remember to buy. I can give her everything she needs freely and easily from my body and it carves out skin to skin cuddling time for us each day. It wasn’t easy but I appreciate the benefits that this most difficult battle has bestowed on my daughter and I hope I can prepare and inspire others to undertake the journey. I hope this knowledge can help you mentally prepare and know that it isn’t all the perfectly lit, peaceful Instagram posts you see. It’s ok to not love breastfeeding, and it’s ok to choose not to do it. And if you suffer while embarking on this endeavor, know that you are not alone.
Today is the one-year anniversary of the Borderline Bar and Grill mass shooting incident that occurred in Thousand Oaks in Ventura County, California. With so many of these types of incidents occurring each year in the U.S., you might not recall the details of this particular one. A gunman (young male ex-Marine) entered the popular line dancing / country music establishment just before midnight on college night. He shot staff members, then opened fire on the patrons as they fled, many jumping from second story windows to escape. Two officers made entry and engaged in a shootout with the suspect, Ventura County Sergeant Ron Helus was fatally wounded. The gunman killed himself before authorities attempted a second entry. A total of 12 innocent lives, mostly college students, were taken that night. The incident hit Thousand Oaks hard and the community was still reeling from the tragedy when many residents were forced to evacuate from the Woolsey Fire less than 24 hours later.
This was also the first (and currently the only) mass shooting incident that I ever responded to. As I listen to the news broadcasts about the community healing events and the dedication of the Ron Helus memorial highway today I am remembering how this tragedy impacted me personally and what elements made this response unique among all the natural hazards induced disasters that I’ve responded to. At the time, I hadn’t yet found out I was pregnant with Scarlett. So much has changed in this year and it’s given me the clarity to reflect honestly on what was the craziest day in my emergency response career so far, and how responding to this man made disaster was different in many ways than responding to nature induced disasters.
A Different Rhythm
Unlike the frequent wildfire / hurricane / storm responses that we emergency managers are used to dealing with mass shootings are quick. For ‘natural’ disasters we usually have days to ramp up our response as weather predictions show us when the danger is likely to occur to our communities. The response period is prolonged as we issue evacuations and then monitor sheltering and impacts with our EOC’s active for several days or weeks until the threat has passed. With mass shootings, nearly 70% end in less than 5 minutes. Of course, we are still in response mode while first responders arrive and establish command on the scene. But the incident very quickly enters the recovery phrase, the threat has passed in the blink of an eye and as emergency managers our role is entirely to deal with the aftermath. Your EOC does not need a position dedicated to advanced planning, weather monitoring or predictive services on fire behavior. These incidents are extremely hot and heavy—they come on quickly with intensity and are almost always totally unexpected. The good news is that your EOC activation will not last long, the bad news is that you will immediately have fatalities and that always ups the ante on any response.
Because you already have fatalities and these were no accidental deaths, your coordination will have to work around a criminal investigation of the incident. That does mean that your incident command post will need to be organized to endure for a much longer duration than law enforcement led incidents usually do. There will be new partners descending on the scene to fill their roles and your agency may have never worked with them before. One of the most critical being the Federal Bureau of Investigations (FBI) and their Victim Services Division. Your state may also have a victim services branch that will want to be involved in the response. This means that your field staff will almost certainly be seeing a lot of new faces at the ICP, but if you have taken the time to plan and train in advance they should at least be aware of the support these agencies can offer and what their processes are like. Be aware that victim identification may take longer than it would for a single shooting or for a nature induced incident because of the ongoing criminal investigation and the involvement of the FBI as they determine whether the incident will be categorized as terrorism.
The Role of Emergency Managers
The most important role that emergency managers should own in these incidents is to coordinate a Family Assistance / Reunification Center. I prefer the terminology ‘Assistance’ Center since inherently some will not be reunified with loved ones and the usage of this word can bring unnecessary additional grief to the families of the deceased. At the Ventura County EOC supporting the logistics of both the Incident Command Post and the Family Assistance Center quickly became our primary focus. The ICP will need things like lighting, barricades, and additional security measures to protect the responders from the public due to the sensitive nature of the response. The Family Assistance Center will need a location, and agency representatives who can assist families including behavioral health staff, chaplains, the American Red Cross and any other local NGO’s who can offer support, and law enforcement representatives to provide and collect information. Both locations will need basic items like tables and chairs and it helps to create a comforting environment to be able to provide things like tissue, snacks, and coffee at the Family Assistance Center. It’s ideal to get this going very quickly to alleviate the pressure on the ICP as family members and media will be drawn to the scene of the crime. If you have a FAC plan in place with locations and agency contacts predetermined it will certainly expedite the process. Remember that this could happen in the middle of the night, as it did in Thousand Oaks, so having 24-hour points of contact for facilities and agencies is ideal.
Gun Control Politics
Your jurisdiction will quickly become the focus of national
and international news attention. You shouldn’t be surprised if you’re trending
on Twitter very quickly and ‘your town + strong’ becomes a popular hashtag.
People are shocked and horrified by mass shootings, and the attention will be
immediate and intensely laser focused on the incident. Although natural
disasters may cause more physical destruction and also take lives, mass
shootings are seen as more preventable and the brutal intentionality of these
incidents draws the attention of the nation, if not the world. During the
Borderline incident, we were shocked to receive an interview request in Hebrew
from a news outlet in Israel. When planning for mass shootings, the importance
of effective public information cannot be overstated. You must have your best
PIOs available both at the ICP and in the EOC to disseminate accurate
information, showcase what your agency is doing to respond, and to convey compassion.
You will also find yourself thrown unwillingly into the national gun debate
immediately and both elected officials and PIOs should be equipped to respond
appropriately to heavily political questions they may receive. I highly
recommend testing public information as a core capability during mass shooting
exercises as it can become overwhelming quickly and commanding messaging with
clarity and dignity is critical in how your response and your community will be
portrayed and remembered in the international eye.
The absolute most important element of a mass shooting
response in contrast to a natural hazard incident is the intensity of the
emotions involved. Be prepared for an extremely somber atmosphere, your EOC
will feel very different than it does during routine weather events. While your
EOC staff will be working very hard to fulfill their roles, they will also be
very distraught, saddened, and scared that such a horrific tragedy has occurred
in their community. In Ventura, everyone knew Sgt Helus, he had trained with
the EOC team and had been involved in the Thomas Fire response the previous
year. So while the team was working hard intellectually to deal with an
unprecedented type of response, they were also working extremely hard
emotionally to process that a colleague had been murdered. In the December 2015
San Bernardino terrorist attack, the victims included many county staff who
were attacked during a holiday luncheon. These incidents often hit very close
to home for those of us involved in the response and can have ramifications for
continuity of operations as well. When everyone on the team is devastated by
the deaths of colleagues or if some of the victims include the team members,
how can you continue to respond and provide services to the community? While
it’s a very delicate subject and nearly impossible to fully prepare for, I
recommend that these personal elements be tested and discussed during any
emergency exercises with mass shooting scenarios. And if you are responding to
an EOC for a mass shooting as an outside agency representative, remember that
this is deeply personal. While you may have dealt with loss of life during a
disaster before, as we had recently in the Montecito mudslides incident, this
was different, this was intentional murder. Take off your vest for a moment and
remember that you are all human beings and the most important thing is to
recognize and honor the humanity of those responding beside you. They are
dealing with loss while still performing their duties and they can use your
personal support. The night that I responded to Borderline, I wore my Ventura
OES polo instead of my CalOES one (against protocol). I hoped this small,
non-verbal gesture would show them that on that night I responded as one of
them. I greeted each of the team members with compassion, looking into their
eyes and telling each that I was sorry for their loss, as I realized these were
not simply my colleagues they were my friends. I came that night not just as a
state employee supporting local government, but as a human being honoring their
organization and giving all of myself to the team however I could.
Today, I honor the memory of those innocent lives that were taken too soon a year ago and particularly the heroism of Ron Helus, who died trying to stop additional murders in his hometown. The community of Thousand Oaks has been through a tremendous amount of adversity in the past year and it’s been my honor to support them as a state liaison. It’s important to remember that while these incidents will be ‘over’ quickly, the healing and recovery process will take years. Thousand Oaks has responded with some innovative outlets for community healing, including a writing project and a community healing garden. In remembrance of this tragedy, take some time today to think about your own plans for an active shooter and what you can add or exercise next to remain vigilant to the nuances of these man made incidents.
For the past 3 months I have been spending all my time with our
12-week-old daughter, Scarlett. It’s been quite a change of pace for me as I’ve
been watching the wildfires take off from the confines of my couch, fighting
the urge to get out there and get involved to help coordinate response. My
husband JB worked long hours at the Saddle Ridge Local Assistance Center for 4 consecutive
days and on the fifth day when he was supposed to be home earlier he had to stay
late to work a new EOC activation for the Palisades Fire. This meant more FOMO
for me and more hours of one-on-one time with Scarlett. As much as staying home
goes against my nature to get out into the field and dive straight into these
emergency management challenges, I have tried to really embrace my new,
non-permanent role as a stay at home, full-time mother to Scarlett G and use
this new lens to expand my viewpoint on the human experience.
