Michelle’s Birth Story

The due date for our baby was August 18. After the 36th week of pregnancy, we had doctor’s appointments every week. On August 11, we had an appointment with Dr. Cernadas at 3:15pm. She did a vaginal exam and told us that the cervix was still completely closed. The fetal heart rate seemed normal. However, Amber told her that she had been feeling less fetal movement recently. Because of that, we were sent to the ultrasound technician. We had no idea what the ultrasound images meant. We asked the technician but she was reticent and told us to wait for the doctor. Dr. Cernadas told us that the baby was doing fine but the amniotic fluid was low. Therefore, she asked us to go to the hospital immediately where labor would be induced.

We weren’t prepared for labor at the time. I had packed up most of the stuff for labor and delivery a week ago, but Amber seemed to think that the baby would either arrive on time on August 18 or late. Anyway, we came home to pick up our bags which included some reading material, toiletries, baby clothes, camera and laptop. Around 5pm, we left for Saint Peters University Hospital. The hospital is close by but this was rush hour, so it took us almost half an hour to get there.

Once at the hospital, Amber was admitted and we were put in LDR room 10. Amber was given an IV and fetal monitoring sensors were put on her belly to record her contractions and fetal heart rate.

We were told that Amber would be given an injeted medicine to soften up her cervix tonight. Labor induction would wait till tomorrow. It was extremely boring waiting for the medicine, so I started reading The Complete Robot.

The medicine Cervidil was injected to “ripen” the cervix around 9pm by Dr. Karanikolas (another doctor in the group practice we went to). He told us to sleep well as tomorrow was going to be a long day.

Since we hadn’t had the chance yet to inform our parents, we called them now that it was early morning in Pakistan. We told them that delivery could still be 48 hours away and not to worry if they didn’t hear from us in the meanwhile.

Amber was not allowed to eat or drink anything except ice chips. However, it was late and I was getting hungry. It turned out that the hospital cafeteria closed at 7pm. I didn’t want to go out to eat, so I ordered some food for delivery. After that, we went to sleep around 12:30am. Amber was having trouble sleeping, so she asked for some medicine to help her sleep. Even that didn’t help her nerves much.

We got up early around 7:30am on August 12. Amber was feeling nauseous and had menstrual cramps. She took a shower to feel better. Around 9:15am, Pitocin was introduced in her IV to induce labor.

Dr. Fisher was the doctor on duty at the hospital for the day. She is new to the group and we hadn’t seen her before. She seemed good and confident. However, she had no idea when labor would start and how fast it would be.

By this time, Amber was very stressed and was crying again. She had cried earlier as well when she had called her mom last night. I had heard about postpartum blues but these seem to be prepartum ones.

We started noticing contractions around 11am. Their duration was 30-40 seconds and they were 2-3 minutes apart. This was good news. The contractions were getting stronger over time.

The nurse reported the cervix dilated to 3cm and the baby’s station as -2 at 12:30pm. Amber asked for pain relief at the time and an epidural was ordered. The anesthesiologist Dr. Jenkins came to give the epidural at 1:30pm and immediately threw me out of the room. I returned triumphantly 20 minutes later.

Amber’s water was then broken by Dr. Fisher and an internal fetal monitor put on the baby’s head to record her heart rate. This was a much cleaner signal than the external monitor which had to be moved around periodically.

More than 30 minutes after the epidural was inserted, Amber was still feeling pain and the pain was getting a lot worse. The anesthesiologist was called again and he gave Amber a large dose through the catheter. When that did not work, he decided to redo the epidural. I could not see the procedure as I was again shown the door. This time the epidural worked and Amber felt much better. The epidural also affects blood pressure and Amber’s was down to 92/42 at one point. However, it stabilized around 4pm.

At 4:24pm, we were all very surprised to discover that Amber had progressed to a 9cm dilation and a +2 baby station in the last 3 hours. Wow! That meant delivery was close. However, Amber started feeling extreme pain and was given a large dose in her epidural.

At 5:15pm, the pushing phase of labor started. It was time to bring the baby out into the world. Amber’s pushing did not seem to work much beyond tiring her down. It took more than 1.5 hours of pushing to get the baby out.

