Jenny Novak, MEP, CEM®

Emergency Manager | Speaker | Writer

Category: Uncategorized

Evacuation Messaging: Best Practices from the Thomas Fire

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.

The first WEA alert for the Thomas Fire.

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.

Thomas Fire perimeter map from early in the fire’s progression.

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.

Briefing at the Thomas Fire Incident Command Post.

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.

EOC organization chart from the Thomas Fire.

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.

Inside the EOC.

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.

Presenting Ventura OES with the Exceptional Service Award at the 2018 CESA Conference.

Saving Lives

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.

Breastfeeding: Challenges and Solutions for New Moms

How is Breastfeeding ‘Hard’?

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.

My anchor in the early days.

Time Consuming

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!

Incredibly Painful

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.

Scarlett sleeps after a feeding.

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.

Scarlett naps on the Brest Friend nursing pillow.

Literally Draining

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.

The Pressure

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.

Tired Mama and Baby.

Solutions

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.

Lactation Consultants

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.

The gel soothing pads and nipple butter I used.

Accessories

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…

Eating dinner over my baby thanks to my helpers.

Helpers

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.

Learning to multi task after a feed.

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.

The Birth of Scarlett G.

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.

Hypertension

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.

The Induction

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 cramping.

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 feeling.

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 pad!

“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 help.

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.

The Bed

“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 through this.

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 when.

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 Surgery

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.

She came into this world screaming!

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.

Our first family photo

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 immediately.”

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 her.

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.

Extreme Event Resiliency Feature

Extreme Event on the Road: California Campus Spreads Resilience

Koshland Science Museum (February 13, 2017)

Our program was featured on the website for Extreme Event Resiliency Game! A great way to teach groups about the disaster cycle and the concept of resiliency. I have facilitated the hurricane scenario exercise with 3 groups on campus and 3 groups of American Red Cross volunteers. In April 2017, two additional groups on campus will get to experience the earthquake scenario.

Westlake Incident / Antelope Valley Mudslides 10.15.15

The mudslides that struck the Antelope Valley area on October 15th, 2015 were violent, sudden, and devastating to those living in the areas affected.

CSUN Zombie Preparedness Scavenger Hunt

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Over 250 CSUN students completed the scavenger hunt, building preparedness kits. Over 70% of the participating students were building their very first emergency preparedness kit.