Having spent every day and night of her life with her so far, I have had the priceless opportunity to watch a brand new human being emerge from the womb, adjust to a shockingly different environment, and begin to grow into a little person who tries to communicate. It has been nothing short of miraculous. I recently took some time to reflect on what she has shown me firsthand about the innate abilities of human beings to adapt and overcome the incredulous challenge of being helpless, immobile, and incapable of speaking in a massive obstacle-laden landscape. Before we fill our worlds with layers of experiences and years of learning, what are the native traits that we develop immediately, to cope with such a traumatic transformation as transitioning to life outside the womb? Spending time with Scarlett has allowed me a unique ‘back to basics’ perspective on our human resilience before it is colored by the complexities of adulthood. She is simply trying to survive, and it’s been fascinating to watch her develop behaviors that promote growth and endurance in this whole new world.
The Power of Self-Soothing
In the first few weeks after we brought her home from the
hospital, Scarlett would sometimes cry unconsolably. As a newborn, crying was
really her only way to communicate and I am sure there were many things that
she found frightening and uncomfortable about her new home. It used to take mom
and dad spending serious time rocking her, swaddling her, cuddling her or
speaking to her softly to get her to calm down. But as she has grown, she has
found her own way to calm herself down and has gained a very powerful tool. My
baby sucks her thumb, and it instantly pacifies her. She constantly resists the
pacifier, which we’ve come to terms with although we still offer it from time
to time. Scarlett has learned that her own two lips can form the perfect fit to
cradle her thumb and turn it into a readily available calming tool. Now
whenever she gets bored, mildly uncomfortable, cranky or tired she will simply
turn her head, find her thumb, and breathe a sigh of relief. She puts herself
to sleep this way and wakes up in a much better mood! This has really shown me
how powerful it is for adults to discover effective tools of self-soothing that
we can practice in our daily lives.
Now, I’m definitely not advocating that we suck our thumbs,
but it is incredibly empowering to be able to take control of a stressful,
irritating mindset and transform it into peace and clarity. Practices such as
deep breathing, stretching / yoga, meditation, walking or exercise, writing or
reading, going outside, or having a hot cup of tea can really work wonders on
helping to soothe our anger, anxiety, or irritation. It is important to try a
few soothing mechanisms and learn what works best for you as an individual so
that you can keep it in your back pocket as a frontline defense when you are
thrown into high-stress, crisis situations. I think coping tools which rely the
least on external resources are the most reliable since you need only to
exercise a behavior within your own reserves. For me, it’s walking that will
immediately calm me down. Stretching and deep breathing also help me to eradicate
stress and center myself during times of crisis.
The Power of a Smile
I struggle to identify when Scarlett’s first smile occurred
because I feel like she has been smiling since day one. But she has certainly
learned to utilize her smile as a tool to break the ice with new people and to melt
mom and dad’s hearts into giving her whatever she wants. It might seem simple,
but I think there is an important lesson behind the fact that smiling is one of
the earliest behaviors that babies develop. A smile is the gateway to
friendship, to developing social capital with other humans around you. As a
helpless baby, she’s learned quickly that smiling gets people to smile back at
her and emit affection and love. Smiling gets people on her side. I have
noticed this as her mom as well that walking around with a smiling baby
instantly endears me to strangers at the grocery store or on the streets.
People who would normally walk by me with their hardened big city expressions,
completely open up to me and I feel more welcomed and acknowledged wherever I
While it’s very basic, smiling and establishing good
relations with our colleagues, neighbors, and fellow human beings is a crucial survival
tool. The more that community resilience is studied the more it is shown that having
a strong social fabric within a community is correlated with the ability to
bounce back more quickly after a disaster or crisis. Exercising good relationships
makes us happier people and gives a network to rely on when times get tough. It
is also well known within the disaster world that you are most likely to be
helped by neighbors or people around you when a disaster occurs since first
responders will be spread so thin. A smile today is an investment in your future
social capital—it’s easy and completely free.
The Power of the Unknown
New babies spend the majority of their time on their backs exerting minimal energy to look up at people and things around them. When placed on their bellies, babies typically struggle. They have to work extremely hard just to lift their massive heads off the ground and look around. For some reason, Scarlett loves ‘tummy time’ and I think I know why. Even though she must push her neck muscles to new extremes, she is mesmerized by this different perspective on the world around her and will work as hard as she can to be able to access this window into the unknown. From her belly she isn’t stuck staring at ceiling fans and drab white paint. She can see blades of grass, plants, the lower shelves of bookcases, the print on the bedskirt, mommy’s feet, and the detailed pattern of the rug. There is so much to see and discover from this new perspective. The added bonus is that if she works hard enough she will be able to crawl very soon from this position, which will add the whole new dimension of mobility to her human experience.
It’s easy to look at things the way that we always do, the way that we always have. We can simply lie on our backs and see a sterile, clean cut version of the world with minimal complications, where we see the people that choose to come in and out of our scope of vision. It’s much more challenging to force ourselves to turn around, seek out new places, try new activities, interact with different people, languages, sights and smells. Sometimes we have to take on a new challenge to open up a new dimension of ourselves and unlock the next level of our lives. If you want to someday be able to move up or move on, take some time today to open up a new portal into the world around you by analyzing the challenges you have in front of you, perhaps one that you have been ignoring just because it seems too difficult to even begin to tackle. Think about what it would take to overcome this challenge and begin by taking baby steps toward surmounting it. It’s not about improving what you know, it’s about embracing what you don’t know.
Even though I’m the mommy and she’s the baby, Scarlett G has taught me a lot about the human experience. I hope to be able to use the lessons I’ve gleaned from her survival mechanisms to better my own adult life. When you strip away the complexities of our adult world and truly go back to basics you can discover more than you might have imagine. Even though I’m not jumping out to coordinate the next wildfire response I am learning something new about resilience right here, in my own home. So today I challenge you to practice one of your self-soothing powers, to smile at a stranger and to identify a challenge in your life that you can work to overcome. You never know what new worlds will open up to you on the other side.
Last week, California experienced the largest Public Safety Power Shut Off (PSPS) to date when Pacific Gas & Electric (PG&E), its largest investor owned utility cut power to approximately 738,000 customers in 35 counties. One of which was Humboldt County, where I grew up and still have many friends and family members, which lost power for 24 hours with one day’s notice. Another was Tuolumne County, where my sister-in-law and her family live, where customers were plunged into darkness for nearly 4 days. While I have been dealing with the new reality of PSPS as an emergency manager for more than a year, most people are only learning of the protocol and its significance this month as a result of the massive outage.
I wanted to take the opportunity while there is public attention on this issue to write an opinion piece on PSPS and its ramifications. While I am currently employed by the California Governor’s Office of Emergency Services (CalOES), I want to be clear that what I’ve written here is my individual opinion and does not represent the opinion of my employer. However, I do want to commend Governor Newsom on his letter earlier this week to the California Public Utilities Commission and echo some of his sentiments that the scope and duration of this PSPS was unacceptable and executed with astounding neglect and lack of preparation on behalf of PG&E.
What is PSPS?
Public Safety Power Shut Offs, or ‘PSPS’ as they are affectionately called in our industry, are a new tactic employed by investor owned power companies in California to proactively shut off power in specific areas during times of high wildfire risk. While San Diego Gas & Electric (SDG&E) has been practicing this for years, Southern California Edison and Pacific Gas & Electric have just started implementing PSPS in the last couple years, due mainly to the fall out from recent devastating fires in Sonoma, Butte and Ventura Counties that were determined to be started by electrical equipment. This allows the companies to play it safe when weather conditions are primed for wildfires and avoid potential future liability that could be incurred through wildfires caused by electrical equipment. They closely monitor the impending weather conditions utilizing their own staff meteorologists, then send field staff out to the most fire prone locations as the weather event commences. When localized weather equipment and field staff concur that dangerous conditions exist, they proactively shut off power to select circuits in vulnerable areas.
People generally aren’t too happy about this new protocol—it
means that perfectly good groceries will rot in refrigerators and cranky Californians
will fumble with flashlights in sweltering homes on the state’s hottest days.
For what reason? Will this really stop wildfires from starting? Great
questions, I’ll attempt to address this below. It’s important to note that
although many people are seeing ‘CalOES mandated’ with some of the
notifications on the power outage, CalOES does not mandate the power companies
to turn off power. CalOES mandates that if they are going to do this, that they
notify both customers and local governments in the affected areas in a timely
The highly publicized widespread planned outages allowed us a view into the current level of California’s preparedness, and it didn’t look good. In Humboldt County, gas station lines were extremely lengthy until they transitioned into being eerily empty as many stations ran out of gas. Grocery stores were swarmed with crowds until the shelves were cleared of water, canned goods, toilet paper and other essentials. Some stores offered steep discounts on perishable refrigerated and frozen foods that were likely to be destroyed in the extended outage. There was a general sense of mayhem as people went into a frenzy trying to prepare for a few days without power. This shows us that in general, people didn’t feel that what they had at home was adequate to comfortably survive even a few days. This is not a good sign for being prepared for the Big One. Fortunately, it’s a great time for emergency managers to capitalize on this by encouraging participation in the Great ShakeOut earthquake drill later this week.