Finally, at 6:57pm, Michelle was born. Dr. Fisher did an episiotomy to get the baby out as the baby’s heart rate had dropped below 100.

Immediately after Michelle’s birth, a number of medical staff rushed into the room. It turned out that Michelle’s Apgar score at 1 minute was 5 which is a little low (I think 8-10 is considered normal.) The medical staff dried her with a towel and held oxygen under her nose. This got her Apgar score at 5 minutes after birth to 9 (and hence normal).

While this was happening, the placenta came out and Dr. Fisher did the stitches for the episiotomy on Amber.

It took us some time to realize that our baby had been born. Michelle looked so beautiful and cute. As I held her, I was overcome with emotion. I had told Amber earlier not to be surprised if I cried at Michelle’s birth. Fortunately, I didn’t. I was also afraid of holding Michelle in my arms, but warmed to the task immediately.

Amber tried breastfeeding Michelle at the time but Michelle didn’t latch on. So the feeding was postponed to after moving to the postpartum room. Michelle was then taken to the new-born nursery for some measurements and tests etc. I went with her and noted down the measurements. Michelle was 6 lbs 9.2 oz (2.98 kg) which is at the 20th percentile (according to CDC). Her length was 20.5 in (52.07 cm) which lies at the 85.52 percentile. Her head circumference was 13.25 in (33.66 cm) which is at the 25.17 percentile.

The nursery kept Michelle to do some tests while I accompanied Amber to the postpartum room. St Peters has both private and semi-private rooms. We were lucky to get a private room, which meant I could stay with Amber and Michelle and sleep on the sofa-bed in the room.

Labor and Delivery: A Technical Note

During labor, an external fetal monitor is used to record the baby’s heart rate and the uterine contractions. The sensors are placed on the mother’s belly. Later, during the pushing phase of labor, a sensor is connected to the baby’s head to record her heart rate more accurately, thus becoming an internal fetal monitor.

Older fetal monintors recorded these measurements on paper, graphing the fetal heart rate and contraction intensity over time. Nowadays, there is a paper output as well, but the main output device is a computer monitor. I was quite impressed and engrossed in the machine. In fact, I had a competition going on with Amber about who could predict the start of the contraction earlier, with her reliance on her senses and mine on the sensor data. Needless to say, I lost except when she was under the influence of the epidural anesthesia.

Considering the importance of the fetal monitor, I was surprised to find out that the computer was running Microsoft Windows. How did I find that out? You get one guess. Yes, the computer crashed during active labor. Amazing! The paper output continued working, but the computer which was being used to record show the monitor outputs from all labor rooms as well as to record doctor’s and nurse’s notes crashed and had to be restarted after a while.

As I mentioned before, the hospital recorded Michelle’s time of birth as 7:01pm while she was born at 6:57pm. I noted down the correct time from my watch which had been synchronized with atomic clock data just a few days ago. The hospital recorded the time that was on their computer (yes, the same one that crashed). It was 4 minutes too fast. I don’t know whether the hospital has heard of time servers and network time protocol, but it would do well to set up a time server computer on their LAN and then synchronize all computers’ clocks to the server.

The Proudest Day

Michelle Zakaria was born at 6:57pm (that was the correct time, though the St Peters clock said 7:01pm and that’s what they recorded) on August 12 at Saint Peters University Hospital, New Brunswick, NJ. She weighs 6 pounds 9 ounces (3 kg) and is 20.5 inches (52 cm) long. She is healthy and the most beautiful baby ever.

Amber is happy but extremely tired. I can’t contain my excitement.

It’s Time

Well, not exactly. But we had a doctor’s appointment today and the amniotic fluid seems to be a bit low while the baby seems to be doing fine right now. So our doctor has asked us to go to the hospital right now for labor induction.

I am taking the laptop with me. I don’t, however, know whether I’ll be able to blog from there or not.

In any case, I’ll update after the baby is born.

Off we go to Saint Peters.

