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.
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.
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.