The upside to this is that people were forced to give disaster—or
living in this alternate universe without power—their thoughts and attention.
It is so common for people to push it out of their minds by saying they’ll
prepare next month or that disaster won’t happen in their lifetimes. When they knew
that the outage was impending, people considered their current commodities and
took action. While a full tank of a gas or stash of canned goods will be fleeting,
some of the items procured will have a lasting impact and will boost overall personal
preparedness. Perhaps people will be more likely to purchase generators to
mitigate the darkness of future outages. Thinking through the scenario and
discussing it with family members is also going to pay dividends toward the
creation of a family emergency plan, even if it’s conversational and focused
mainly on power outages. Hopefully it can start the train of thought toward
greater emergencies and what to do if gas or sewer systems are also not
working. Maybe in the future, people will recall the long gas station lines and
remember what a precious commodity fuel really is so they’ll keep their tanks
at least half full so that emergencies won’t limit their mobility.
The outages had a big impact on small businesses that did
not have generators. In Humboldt County most of these businesses were forced to
close and lose revenue for the duration of the outage. Gas stations closed such
as the Chevron in Eureka where my brother works and even the Safeway in Arcata
where my mom works as a result of their generator malfunctioning. Excess
product that needed refrigeration became waste and money was lost on these
products. While corporations like Safeway and Chevron will be just fine, a PSPS
event can wreak havoc on small businesses that are often teetering on the brink
of profitability in rural areas such as Humboldt or Tuolumne.
As with most disasters, populations with access and functional needs will be the hardest hit with PSPS. Lower income people who cannot afford to refill their freezers and refrigerators with food staples that they’ve been depending on were adversely impacted by this event. Hourly employees of shuttered businesses lost wages when they could no longer go into work. As a breastfeeding mother, I could be very impacted by an outage. I would be horrified to lose my supply of frozen milk that I have been building for months—it is literally priceless, produced by my own body for my infant and cannot be replaced.
Perhaps the most important consideration of all for PSPS, is those who need electricity for medical reasons. This includes those dependent on oxygen, dialysis or CPAP machines, motorized mobility equipment or insulin that needs to be refrigerated. A power shut off can be catastrophic for people with these needs. PG&E was outspoken on social media during last week’s outage that these patients need to develop their own emergency plans and be prepared. Is this an acceptable stance to take when lives are at stake because a power company wants to reduce their own liability?
Impact on Emergency Management
For local emergency management agencies, PSPS means more
planning calls and more Emergency Operations Center (EOC) activations in
anticipation of possible emergencies rather than in response to real
emergencies. While this can be great practice in activation protocols and
running through the process for smaller jurisdictions that don’t get much
action, it can also become a huge headache quickly. And it can present a level
of danger—if staff are already tired from being activated for a forced power
outage, does it make them more capable or less capable to respond swiftly and
competently when real disaster strikes? I know that at the Regional level, activations
for PSPS exhaust our resources quickly. CalOES deploys Emergency Services
Coordinators to any activated counties and also to utility EOC’s. If a real wildfire
emergency occurs and shifts need to be filled overnight and to staff our
Regional EOC, then we quickly begin to run out of personnel resources and must
rely on overtired staff who would’ve otherwise been refreshed and ready to go when
the real fire ignited. I can personally testify to this happening in November
2018 when the Camp and Hill / Woolsey fires began as we had been in PSPS mode
all week. Although I’m out on maternity leave, I have also heard that this was
the case last week with the October 2019 Saddle Ridge fire. These types of
activations will become more and more common, with Southern California Edison already
moving into a constant state of EOC activation for every weekend through
wildfire season in 2019.
The other drawback is that the capability of communicating important
emergency evacuation information with the public can be greatly diminished if
power is out. There are many ways for wildfires to ignite and cutting the power
simply won’t mitigate all fire start potential. So if a fire starts a different
way and begins to impact a community in the dark, how can emergency management
quickly notify them? Television media won’t reach them and cell phones may have
varying levels of battery power depending on outage duration and community
access to generators. Sending first responders door to door is a very resource intensive
option that can be slower than other methods. This presents a greater danger to
PG&E committed to opening one ‘Community Resource Center’ per county with a maximum of 100 people to provide device charging capabilities and controlled temperatures. While I appreciate the gesture, I find it almost laughable that these centers would even begin to meet needs. In many of the 35 impacted counties, it would be quite a drive for those most at risk in the more rural mountainous areas to the resource center in the more populous part of the county. In Humboldt County, the resource center opened hours after power had been restored for much of the county, with the exception of the distant rural areas. This quickly becomes a need that local emergency management becomes involved with by opening additional cooling centers or resource centers. These centers further stretch staff resources that would be needed as shelter workers if a wildfire hits.
As stewards of the whole community, local emergency managers
must also plan for the needs of the medically vulnerable populations previously
mentioned. Since many do not have the resources or knowledge to fully prepare
themselves as PG&E suggests, emergency managers try to fill this gap by working
with public health to identify and check on the well-being of these populations
during outages. As you can imagine, this can quickly become an information
management challenge and a losing battle as the number of people impacted increases.
Does it work?
In short, PSPS will never be able to stop all fires from
starting and it is impossible to prove success with this protocol because we
will never know if electrical equipment would’ve started a fire during the time
of the outage. From my observations, it has already not worked on November 8th,
2018 when the Woolsey Fire started from electrical equipment during a time that
Southern California Edison had actively been implementing PSPS protocols all
week. The Camp Fire also ignited that day and was started by electrical
equipment although I’m not sure if that area was being analyzed for PSPS that
day or not.
Even with the best analysis available, I believe that it is
impossible to know exactly where and when a fire will begin. Wind and weather
conditions can shift in an instant. We all know that weather predictions are
not all that accurate all the time (sorry NWS friends) and these predictions
are what PSPS is solely based around. I also do not believe that shutting off
power to massive areas as was conducted by PG&E last week is the solution. So
many of these areas never had any fire danger, including the one nearest and dearest
to my heart, coastal Humboldt County. My parents had wanted to run their heater
because it was actually chilly, cold and plenty humid, with overnight temperatures
down to the 40’s in their home a mile from the Pacific Ocean in October. But
they couldn’t because their power was off for fire danger. Putting so many
people in the dark who are nowhere near the danger zones seems to me to be more
of an attention-grabbing political ploy than an actual life safety necessity. I
believe that the leadership of California’s investor owned utilities hope that
these massive outages will create political pressure to legislate them out of
liability for future fires in exchange for keeping the power on.
As evidenced by last week’s outage, PG&E was not
prepared for the level of customer service and information needs that their planned
outage created. Humboldt County was not on the list of impacted counties until
the day before the power outage occurred. The notification process to
individual customers was subpar, with many complaints of never receiving the notification.
The company’s website crashed and customers were unable to gain information as
to whether the outage would impact them. Clearly, there is much work to be done
before the company claim to be prepared to undertake such a massive planned outage
How can we stop CA wildfires?
While shutting off power may stop electrical equipment
driven wildfires from starting, there are other measures that I think would could
be bring similar success without such adverse impacts on populations. For one, PG&E
should begin by focusing their efforts on updating their infrastructure to upgrade
transmission lines and increase grid segmentation so that if they choose to
continue with PSPS in the future they will have the capability to be much more
targeted. Such incredibly large swaths of land were impacted by last week’s
outage and this could have been avoided if they had the capability to segment
their grid to focus impacts the way that Southern California Edison and
Additionally, the impacts of PSPS could be mitigated by investments in microgrid technology. A microgrid is a localized group of electricity sources that typically operates connected to and synchronous with the traditional centralized grid but can disconnect and maintain operation autonomously. An excellent example of a success story for this type of innovation was revealed in Humboldt County last week when the Blue Lake Rancheria’s microgrid continued to function while the rest of the county went dark. The tribe has been a huge proponent of resiliency planning and has become a leader in tribal emergency management, even bringing FEMA’s emergency management advanced academy to Humboldt earlier this year! During the outage, the tribe’s gas station remained functioning and their facilities provided access to electricity and warmth for local families. The tribe also worked with the Humboldt County Department of Health and Human Services to house eight people who relied on electricity for medical needs in its casino—an outstanding example of an intergovernmental and quasi public-private partnership. In the darkness of PSPS, this mini success shines a light on potential future technology advances that could alleviate hardship.
Unfortunately, it will not be such an easy fix as shutting off power to decrease wildfire frequency. California experienced a prolonged drought from 2011 – 2015 that was the driest since record keeping began in 1885. The amount of dry vegetation in the state’s wildlands coupled with the devastating effects of bark beetles creates a massive amount of fuel that is ripe for burning. Additionally, the state continues to experience record breaking temperatures and an increase in the number of extremely hot days. When humidity dips and high winds commence, massive wildfires are born. While the Cedar Fire of 2003 was California’s largest wildfire for 14 years, the Thomas Fire (2017) only held that title for a mere 8 months before the Mendocino Complex fire overtook it. These disasters are increasing in intensity and frequency due to climate induced conditions. Examining the drivers of climate change and taking action to reduce anthropogenic impacts on the environment is one avenue of working to reduce wildfires.