Breastfeeding Class

When we registered for the class at St Peters, we asked if it was for women only or for couples. Since the breastfeeding class was open to couples, we both attended it. However, when we got there, I wondered what I was doing there. There were only 3 of us guys while there were 13 women. Most women had come alone, but one had come with her mother.

I also had no idea what I was supposed to do. It turned out though that my presence was useful since Amber was a very bad student that day. If I hadn’t been paying attention, we wouldn’t have gotten how to position the baby for nursing or the other information the instructor (a lactation consultant at the hospital) provided.

Amber asked the instructor about breast pumps and feeding the baby after she goes back to work. The instructor recommended a couple of pumps and also suggested how to get the baby used to drinking expressed milk from the bottle during the day.

The American Academy of Pediatrics recommends breastfeeding exclusively for the first 6 months and then supplementing breast milk with solid food until at least 1 year of age.

Strangely, despite the many benefits of breastfeeding, only about 3 in 10 babies are being breastfed at 6 months of age in the United States. Breastfeeding declined in the US for about two-thirds of the last century, but has since recovered somewhat. The overall rates still remain quite low as this article points out.

More than two thirds of mothers breastfed in the early 1900s […]. However, both the incidence and duration of breastfeeding declined in successive cohorts, beginning in the first decades of the 1900s […]. Initiation rates in the 1911–1915 cohort were nearly 70% of women, and nearly 50% in the 1926—1930 cohort; however, in the 1946—1950 cohort, only 25% initiation rates were noted […]. Initiation of breastfeeding reached its nadir in 1972, when only 22% of women breastfed […].

By 1975, however, breastfeeding initiation began to increase, from 33.4% in that year to 54% in 1980, and subsequently to 59.7% in 1984 […]. There was a dip in breastfeeding initiation rates in the late 1980s, followed by a return in the mid-1990s to the high levels observed in the early 1980s […]. Thus, after a dramatic increase in the 1970s, breastfeeding rates remained relatively static from the early 1980s to 1995. As of 1995, 60% of new mothers initiated breastfeeding, with 20% still breast-feeding at 6 mo. […]In 1997, 62.4% of mothers initiated breastfeeding, and 26% continued to 6 mo; newly reported was a 14.5% breastfeeding rate at 12 mo.

In Pakistan, according to UNICEF, the percentage of children who are:

exclusively breastfed (< 4 months) 16%
breastfed with complementary food (6-9 months) 31%
still breastfeeding (20-23 months) 56%

According to the World Health Organization, no more than 35% of infants worldwide are exclusively breastfed during the first four months of life.

In other pregnancy news, our baby is due this month. In fact, since more than 36 weeks are gone, she could be born any time now and not be a preemie.

Childbirth Class

Saint Peters University Hospital offers childbirth classes in two formats. Either you can take the class one day a week for a month or spend a whole day one weekend learning about childbirth and specifically Lamaze. We decided that spending 7 hours (9am—4pm) was the better option. So, off we went with 2 pillows (for the breathing practice on the floor).

The class was interesting and we did find out a number of things we didn’t know about labor and delivery. But as they say, knowledge can be a dangerous thing. My idea of taking this class was to find out about childbirth and get Amber to be more comfortable about it since she has been a little scared of the whole process. That, however, backfired since Amber seemed to grow more frightened as she found out about all the pain and the length of labor. Ignorance, in this case, might have turned out to be bliss.

The breathing techniques did not impress me much. I am not sure how effective they are. However, present labor and delivery practice is much better than it was for our parents’ generation when science and medicine was quite misused and misguided. Our instructor, who had been a nurse longer than I have been in this world, did tell us about all the narcotics and other strange practices from 30 years ago when childbirth was considered a surgical procedure. In my opinion, some people are going too far in the other direction nowadays with natural births in bath tubs etc., but at least it is considered a natural process now.

One reason we took this class at our hospital was that we wanted to get a look at the maternity facilities we’ll be using. A tour was included in our schedule. The LDR (labor, delivery, recovery) room looked nice and comfortable (I am sure it won’t be when we get there during labor), but the postpartum room could be better. Only half of their postpartum rooms are private, the others are “semi-private”. I guess that means 2 patients per room. The rooms also seemed too small with a not-so-good chair for me. The hospital is otherwise pretty good in terms of their medical expertise and facilities.

My Surprise Baby Shower

I was really surprised to have one.

Baby shower seems like a big pregnancy thing in the US. When we started our baby registry at Babies R Us, the lady asked Zack if he needed shower invitation cards and hesitently he said No…Yes…may be… So she gave us 50 free cards which are useless for us. Actually some people even asked me why we set up the registry since no one would be buying us anything from there but we had it for our own record.

We have practically no family in the US, so unlike the norm around us we were not expecting any family member to throw us a shower. We did, however, get a lot of gifts from our family back in Pakistan. My mother-in-law and sister-in-law sent us 7 hand-knit sets, my brother sent me two baby dresses and one bedding set. My mom, who had not touched the needles for last 20+ years, knit three baby sweater sets for our baby and also she sent us 12 baby dresses.

I also recently changed my job from one software system to another within the same parent company and almost all of my friends of 5 years and colleagues were either force-adjusted or spread out in various software business units, so I wasn’t expecting any gifts/shower from the folks at work.

Every now and then people will ask me “So did you have baby shower yet?” Or like “it’s good to have registry as most of the small stuff others will buy for you.” And even though I will brag about the gifts our family sent, they will give me a look of pity.

This friday, life was going as usual. These days I have way too much work. Practically I am working more than 10 hours a day. Since my manager is on vacation, I am also acting on his behalf which makes me practically on call for 24 hours and I have conflicting management meetings and technical meetings all the time.

So like I said life was going on as usual. I had a meeting scheduled with one developer to go over some design and architectural details for some feature at 1:30pm and then I was meeting our product managers for some upcoming demo opportunities at 3:00pm. So I went to the developer’s office at 1:30pm and she seemed a bit out of it. I tried to go over the technical details but she did not seem to be following.

Meanwhile, another senior architect walked in and told me that our CEO had some questions for an upcoming demo and he would appreciate it if I could help them out with some technical information. I was a little upset with the unexpected additional work but I said ok let’s go. We walked to our main conference room. The door was closed. When he opened the door, I can’t describe how much overwhelmed I was. The room was fully decorated and there were 50+ people from at least 10 different software business units including most managers and our VP. Yes, the friends who were all scattered in different orgs, the people I worked with on various projects for the last 5 years and friends who were force-adjusted from this company were all gathered to share the excitement of the most wonderful experience of my life. They had arranged a surprise baby shower for me. There was plenty of food and gifts but what mattered the most was the thought.

I could not speak for may be 5 minutes. I was almost in tears and to embarrass me later, they took a lot of pictures.

All I can say is that I was touched and there is no better feeling than the feeling of sharing joy, happiness and special moments with your friends.

Buying Baby Stuff

What better way to start shopping for our baby than to buy new bedroom furniture for ourselves? It makes the expense of the baby’s things trivial by comparison and postpones the day when you can buy stuff for the baby by throwing a wrench in your finances.

Looking at a Babies R Us list of stuff a baby needs, it seems like a million things. And a lot of them will be useful for only a few months before the baby outgrows them.

The biggest ticket item we have bought is a crib. Since all of our furniture has cherry finish, the crib has to be the same. However, we have got quite a few shades of cherry in our apartment now. Among other requirements, the crib had to have an easy, one-hand rail-release mechanism. The crib we finally bought was expensive but we like it.

A so-called Travel system is, in fact, a stroller plus an infant car seat. Most of the models were quite heavy and big, useful only if you have an SUV or a minivan, I guess. We bought the lightest travel system we could find.

When I put the infant car seat in our car, it barely fit. I had to move the front seat all the way forward to get enough space for the rear-facing infant seat in the back seat. That means that the infant seat can’t be behind the driver’s seat since I drive with the driver’s seat pushed all the way back. Also, when Amber will be driving, I’ll have to sit with the baby in the back seat.

I thought it was only our Corolla that was almost too small for an infant. But looking at the leg room data for midsize cars, they don’t seem much better either. And here I was, thinking of buying a car even smaller than the Corolla for myself.