Another is to reduce further development into the Wildland Urban Interface, the area where suburban developments encroach into traditionally wild environments. California has more people and homes located in the WUI than any other state in the continental US—close to 4.5 million homes and 11 million people. This creates a new type of ignition ready fuel for small brushfires to really take flight. While communities continue to expand outward into the hills and the state faces a housing affordability crisis, policymakers and community developers must consider the price that we will pay when wildfire strikes these areas and reconsider the decisions to continue to infringe on these wild spaces.
Until we are ready to truly address these greater issues, no
amount of PSPS will solve California’s wildfire crisis. Is it worth the death
of a medical patient dependent on electricity to possibly save the lives and
property of many from a wildfire that does not yet exist? While policy makers
must grapple with these decisions, California emergency managers must react to the
new normal in the wake of devastating climate change induced disasters and rise
to this challenge.
Since birth stories were one of my favorite ways to learn
and get inspired for labor while I was pregnant, I now want to share my full
story. Be aware, it’s a lengthy one, but it kind of has to be since my labor
was quite lengthy as well.
My birth story must be prefaced by disclosing that I have
chronic hypertension. Since my early twenties, I have a history of high blood
pressure readings that can only be explained by family history, since both of
my parents have hypertension although neither of them developed the condition
so early in life. For at least five years, I’ve kept my blood pressure well
under control through daily medication. It has been a well-known and easily
managed condition. When we began trying to conceive last year, I switched to
Labetalol, the most widely used blood pressure medication for pregnant women as
it is safe for the baby, whereas many other medications are not.
Throughout the pregnancy, I knew that having chronic
hypertension automatically classified me as a ‘high risk’ pregnancy and
increased my risk of developing preeclampsia, a very dangerous condition that
can result in excessively high blood pressure, seizures and even fatalities.
But it wasn’t until about midway through the pregnancy that my doctor told me
it’s a best practice to induce patients with hypertension 1-2 weeks early. At that
point, I had been listening to the wonderfully educational podcast The Birth
Hour religiously and I knew about some of the drawbacks to induction. Most
importantly, I knew that I would strongly prefer to avoid induction and let my
baby come naturally when she was ready.
As I progressed through the third trimester, my blood
pressure continued to remain stable—excellent rather, with some of the lowest
readings that I had seen in my adult life. The top number was often below 110 and
the bottom number often in the 60’s. I began to truly question why an induction
would be necessary without even a single high reading throughout the entire
pregnancy. I asked my doctors if I could wait at least until my due date for
induction, since there were no signs of anything going awry with my blood
pressure. They agreed that was reasonable.
All of July I waited for baby Scarlett’s arrival (although
at the time we didn’t know if she was a boy or a girl!), hoping that she would
initiate spontaneous labor ahead of the dreaded induction date. About a week
before my due date (7/28), I had my final doctor’s appointment and she was very
firm about not wanting me to go past the due date. She felt that my risk for
preeclampsia would rise dramatically each day after I was due. She checked me
and reported I was 1.5cm dilated and about 50% effaced. I remained hopeful that
I could get baby to come naturally. To me, the induction seemed preventative
rather than at all medically necessary. I was walking at least 30 minutes every
day, healthy, full of energy, and I would have happily waited another week.
But, I am not a medical professional and this was my first pregnancy. Having
chosen to go the OB / hospital route rather than seeking care from midwives in
a birth center had set me up for this type of advice and conundrum. My husband,
JB, was worried about the possibility of preeclampsia. I felt that I had
already struck a compromise with them to not be induced early and decided I
would go with the plan.
The induction was scheduled for Monday, July 29th
at 5PM. In the days leading up to the induction, when it became more and more
clear that baby wasn’t coming on her own I found myself in tears more than once.
I knew in my heart I did not want to be induced, I was so sad that I was likely
losing what might be my best chance at a more natural birth since I was already
33 years old and could only imagine that future pregnancies would be considered
even higher risk. I was planning to attempt the delivery without the epidural
and with as little medical intervention as I could. But I knew that inducing
the labor would already lead me down a path of medical interventions, and
everything I had heard about the intensity of Pitocin contractions made me very
much aware that I might end up needing the epidural.
So we arrived at the hospital, Monday at 5PM after a ‘last
meal’ of burgers, fries and an Oreo milk shake from The Habit. The ‘stork’
labor & delivery parking spaces outside Kaiser South Bay were nearly full,
leading me to believe that it was likely a busy evening for births. We waited
in the waiting room for nearly a full hour. Right at 6PM, just as I was
beginning to hope they needed us to reschedule, a medical assistant came out
and led us through the doors, to our room that was ready and waiting. I
disrobed into a hospital gown and offered my wrist for the placement of an IV
lock, transitioning from a healthy pregnant woman to the status of hospital
patient. I was promptly hooked up to the wireless monitor, as I had requested
so that I could remain mobile. This showed the baby’s heart rate and monitored
my contractions. To our excitement, the monitor showed that I was having
regular contractions that I couldn’t feel. I was hopeful that this meant I had
progressed and was perhaps closer to active labor than I had thought. Soon
after, I was checked for dilation and effacement—then received the
disheartening news that I was still 1.5 cm dilated and 50% effaced, despite
partaking in all the natural induction remedies that I could and feeling some
At 7PM, they commenced with the first induction procedure—the
placement of a foley catheter bulb which was supposed to dilate my cervix to
4cm, or stay in for 12 hours–whichever happened first. The placement procedure
was more uncomfortable than I had imagined it would be. They had to find the
1.5cm opening of my cervix and get the angle just right in order to insert the
catheter, unfortunately that took a few tries. My husband said that it seemed
pretty quick to him but to me it took forever. It was probably 5 minutes, but
that’s a long time to have a foreign object manually twisted around into your tiny
cervix. The doctor commented that I must have a high pain tolerance, as she had
seen many patients scream in agony at the placement of the balloon and all I
did was silently breathe through it. I was hopeful that was true and that I
could get through my contractions with my natural endurance.
Once it was in place, we waited. It wasn’t the most uncomfortable
thing, but it did exert a constant pressure that made it kind of hard to sleep
that night. The medical team offered to start my Pitocin that night—I guess
it’s common practice—but I hadn’t been anticipating that, and some small part
of me was still hoping that I could get labor into swing without the chemical
so I refused.
By morning, I was starving and patiently awaiting a cervical
check. Much to my dismay, the balloon hadn’t fallen out on its own, which I
knew meant that I was definitely not 4cm. Since I had declined the Pitocin, my
nurses said that it was still ok for me to eat. So I excitedly ordered
breakfast from the hospital menu—an English muffin with jam, cheesy potatoes
and fruit. My balloon removal and cervical check revealed that I was still
1.5cm but that I had increased my effacement to about 70%. Not quite the
progress I had hoped for in my first 12 hours of labor. The next step was to
start the Pitocin, I was in for it now, it was unavoidable.
The Reign of Pitocin
At 10AM my IV drip began and I hoped for the best. The
nurses advised us that the baby was usually born about 24 hours after Pitocin
was started during most inductions, so we shouldn’t expect to progress super
quickly. I tried moving around to get the baby to descend. We took a walk around the halls and said ‘hi’
to the friendly ultrasound tech who had helped with my non-stress tests. I sat
in the rocking chair and bounced on my birth ball. We started listening to the
birth playlist I had created. Every half hour the nurses would come in, check
my contraction progress and increase the dose of Pitocin by 2. It wasn’t until
around 12 or so that I began to actually feel the contractions that told a
rhythmic, abstract story on my hospital monitor. They felt gentle at first,
simple a tugging that coincided with the peaks that I observed on the monitor,
although the monitor did have a delay of several seconds from what I was
It was around this time that I started to use some of the
LaMaze techniques that we had learned through Kaiser’s Prepared Childbirth
course. I preferred the long, deep breathing technique so I started practicing
it when I felt each contraction begin. I had been walking around and moving
quite a bit, so around 3:10 I decided to take a seat on the bed and rest a
little as I knew I might not get another chance if the contractions ramped up.
JB ran out to the car to get something—neither of us can remember exactly why
he left or for what, just that he wasn’t there when I was sitting on the bed
around 3:15PM and I felt the warm, uncontrollable gush of amniotic fluid
between my legs. I sat in the oozing puddle, heart pounding excitedly, knowing
that this must be my water breaking. I was thrilled that it broke naturally,
and thought to myself that maybe I was approaching active labor—it certainly
seemed like something was happening, I had to be progressing.
The frequency of my contractions was increasing, and shortly
thereafter the nurse came in and went to turn down my Pitocin level—which had
been up to 16. She explained that my contractions were a bit more frequent than
they like to see—they want to see established, rhythmic contractions but with
more of a break between them. I thanked her and told her that I thought my
water had broken. JB walked back into the room, right as the nurse went to get
the test kit.
“Babe, I think my water broke!” I exclaimed.
“Really?” He was excited, but a little disappointed that he
had been out of the room during such a big milestone in labor.
“Yep, it’s amniotic fluid. Your water has broken, and it’s
clear—no meconium in the fluid.” The nurse announced, sharing our joy at the
progression of my labor.
She helped me into the bathroom and helped me clean up the
strange mix of fluid and blood that was seeping out of me, handing me a pair of
mesh hospital underwear and the largest pad I had ever seen. It was so massive
I wasn’t sure how it would even fit in the underwear, it was as long as a puppy
“I hate to tell you this but there’s going to be a lot more
of this—it’s going to get messy so don’t worry too much about trying to keep
clean.” She advised me. At that point, she also let us know that she and the
anesthesiologists were about to commence surgery for my neighbor’s C-section.
She warned me that should I want the epidural I should ask for it early, before
the pain became insurmountable, since I might have to wait up to an hour for
the anesthesiologists to finish surgery. I felt like I was managing my pain
well, but thanked her for the heads up.
Being on the toilet was comforting, it felt like the perfect
place to embrace the intensifying contractions and expulsion of fluid as each
one swept over me. I crouched over the toilet and held JB, breathing slowly and
intentionally for each one. Between contractions, I quickly taught him how to
count with me as I had been in my head to ease the pain, the counting helped me
feel in control and as if I knew when the pain would start subsiding. I counted
as if it were musical bars, 1-2-3-4, 2-2-3-4, with each bar being a breath in,
and the next being a breath out. I knew that by the time I got to the 7th
bar the contraction was pretty much over. The focus helped distract from the
massive swells of discomfort that hadn’t seemed to be quelled by the nurse
turning down the Pitocin.
We were in this—they were lasting about 60 seconds with only
a 60 second break between each one. If JB wanted to leave to grab something or
we wanted to move / change positions, I insisted that this happen immediately
after a contraction to minimize the chance of not being ready or in an optimal
position when the next one began. We moved around, from a couple positions in
the bathroom, to leaning over a counter in the hospital room, to the slow
dancing / swaying position and to the rocking chair. But the sheer volume of
contractions that showed no signs of slowing was incredibly exhausting. I was
covered in sweat and while I had confidence that I could get through each one,
I knew that I did not have the endurance to do this all night. The breaks were
just too short. It was impossible to get much solace as I was immediately
gearing up for the next inevitable wave of pain. When I had last been checked I
was 1.5. The outlook didn’t seem good for a quick delivery, even though the
intensity—both physically and mentally–was unparalleled to any other situation
I had been through in my life. I found myself wanting an escape. As much as it
helped to move around through each contraction, my thoughts drifted more and
more to the bed and how nice it sounded to just lie back and relax, like the
stories I had heard of women who got the epidural, to get some relief and relax
my muscles. I thought of what the nurse had said about the anesthesiologists
and what they had told me when the process began—that while it was never
technically too late for the epidural, they could not administer it unless you
were perfectly still. And some patients waited to the point where they could
not stay still through the contractions.
I told JB I was thinking about it. He knew that I was hoping
to go through the experience without it, so he suggested that we take a walk
out into the hallways before I ask for it. A walk sounded like something that I
absolutely couldn’t do. I would have to stop so frequently to sway and breathe
through the contractions, and without anything but him to lean on. And I’d have
to deal with lugging the IV machine and trying to avoid the cords. It was way
outside of my comfort zone, which was slowly shrinking in around me as the
hospital room transformed into a world of pain. I told him I wasn’t going to be
upset with him for letting me get it, I told him that there was no way I could
do this all night. I wasn’t sure how close I was but I knew that nothing
sounded better than getting on that bed and finishing my labor there. Seeing
how serious I was, he relented and guided me to the bedside phone to call for
In retrospect, perhaps we should have considered the
analgesic medications at this point. Especially if I was still not very far along,
which I suspected. But I knew that they brought only temporary relief and that
once you got one dose you usually wanted another. I just wanted to go for it,
the epidural loomed in my mind as the golden ticket to relief. I also wonder if
perhaps I should’ve asked to be checked first, but I honestly just did not want
to delay the process of getting on that anesthesiologist’s to-do list.
“Hello, I’d like to request the epidural,” I remember
speaking politely, although my voice probably sounded a bit strained. I tried
not to think too urgently, it could be a while before they could help me. But
at least I had initiated the process, at least help was on the way.
It was 5:45PM when the anesthesiologist arrived in my room
to administer the epidural. JB was instructed to leave the room. None of my
reasoning for resisting it seemed to matter at all anymore, the only thing that
mattered was finding a way out of the cycle of torturous swells of pain. I
never knew I could appreciate anyone’s career choice so much, I didn’t know how
I could ever thank him enough for having the tools and knowledge to get me
They told me that I’d have to be completely still. I needed
to tell him when the contraction was starting, but not to move at all. I said I
could do it. It was a monumental challenge, since I had been relying on
movement to ease the pain for hours, but I was up for it if it meant the end
was in sight.
I remember the song ‘Crash into me’ was playing from my
playlist, and he asked me if I was a Dave Matthews fan, I think because he was.
“Yes, well, I like this song. I like what I know of his songs, but I don’t know
a lot. I’m not a huge fan.” I stammered, not knowing how to properly describe
my relationship with the Dave Matthews Band exactly at that moment. I leaned
forward and meekly told them a contraction was beginning. Then I sat perfectly
still, as I knew that there was some tiny little needle making its way toward
my spinal cord and that any movement I made could really screw things up for
me. I felt like I was playing dead, trying to pretend like the pain that I felt
wasn’t real. That I was somewhere far above and away from the little room and
the small pain ridden body that I was in.
The process was fairly quick. It was only 3 or 4
contractions until I began to feel some relief. He told me that it would take
about 20 minutes to fully take effect and that it wasn’t supposed to numb the
pain completely, it was just supposed to make it manageable and allow me to
relax my muscles. That sounded great to me. And slowly, my muscles released and
I sunk back into the hospital bed—probably for the long haul, although I still
didn’t know just how long.
It was probably an hour or so later. Before 7PM I think,
that the nurses came back in to check my progress.
“You are still at 1.5 centimeters, but fully effaced.” The
nurse delivered the mind-boggling words of crushing disappointment. How was
that possible?? My water had broken, my contractions had intensified to the
point that I couldn’t use my LaMaze techniques to get through them anymore,
they were practically back to back, and at one point when feeling nauseous I
had actually wondered if maybe I might be nearing transition. Yet, what they
were telling me was that all that I had experienced was technically only ‘early
labor.’ I was not even in active labor. After being told I had a high pain tolerance,
then encountering the freight train of cascading, unwavering, ripping agony
right through my midsection for hours, I hadn’t progressed to active labor. I
didn’t fully buy it. The Pitocin threw everything out of its natural order and
I still refuse to fully accept that what I experienced doesn’t count as active
labor. I will never let my lack of dilation disparage the pain that I
experienced, because it was incredibly real. I guess if what I was in was early labor, then
I never want to experience active labor. I think that Pitocin labor doesn’t
really match up to the metrics for what would occur naturally. My body and my
baby were fighting it, despite my efforts to power through.
The silver lining was that I had absolutely made the right
choice in getting the epidural when I did. I will never doubt my decision to do
so. I would have never made it through an entire night of that hell. I think JB
and I would have both devolved into madness.
The next time they checked me—a couple hours later—I was
‘between 3 and 4’ according to the nurse. It was at this point that I began to
doubt that the induction was going to work. All that and no progress? At what
point do we throw in the towel and opt for the C-section? I could feel myself
nearing that point, I was not afraid of it if it was necessary and if I
couldn’t progress I assumed it may become necessary. That night, my doctor was
on shift and she came in to talk to me. She was still optimistic about the
induction and the possibility of a vaginal delivery. She said that as long as I
progressed through the night that there was a good chance of it.
The next 12 hours—the part where I supposedly went through
the ‘active’ part of my labor were spent on the bed, trying to get comfortable
and shift the dead weight of my legs back and forth so as not to spend too much
time in one position and possibly injure myself since I couldn’t fully feel
whether I was in pain on my lower body. I remember also feeling a pressure in
my rib cage that I had not felt before. It seemed unusual, since baby was
supposed to be descending and I hadn’t felt her kick my ribs at all the entire
pregnancy. I squirmed to try to alleviate it, but she was persistent.
I was able to get some sleep that night, although it was
very light, troubled, and hungry sleep. The contractions were not fully gone
although the epidural kept the intensity of the pain at bay. I remember that
the growing hunger in my stomach added to my discomfort and was beginning to
make me feel weak, I was glad that I wasn’t still trying to labor with my
energy levels running on empty.