My definite favorite among the stuff we have bought is the baby carrier. We didn’t particularly like the slings, so we bought the Baby Bjorn Active Carrier. I liked the back support in this particular model which was much better than the others. I think I am going to carry my daughter around all the time in this carrier.

Since we are still living in a one-bedroom apartment, this buying spree has resulted in every corner being filled.

POSTSCRIPT: Our Baby Registry

Doctor or Midwife?

We had been seeing a doctor but the question came up some time ago whether we would like to see a midwife, associated with the doctor’s office, instead and have the baby delivered by the midwife. So, we scheduled our next appointment with the midwife. Talking to the midwife and some friends, it seems that people often go for a midwife for the following reasons:

  1. A midwife can give more time to you during your regular appointments.
  2. A midwife will be with you from the time you arrive at the hospital till after delivery.
  3. People who want a natural birth are also one reason.

We discussed these issues with our doctor as well as the midwife and observed that:

  1. Both the doctor and the midwife give you about equal attention as a patient.
  2. Since our doctor practises with a group of Gynecologists and Obstetricians, there is always someone at the hospital delivering babies. We were assured that the doctor will be there the whole time and not just arrive at the last minute.
  3. We don’t really care about natural birth. Any medical technology that helps in pain relief or makes delivery easier would be most welcome.

There was also a sub-issue of the place of delivery. Both our doctor and the midwife deliver at the St Peters University Hospital. But the midwife also delivers at the Somerset Medical Center. The problem with going with a midwife at Somerset Medical Center was that in case a doctor was needed during labor/delivery, the local doctor there would be called instead of our doctor. Therefore, we decided to have our baby at St Peters.

Because of the enumerated list above as well as the fact that we were just more comfortable going with the doctor (especially if something goes wrong), we stuck with our gynecologist.

What’s in a Name III

This is the last post in my series of thinking aloud about our baby’s name.

We were thinking about our daughter’s last name when I found an article about the issue of women taking their husbands’ last names. A debate then started in the blogworld about this issue. For example, see Crescat Sententia.

Matthew Yglesias favors women keeping their own name after marriage.

The basic dilemma is that, for many women, their lives will go better if they just take their husbands name. It’s more convenient in a whole lot of ways. But if everybody (or even just most people) could be pursuaded to keep their own names, then the “convenience” factor would cease to point toward the name switch. Plus, things would be fairer. The question is how do we get from here, where it’s often rational to change your name, to the fairer world where it’s usually rational not to change it?

Diotima rubbed me the wrong way with this comment.

I think it’s incredibly important for a family to have the same name. A family isn’t just a collection of autonomous individuals, but shares a common identity. So, my thinking lately, is that I’ll pull a Hillary when I get married and keep my last name as a middle name: Sara Butler X.

I guess I don’t have a family then, just a collection of individuals. I guess her response is limited to her culture only since different cultures have very varying practices on this matter. For example, here is a Kenyan tribe tradition.

In my father’s tribe, it’s not customary to take the last name of one’s father. Each kid gets his/her own last name. The name is determined by the conditions under which the child is born, i.e. morning, noon, night, raining, etc. The last name also varies in the spelling with regard to gender: girls’ last names begin with A, boys’ with O. With Kenya having been a British colony, some Kenyans use their fathers’ last names in keeping with the European tradition. Some don’t. However, even those who use the European system of naming still have a “middle” name; more accurately, two last names.

Or consider the rigid Japanese laws.

Hiroko Mizushima has been married several times to the same man. But theirs is no soap-opera saga: Dr. Mizushima once divorced her husband to get a passport so the name would match her other documents. She remarried him to have their baby, and then filed for divorce again to continue publishing under the byline with which she’s built her career as a child psychiatrist.

“We’ve been married for nine years and never had any real intentions to get divorced,” Mizushima says. “But I write in international journals and have patients who know my name, so how can I change it?”

The couple is legally married again, but Mizushima insists on going by her original family name, which is technically illegal.

Mizushima is supposed to make laws, not break them. As a freshman politician who was elected to the lower house of parliament this summer, she is leading a drive to change the timeworn laws that require members of a family to have one last name.