I’m fortunate that I was in a state of drowsiness and not
fully able to understand the scare that happened around 3am that night. My
baby’s heartrate plummeted after I shifted to my right side—her heart rate was
down into the 40s for more than 4 minutes and all the medical staff on the floor
were gathered in our room. JB tells me he woke up and realized what was
happening, that there was a crisis going on. I have no memory of this, just
that they wouldn’t let me stay on my right side. They were about 30 seconds
away from taking me in for an emergency C-section, when her heart rate climbed
back up and stabilized in the normal range. Thankfully.
Stage Two/ Terrapin Station
I think I was checked twice during the night, once I was
‘5-6’ and the next time ‘8-9.’ By 7AM, when the shift was changing, the night
nurse checked me one last time and declared me complete. It seemed incredulous
that I had gone through such a monumental opening and even through transition while
barely feeling a thing. I was ready to push, but they weren’t really in a hurry
to have me start, I’m not sure why. They brought in a kit with tools to prepare
for baby’s arrival. A new team of nurses came in, one with 35 years of experience
who was actually retiring the next week. It wasn’t until 9AM that they got me
in position to push and so it began.
I could feel and move my feet, but not most of my legs so I
relied heavily on the help of JB and the nurses to move my legs into position,
and then to help hold them up as the process began. I was instructed to start
pushing when I felt a contraction beginning, and to push hard for a 10 count,
holding my breath, then release to grab another breath and repeat. For each
contraction, they said I should do this 3-4 times. While I could still feel the
tightening of the contractions, it was impossible to tell if it was going to be
a big one or just a small blip on the monitor. And sometimes my desire to push
tricked me into thinking that one was starting when it wasn’t. They wanted me
to take breaks between the pushing to regain my strength. It was really up to
me to know when to push though because it would take at least 5 seconds for the
monitor to reveal what was happening, so I couldn’t rely on them to tell me
It was challenging, they told me to make sure I was push all
the way through and bearing down—as if I was taking the biggest poop of my
life. I was not supposed to hold any of the pressure in my face, but when
you’re holding your breath it’s tough not to. They told me I got the hang of
it, and that I was pushing correctly—especially since I pushed out 3 stools
during the first hour or so! It was a whole new level of intimacy with JB, he
had never seen me poop before and I can only imagine how raw and completely
unsexy his view of my nether regions was. But it didn’t bother me in the
slightest, I knew how common it was to poop during pushing and I had mentally
prepared for it. My only goal at that point was to get this baby out and into
the world. We were ready.
Despite pushing correctly, Scarlett didn’t seem to be
descending. When we started I was told she was in a +2 station, meaning her
head was above the pelvis still. And I knew that she couldn’t have moved that
much because I continued to feel an intense pressure in my left ribs. I was
sure that the balloon, and the cervical checks and the hands had prompted her
to retreat as far up into me as she could. She was jammed up in there and no
amount of external nudging with the nurse’s hands and mom pushing could
dislodge her. The nurse could feel her body at an odd, diagonal angle through
my abdomen. Despite being head down, her position was not ideal for a trip
through the vaginal canal as she was sort of twisted diagonally across my
abdomen. We all remained optimistic that I could do this though, that I could
deliver a healthy baby vaginally after a multi-day labor. But the clock kept
progressing, and baby did not.
I felt like I needed to have gravity working with me instead
of against me as it seemed to be. That was the big drawback to the epidural, I
couldn’t squat or easily get into a hands and knees position where gravity
could help coax her out. The nurses came up with a couple of different
positions that I could try without having the use of my legs, we used a sheet
around a labor bar so that I could lean upward into more of a sitting position.
But, the morning wore on and nothing we tried seemed to help. I kept hoping I
would hear them say that they could see the head or some other real sign of
progress besides just encouraging words. Throughout the pushing amniotic fluid
streamed out of me from time to time, and unlike when it first appeared on
Tuesday afternoon, there was now meconium present in the fluid. Everything that
had transpired had likely stressed the poor baby a bit, and she had passed her
first stool just in the last few hours. It wasn’t a big deal, but it made me
sad to think of her distressed and resisting.
It was 12PM when the midwife came in and declared that her
position was still +2, after 3 hours of pushing. I had heard in other birth
stories that people are often not allowed to go past 2 hours, but they were
being generous in allowing me the time to try to get her out before resorting
to surgery. They told me I could try until 12:30 and then they were going to
have to call it unsuccessful, and we would go to the operating room. The
deadline made me try even harder—the pushing actually felt really good too. It
was a relief and pushing into the contractions seemed to counter the power of
their pain. It felt natural, and as each contraction came, I continued to push.
It couldn’t hurt since I was 10cm—even though it wasn’t getting me anywhere.
First Birth, Second
At 12:45, Dr. Lopez came in and introduced himself and I
signed some paperwork. He explained that C-sections were generally safe but
came with some risks, that the major difference with a C-section delivery was
the price, but there wasn’t really another option at that point. She was too
high for a forcep or vacuum assisted delivery. The team that would be
performing the surgery had a cumulative total of about 150 years of experience.
I was in good hands and I knew they did this every day, multiple teams per day,
as they had done with my neighbor only hours earlier.
This is the part where I feel like my previous surgery
experience really helped me to keep a positive attitude—I really was not afraid
at all. I was a little disappointed that after so many hours of labor it was
going to end in a C-section, since I could’ve just scheduled one and avoided
all the pain and drama. I wasn’t really looking forward to having another scar
on my abdomen, and having future deliveries be complicated by a previous
C-section, but I was not fearful. It wasn’t ideal, but I definitely understood
the necessity of it after all the exhaustion, the hunger, the pain. We were
beyond ready to meet her and she needed to come out, despite her stubborn
inclination to gravitate toward my ribs.
JB was instructed to put on his scrubs and wait outside, and
I was wheeled into the operating room where the team prepared for surgery.
Since I already had the epidural in place, it was just a matter of some
additional medication to further numb my abdominal area. They put up a blue
curtain, and I was surprised at how close to my face it was. It was so odd to
be awake for all of the busy, perfunctory medical preparations and small talk
amongst the staff that typically occur when the patient is placed under
anesthesia. I remember being cold, so cold. The blankets they put over my
shoulders and arms didn’t seem to help. I was shivering. It’s a normal affect
of the medicine, they said. It didn’t make it less uncomfortable.
JB had been outside waiting—I later found out for about 30
minutes! It didn’t seem that long to me. He was trying to keep our closest
family members updated about the situation as we kept getting tons of messages
from people who knew that we had checked into the hospital on Monday, since it
was now Wednesday afternoon. The doctors finally brought him in. He asked if he
could watch, but they advised him he should be with me. We held hands as the
surgery began. It was just like I had heard it described by so many, just the
sensation of tugging. No pain.
Then we heard it—the loud, livid cries of our baby! She certainly
came out with fully developed lungs and a strongly emotive voice she knew how
to use. They told him he could go take pictures, so he excitedly ventured to
the otherside of the curtain where he saw a gory mess of blood and a baby girl
with a red, scrunched up angry face and a head of thick brown hair!
“It’s a girl!” JB exclaimed, bringing to a close our 9
months of waiting, wondering, hypothesizing and flip flopping.
They quickly suctioned her lungs (since meconium had been
found in her fluid) and performed some initial screenings. Daddy stayed with
her during that and cut her cord, I knew right away that she was going to be a
daddy’s girl forever. They brought her to me when they could although we didn’t
have the ideal skin to skin golden hour experience that we had been planning.
It was frustrating to not get to see her right away when she emerged, or to
have her immediately plopped onto my chest while we were still connected via umbilical
cord. But it was nice to hold her when she was so fresh and so tiny! I remember
she looked at me with her big eyes and the three of us shared an embrace, and
our first family photo. I was in awe of her and couldn’t believe everything
that had transpired. They told me her apgar scores were 8 and 9 respectively,
he told me “we never give tens anymore,” so she was basically as healthy as
could be. She clocked in at 7 pound, 13 ounces and measured 20 and a half
inches in length. The doctors sewed me back up and after a short while we were
brought to the recovery room. There, we had some family bonding time and she
got a chance to nurse for the first time. I was amazed at her inherent
knowledge of how to latch and suck. My breasts didn’t feel it with near her
level of intuition.
“Penelope?” JB asked me, since that had been our frontrunner
name for a girl for months.
I shook my head.
“Scarlett,” I said, “I started thinking of her as Scarlett
It was a name we had both agreed upon later in the
pregnancy. I thought it was beautiful, and I found out later that he had
suggested it because of the Grateful Dead song Scarlet Begonias. Which hadn’t
even crossed my mind, but I am happy now that there is a song associated with
There is so much more to be said, about the recovery, the
breastfeeding experience, and the challenge of the newborn weeks—but that is
the story of Scarlett Genevieve Brown’s birth. It was a long one, but she was
born before July could end and she is nothing short of the gorgeous, long-haired
summer baby that we had dreamed of.
It’s taken me
some time to write about Scarlett’s birth and to process the whole experience.
It almost goes without saying that these past 2 months have absolutely changed
my entire life, yet I am saying it because that fact can also not be
understated. Newborn babies are incredibly sweet and angelically cherub-like in
their chubby, rosy cheeked aesthetic. Their earliest smiles will pull at your
heartstrings in a way that you can never have fully anticipated before you see
their little faces and big curious eyes. Yet the first month also brings a
suite of new challenges the depth and intensity of which you never fully
understood, certainly not leaving much time for anything extra.
But I’m happy to say that now that we are nearing the 2-month mark, we’ve gotten into a pretty good routine that’s allowed me some time to get back to the computer to write. As a follow up to my earlier post on how my experience with cancer affected my outlook on pregnancy, I wanted to share some nuggets of advice now that I’m on the other side of the experience. In short, I was induced and had a 43-hour labor, including 3.5 hours of pushing and a diagnosis of ‘failure to progress’ through the pushing stage. The whole thing ended in a C-section. It wasn’t a great experience, but I’ve bounced back and my little angel is more than worth it. Here are some recommendations I have on what you can do ahead of time to maximize your resiliency through a difficult (or even an easy!) labor.
Education is Empowerment
I went into pregnancy with very
little knowledge of what it would be like, and what factors to consider when
planning a birth. Like most young American women, I just assumed you go to the
hospital and they guide you through it. I thought home births were for new age
hippies. I didn’t have many close friends or family who had gone through
pregnancy and I had never seen a birth.
Like a good former academic, I purchased some books about pregnancy when my pregnancy test first lit up positive. What to Expect When You’re Expecting and the Mayo Clinic Guide to a Healthy Pregnancy were my first purchases. But it was 50 Things To Do Before You Deliver, a light-hearted, brightly colored listicle of a book that brought me to the best resource I discovered during pregnancy. The book suggested listening to birth stories, and specifically recommended a podcast called The Birth Hour. After my first listen, I was hooked—it really changed how I thought about the whole process and broadened my perspective of what birth could be. I was already midway through my second trimester by the time I started listening, but I have to say that it was the single most valuable way that I learned about birth.
Learning through listening to real
birth stories from other women allowed me to be exposed to a very wide range of
possibilities. It was striking to hear how each experience was unique, yet as I
began to listen religiously during my daily walks, I began to pick up on common
patterns to labor and delivery. Investing the time in hearing these different
perspectives was so much more educational than just reading a medical article
or book chapter that listed out different medical interventions or the stages
of labor and what to expect. I really felt like I understood how certain
decisions—like whether to get an epidural and when, might impact the course and
outcome of labor.
I learned why many women chose to
go the route of home birth or birthing center rather than hospital, after
hearing multiple stories about pushy hospital doctors or the detached,
nonpersonal experience of having a stranger who viewed you as a medical record
number rather than a person deliver your baby. I listened to women describe how
real and beautiful it was to experience all of the feelings throughout the
labor—pain, relief, and pure joy. Many women believed they really benefited
from developing an understanding of the full capabilities of the body and how
we are meant to reproduce by going through the delivery unmedicated.
Another benefit to learning through
birth stories is that you are inherently learning through multiple sources.
Whenever I delve into a new subject I make sure to use multiple avenues of
learning so that I can cross-reference the most salient points from each and
get a more informed perspective. We also took a La Maze class through Kaiser,
which added another layer to my education. The class didn’t start until I was
35 weeks pregnant, so I was at the tail end of my pregnancy and we weren’t even
sure we’d finish if the baby came early. The class reinforced much of what I’d
picked up through the Birth Hour and allowed us to practice breathing and
movement techniques together. The instructor had given birth 5 times—all
unmedicated. She had a strong preference for natural labor but discussed medication
options as tools that you could turn to in your toolbox—under certain
circumstances they could be very beneficial.
Know Your Birth Philosophy
I recommend becoming educated about the wonderful
world of birthing as early as possible. This allows you to choose from the
beginning what type of care provider you want to seek—midwife or OBGYN, and to
begin advocating for yourself and your birthing preferences up front. You may
hear about a Birth Plan and how you need one. You’ll probably find it on the
checklists of the pregnancy apps you’re using. Or you may be handed a standard
paper birth plan to fill out with check boxes from your doctor’s office, like I
was. However, I would advise against developing too rigid of a birth plan. I
don’t believe it’s a checkbox kind of activity—these are not simple black or
white, yes or no type questions.
The more I reflect on my experiences, it
becomes clearer and clearer what a grey world it is. That’s why I recommend
understanding the different techniques that might be used, particularly if you
are being induced, and evaluating how you feel about each one so that you can
develop a sort of birth philosophy rather than a hard and fast plan. In my
case, they used a foley balloon to mechanically induce dilation for the first
12 hours of my labor. While it didn’t work well in my case, I’m glad we went
this route rather than the cervix softening medications that are sometimes used
to start labor. Understand each of the tools in your toolbox and set an overall
goal for your experience. Then, you can match your tool selection with the way
your labor progresses to help you meet that goal. It is definitely important to
have a birth partner / labor coach / doula to discuss this with beforehand,
this person should understand how you feel about the different options and be
able to advocate on your behalf if you are not able to during labor. Believe
me, it can get intense quickly, especially if Pitocin is involved, and your
ability to have a rational conversation may be greatly diminished.
In my case, my birth philosophy was to approach the experience as naturally as circumstances would allow but I was not against utilizing pain medications if my labor became particularly long or difficult. I researched alternative pain relief measures and prepared to use tools such as aromatherapy, visualization, music, massage, breathing, and movement. I was against being induced, but given my doctor’s stern recommendation that I was at high risk of developing preeclampsia due to my pre-existing chronic hypertension, I was willing to undergo induction. However, I was not comfortable with inducing any earlier than 40 weeks, despite her initial recommendation of doing it at 38 or 39 weeks. Due to hearing the many induction stories on the Birth Hour I was well aware that beginning labor through medical methods often leads to a ‘cascade’ of medical interventions until the baby is born. Knowing this beforehand, I came to terms with the fact that I would be a lot more likely to ask for the epidural if I was induced—I had heard time and time again about how Pitocin can create extremely intense contractions as the chemical forces your uterus to contract, and often does this overly well.
Having a birth philosophy ended up suiting me very
well. I did not feel like I had failed when I asked for the epidural about 24
hours into my labor when I had failed to progress in dilation at all (I was 1.5
the entire time) and was exhausted by the frequency and intensity of the Pitocin
induced contractions. With the epidural, not only was I able to get some rest overnight,
my body was also relaxed enough to dilate to 10 centimeters. I’m not sure if I would’ve
gotten there without it.
A year earlier I had used my emergency management
skills to plan my own wedding, developing a full event action plan complete
with a down to the minute timeline, set up diagrams, contact rosters and
organizational charts. Unlike weddings, birth is one of the few things in today’s
perfectly planned, calendar-centric world where you cannot anticipate the
timing and progression of events. It was both freeing and a little intimidating
going into the birth experience knowing that I must relinquish control of the
process. My baby and my body would guide me through and I had to trust them.
For our La Maze class, we were instructed to identify an object to serve as a ‘focal
point’ during our breathing and laboring. I decided to make a vision board with
relaxing imagery and motivational quotes. One of the phrases I selected was:
Birth isn’t scripted, it unfolds. And through 5 weeks of practicing with the
focal point in LaMaze, I think I truly came to believe it.
This mentality helped me greatly when the
doctors recommended that I be moved to the operating room for a Cesarean
Section after nearly 4 hours of pushing. While my birth philosophy had always
involved a preference for birthing through a vaginal delivery, I knew in the
back of my mind that a C-section was a possibility. My own birth was via C-section,
and I had known a few friends recently who had to give birth this way even though
it was not planned. One in three births in the United States occur via C-section,
and I knew that even though Kaiser prided themselves on having a lower rate
than most and doing everything they could to encourage vaginal deliveries, the possibility
was there. I remained calm and was, at that point, grateful that we were most
definitely going to meet our baby very shortly.
One of the reasons I was able to remain calm and matter of fact during a time when the doctors said many women are in tears and extremely frightened, was because I took some time during my third trimester to reflect on my strengths. Going into labor, I wanted to visualize myself as strong, as a survivor. Writing has always helped me process things and create deeper understanding in my own life, so I wrote about how my experience as a cancer survivor shaped my mentality as I approached labor. While not everyone may have as dramatic of an experience to reflect on as I did, I challenge you to think critically about life experiences where you were strong–physically or emotionally–and channel that inner strength as you go into labor.
teacher told us that she would rather give birth than have strep throat. In her
experience, strep throat was way more painful. I think most of us were skeptical
about this, given the many horror stories out there about labor and the way
that it is depicted in popular culture. But, her point was that this pain has
an end game, it has a purpose, whereas illnesses and broken bones do not. You
can recall an experience like an illness, injury, training for a marathon or
sport, or even getting through a difficult divorce where you were resilient and
use that documented example to show yourself why you will get through labor.