As Brian Ulrich points out, the naming conventions arose out of specific cultural/historical factors.

The American way of assigning surnames stemmed from a combination of urbanization in the late middle ages (how to tell John the Baker from John the Miller) and Norman record-keeping with respect to property rights and needing a word to call different descent groups. It was set up on a strictly utilitarian basis.

Other cultures developed different naming patterns. In Arabia, the key question was descent and figuring out who was related to whom and to what degree. [… I]n this system there is no provision for women taking a husband’s name, though Yasser Arafat’s wife is Suha Arafat, probably a sign of Western influence on the elites. Names are about ancestry and origin, not a means of defining a bounded entity for the purpose of property rights.

Does anyone have any suggestions about books which cover the cultural history of naming conventions and the factors which shaped them?

But I digress. This post is not about women taking their husbands’ name after marriage. It’s about what to name our child. On that topic, One-sided Wonder thinks it is important for children to have the same last name as their father.

I’m in favor of keeping your own name, and I don’t think it’s very important for a mother to have the same name as her children. The maternal bond is such that it doesn’t need that sort of reinforcement. (And I say that as someone who has had a different name from her mother most of her life.) But I do think it’s very important for a child to have the same name as her father.

When a woman elects to keep her maiden name, some people have suggested hyphenating the last names of the parents for the children. But that gets out of hand pretty quickly. Crescat Sententia has another suggestion.

I find hyphenation a response that only is good for a generation or so, not to mention that it doesn’t work so well with salty names. I had a friend in high school whose mother’s last name was Saltanovitz and father’s last name was Przybylski. They did the most equitable thing I can think of: each parent used his or her own name, one child became Saltanovitz, and the other became Przybylski. As far as I know, the family doesn’t feel disunified because of embracing both names.

In Pakistan, we do not have any set standards for last names. Some people use their family name (acquired because of tribal, clan or occupational reasons) as their last name. “Khan” is probably the most common one. Another common family name is “Syed” but that is usually used at the start of the name rather than the end. Most people’s names do not contain a family name. This is changing over time. For example, Pakistan’s President-General is named Pervez Musharraf. “Musharraf” is actually his father’s name. But he has started using it as a family name by naming his son “Bilal Musharraf.”

In my case, my last name “Ajmal” is my Dad’s given name. To confuse matters further, it is his middle name.

We also do not have a fixed tradition of a woman taking her husband’s name at marriage. However, British influence does mean that some people do so. The lack of a family name can cause problems with this issue though. Some women thus take as last name their husband’s last name, which might be her father-in-law’s given name. Others tag on their husband’s first name, especially in social situations, but sometimes also legally.

When Amber and I got married, in a fit of romance and sentimentality, we decided that Amber should take my name as her last name. Since I didn’t really have a surname, she switched from “Ambrin Asum” to “Ambrin Zakaria.”

This didn’t present us with any problems in Pakistan. But it did require us to listen to a long lecture by the immigration officer at JFK when we first came to the US. He said something about how familial relationships can be found without sharing a last name. I just hope his last name wasn’t Smith, of which there are about 3 million in the US.

Other problems we have encountered include all the “Good Samaritans” who helpfully “correct” our names whenever they see them together so that Amber and I share the same last name. Thus, I become Ajmal Zakaria, which causes further problems and we have to get my name fixed.

There was also a health insurance company who did not have a last name field for dependents of the subscriber. Since Amber was the primary subscriber, I became Zakaria Zakaria in their database.

Therefore, in addition to a first name, we need to choose a last name for our kid. Our first thought was to change our last names so that all three of us share the same last name. But that would result in a lot of hassle for Amber and me. So, we are going to stick to our names and just choose a last name for the baby. There are three options:

  1. Ajmal: My last name and my Dad’s given name.
  2. Zakaria: My first name and Amber’s last name.
  3. Some other name.

Option 3 would confuse the heck out of people, so that’s out.

Deciding between options 1 and 2 depends on utilitarian issues like convenience as well as how well her first name goes with the chosen last name.

Any suggestions?