In addition to
using a past example, you can also strive to cultivate endurance while you’re
pregnant. Doctors recommend walking and other moderate exercise while pregnant as
healthful for both mom and baby. As you get further along it can feel pretty challenging
just to walk for 30 minutes, especially if there are hills or heat waves
involved! As you continue to conquer physical milestones during your pregnancy
you will be creating an endurance in your body that can be called upon during
delivery. Yoga and meditation have also been shown to promote wellness in
pregnant women, and fostering this strength of mind-body connection can work
wonders on boosting your stamina during labor. I walked pretty much every day right
up until the date of my induction, and practiced yoga regularly throughout my
pregnancy—both of which I credit with helping me build the power to push for
nearly four hours.
While I was ultimately
unsuccessful, I have not let that bring me dismay. My baby’s positioning wasn’t
great—her feet were crammed way up in my left ribcage for the entire second stage
of labor and she refused to budge even though the nurses told me I was pushing
correctly (as evidenced by the three stools I passed in the process!). I chalk
it up to her not being ready, and the induction process as a whole not being
effective in convincing her it was time to make her appearance. But the
important thing is that she is here! Her apgar scores of 8 and 9 upon birth and
she was happily average on all accounts, well except for her thick mop of
In this post, I’ve tried to summarize some of the main takeaways, but if you’re interested in more details on my lengthy labor, you’re welcome to read my full birth story (be aware it is 8 pages long!!).
As I approach the due date of my first child this weekend, I am reflecting on how this pregnancy journey has been shaped by my experience as a cancer survivor. For many young moms, labor and delivery will be their first / most serious experience with the medical system, and possibly their first overnight stay at a hospital. And many cancer survivors are older, already mothers and not trying to conceive while in recovery. As someone who was diagnosed with cancer (a very rare clear cell sarcoma within the colon) at 26 years old, and becoming a mom afterward at 33 years old, I find myself in a unique position—with both benefits and drawbacks.
When I got the diagnosis in 2012,
becoming a mother was one of the primary goals that I quickly realized I still
wanted to accomplish with however much of my life that remained. I made a
bucket list of sorts and having a child was right up at the top. Of course, to
create the ideal environment to raise one would take years. I had not yet found
my partner, my career was not yet well established and certainly living in a
house with four roommates was not the best place to raise a child. It took
time, and I’m forever grateful to have had these 7 years to get where I wanted
to be; here, as I am about to experience the joy and journey of motherhood.
With the goal of ending on a
positive note, I’ll begin by addressing downsides to going through pregnancy as
a cancer survivor. The first is that you can’t go for your normally scheduled
follow up scans. After primary courses of treatment such as chemotherapy,
radiation, or surgery, cancer survivors are typically kept under surveillance
for years through follow up imaging to ensure our bodies are still cancer free.
Unfortunately, MRI’s / PET Scans and babies in utero don’t mix. Depending on
the frequency your doctor is recommending, this can certainly throw a wrench
into your follow up care plan since pregnancy is more than 9 months and many
people are supposed to go multiple times per year. Skipping recommended scans
can certainly make a survivor nervous because the fear of recurrence is
omnipresent, very real—always there, just out of sight. Clear scans keep you
reassured of your health and help you continue forward on your life track with
reduced anxiety. I am very fortunate in that being 7 years out with no
recurrences I have only been going annually for the past couple years. My
oncologist actually approved an even longer gap for me to accommodate my
pregnancy and recovery—waiting about a year and a half until Spring 2020. While
it’s a little nerve-wracking to be unsure of what your body is up to for that
length of time, at over 7 years I am feeling pretty good about this–perhaps
I’ve graduated to the 18-month interval from the 12.
The second downside of approaching this as a cancer survivor is the heightened worry with all that can go wrong in pregnancy. There are a lot of tests, many different criteria for levels in your blood draws, blood pressure, your weight, protein or glucose in urine. I actually did experience elevated fear and paranoia that I know is a kind of PTSD from my cancer. At the beginning of my 2nd trimester, my liver enzymes (AST/ALT) mysteriously shot up and I had to go for several repeat blood tests, which continued to escalate to levels over 200. This can be a marker of liver damage or of Intrahepatic Cholestasis of Pregnancy or possibly preeclampsia. Trust me, Google will show you lots of different disorders this can be a foreboding symptom of.
I was referred to the high-risk
doctor and a liver specialist. They even performed an ultrasound on my liver to
check for any damages or suspicious lesions. Boy was that scary for me, it was
the first time since my original diagnosis that I had been told something was
abnormal and needed to be investigated. It was so tough to relax and think
positively as the creeping, agonizing panic of something being wrong with my
body began to sink in from the sidelines. When your body has psyched you out
once already by throwing you a super-rare-cancer-at-26-years-old-wildcard you
are constantly on your toes at any little sign that something isn’t right. Even
after 7 years, I continue to be a bit of hypochondriac, but this was the first
time that doctors were concerned too. In my case, my liver enzyme levels simply
began dropping until they returned to normal levels. No explanation whatsoever.
The body is still nature’s mysterious machine in a lot of ways. For as much as
we seem to decipher about it there is so much more that we have yet to understand.
But as a cancer survivor, it is difficult to trust your body to just be normal
sometimes. You know all too well that just because you feel fine and you’re
functioning perfectly well that doesn’t mean there isn’t something sinister at
play in your cells.
I think the biggest benefit of
approaching pregnancy as a cancer survivor is that I’m not afraid. The idea of
labor and delivery isn’t really scary to me the way it is to some first-time
moms. A lot of people are afraid of getting a C-section, afraid of the
recovery, afraid of the scar, and fearful of infection. But having already gone
through a major, exploratory, emergency surgery on my abdomen I’m not scared of
the possibility of a C-section. It’s not my first choice for how I deliver my
baby, but I have no anxieties about undergoing the procedure if it’s necessary
for a safe delivery. The video we watched in LaMaze class talked about how they
slice through the abdominal walls and the layers of fat and muscle, then pull
it apart so the baby can come out. It made it sound kind of gory and I almost
wonder if it’s designed to scare you—but 7 years ago that happened to me. It
was even worse, a large vertical incision was made through all my layers and my
intestines sliced open, a section removed, then stitched back together. They
poked around at my other organs too since they didn’t know what they were
dealing with at the time, hence the term ‘exploratory.’ That sounds a hell of a
lot more intense than a small, measured, horizontal incision on the uterus. The
recovery? Yeah it was no fun. But I made it, I was able to go on short, slow
walks tethered to my IV pole within a couple of days. It took a couple weeks
for me to be able to go on longer ones around my neighborhood, after the wound
vacuum was removed. Yes, my wound did get infected. Due to the emergency nature
of my surgery I couldn’t do a proper bowel cleanse / fast beforehand. So I had
to wear the vacuum for a week after the infection was discovered, then do
‘wet-to-dry’ dressings and change them myself twice a day until it healed from
the inside out. What are the odds of that happening with a C-section? Very low
I’m sure. The Cesarean is such a controlled, well-practiced procedure. One in
three births in the U.S. occurs through this method. Even the emergency ones
are nothing in comparison to the major, complex surgery that I’ve already been
through, recovered from and owe my life to.
In terms of vaginal delivery and
the whole labor experience, I know many people are afraid of the pain, so many
want to request an epidural immediately to spare themselves from horrible
contractions. I am not so afraid of it, although it is the unknown so I’m also
not opposed to the epidural as a tool for a difficult and prolonged labor.
While it’s true that I have never experienced labor and probably nothing
similar, I did experience prolonged pain and discomfort in my stomach for
months before the surgery. The doctors told me that I must’ve had a high
tolerance to pain to not have come in sooner. This gives me hope that I’ll be
able to endure labor pains.
Am I afraid of the epidural? I’m
a bit hesitant about it, since I’ve never had a needle in my spine before. I’m
hoping not to get one, but again if it will help me relax to get through a
prolonged labor I will. This is a routine procedure that I am confident the
anesthesiologist is well-practiced in. I do have the benefit of knowing I’m not
allergic to anesthesia, having undergone general anesthesia for my surgery.
I’m comfortable in hospitals.
They’ve saved my life once before and got me on the road to full recovery.
Needles, IV’s, and blood draws don’t scare me at all because I’ve gotten used
to these medical tools through the sixteen MRIs / Pet Scans I’ve had for follow
up care. None of these interventions bother me because I literally owe my life
to the benefits that modern medicine can provide.
Most importantly, I think the
cancer has prepared me for this experience in a positive way because I know I’m
a survivor. Because I’ve gotten through something far more horrific and
menacing than childbirth. I know that my body can recover, that I can heal and
fight off infections. I know that I can take small quantities of necessary
opioids for pain, I’ve felt the itching side effects, and I know that I can
wean myself off them successfully. I have been through a much scarier, bigger
battle than this and I am still standing strong.
I approach my first birth with
confidence, with wisdom, with gratitude, and with excitement that this time
when I go to the hospital it will be for something beautiful. This time, my
body has been growing a human being, not a malignant neoplasm, and the birth of
this baby will be spectacular and celebrated. I am experiencing a normal human condition—a
womanly rite of passage that has given longevity to the humanity for
generation. My body is meant to do this and this is one of my dreams.