The Fantastic Voyage of Tanner Roberts

At 10:04 a.m. on Jan. 30, Tanner Max Roberts ended a remarkable journey.

On that sunny Thursday in a suite at St. Joseph Medical Center in Burbank, Tanner was born. As births go, this one was uneventful. But being born--the original voyage from darkness into light--is by its very nature a most extraordinary experience. It has been variously described as euphoric, traumatic, even catastrophic for the baby.

Many of the mysteries surrounding the process, including questions as basic as how labor begins, remain unsolved. Yet over the last decade, ultrasound and other diagnostic devices have opened a window into the womb. Today, it is scientifically possible to, at the very least, imagine what it is like to be born. Here, according to medical texts, published research and expert interviews, is the story of how it might have been for one baby.

Day 266

On the afternoon of the 266th day of Cindy Roberts’ pregnancy, the onetime champion freestyle swimmer lowers her swollen body into a warm bath. Submerged, she feels almost weightless.

All morning, she had been out walking around shopping malls, hoping to hurry the start of labor. She is tired of being pregnant, tired of being big. This pregnancy, she sighs, has gone on long enough.

Inside her belly, another beautiful swimmer floats in his own watery world. On other afternoons, he would stretch and tumble in his amniotic bubble. Now, there is no room for acrobatics.

Even with arms and knees pulled in tight in classic fetal position, his body fills the entire uterine envelope. The womb has stretched to almost 60 times its normal size, but its occupant’s world is shrinking. . . .

Why labor begins when it does is a mystery. The pressure of the fetus on the pelvic floor might have something to do with it. The fetus might trigger it by excreting certain chemicals that signal a level of anxiety about the increasingly cramped surroundings.

The placenta, once spongy with nourishing blood vessels, is growing tough and fibrous in anticipation of its impending functional failure. Just as the fetus’s days in utero are numbered, the placenta too has a finite life span.

At nearly nine pounds--three pounds more than he weighed just a month ago--Tanner is physiologically ready to be born. Cartilage nicely shapes his ears, hair decorates his head and the soles of his feet are sufficiently creased to give him an identifiable footprint.

His head is big and heavy--25% of his body weight. So it is gravity, as much as biological destiny, that pulls him head down into the pelvic basin.

The Pain Begins

That night in the frozen-food aisle at Lucky, Cindy Roberts stops short. A sharp pain, starting in the small of her back and reaching around her middle like fingers of flame, causes her to gasp.

She grabs her contracted belly; from rib cage to pelvis, she is as hard as a basketball.

For weeks, painless Braxton Hicks spasms (named for the gynecologist who discovered them) have been flexing her uterine muscles. But these practice contractions, which stretch the uterus and pump it up for the rigors of labor, have prepared neither Tanner nor his mother for the ordeal to come.

After 20 minutes in the checkout line and only one more serious contraction, Cindy loads a week’s worth of groceries into the trunk of her gray Suzuki and heads home, smiling. It hurts but at last something is happening.

Prostaglandins, the hormones that have kept Cindy Roberts’ cervix intact and the uterine contents secure, have stopped circulating. Suddenly released from these chemical inhibitors, the uterine muscles begin the natural process of expelling the foreign body the uterus has hosted for the last 9 months and 7 days.

The walls of the uterus begin to randomly contract--and with them, the very walls of Tanner’s home. Even without a fully developed nervous system, the fetus at term is capable of experiencing pressure, confinement, restraint. And that might well be what Tanner is feeling.

After six hours of mild and irregular spasms, the uterus settles into a predictable rhythm, contracting every 10 to 15 minutes, each contraction lasting 10 to 15 seconds.

By now, Tanner “knows”--if only by the flood of anxiety-producing proteins in his system--that something is happening.

3 O’Clock Wake-Up Call

At 3 a.m., Cindy and Tom Roberts are wide awake. With son Kevin, 3, asleep in another room, they time Cindy’s contractions with a stopwatch: Six to eight minutes apart. Tom rubs Cindy’s back during each spasm. The contractions are growing more frequent and more intense. Time to call the hospital.

Cindy goes to the kitchen and downs two glasses of Gatorade and two Carnation Instant Breakfast bars for energy. When the time between contractions has narrowed to five minutes, Tom calls a friend to stay with Kevin .

Until now, the pre-dawn hours have been Tanner’s favorite time for “dreaming.” Being suspended in body-temperature amniotic fluid is not unlike being adrift in a sensory deprivation tank.

Before the onset of labor, the fetus also takes advantage of these quiet hours to “breathe.” Even though his lungs are still collapsed and full of fluid, Tanner heaves his tiny chest and abdomen up and down, simulating the inhaling and exhaling that will sustain him outside the womb.

Each breathing episode is marked by a flurry of rapid eye movements of the sort measured in in REM sleep--the stage when most dreaming is known to occur. (By seven months, a fetus is neurologically equipped to dream.)

But now, with the first real breath just hours ahead, breathing practice is over and dreams are put away. Tanner’s activity is reduced to internal functions and basic reflexive responses.

Even Cindy’s ingestion of glucose-heavy Gatorade--a predictable fetal stimulant--provoked only slight reaction. And the ride to the hospital does not seem to startle this small passenger.

The Pain Begins II

“How soon can I get an epidural?” Cindy Roberts wants to know.

It is 5 a.m. and her cervix is dilated 2 centimeters. It must open to 10 centimeters (about 4 inches) for the baby’s head to push through. Each contraction thins and widens the cervical ring, but only slightly and awfully slowly. Or so it seems to Cindy.

In the meantime, she wants an anesthetic.

Tanner is stressed. Every time the uterus contracts, it flattens the placenta, which does his breathing for him. It also compresses the umbilical cord, which delivers the oxygen and removes carbon dioxide.

At the height of each contraction, Tanner is cut off. He can’t get oxygen and he can’t get rid of the toxic gases. With every spasm, he grows hypoxic (oxygen deprived): a life-threatening condition in an older child or in an adult, but the fetus is equipped to respond. Peppering the outside of his aorta are reddish-brown nodules--factories for making the hormones that will sustain him through labor and disappear during childhood.

In a distinctly fetal version of the “fight or flight” response, the stress hormone noradrenaline surges through Tanner’s system. Instead of rushing blood to the skeletal muscles for “flight” (unnecessary for a fetus with nowhere to go), this specialized protein directs fresh blood to the heart and brain--the two organs most vulnerable to permanent damage from lack of oxygen.

In the Labor Room

When Cindy arrived at St. Joseph Medical Center, her contractions were 4 to 5 minutes apart. Now they have slowed to every 7 minutes. “I hate this,” she says. “I hate this.”

“When babies see the hospital door, they say ‘Forget it!’ ” jokes nurse Rita Yates, who has seen this happen before.

Cindy is not laughing.

In Labor-Delivery Suite 2, a hotel-like room with furniture that converts from Danish modern to OR traditional, Yates pulls a webbed belt and fetal monitor around Cindy’s middle to measure the labor.

She rubs petroleum jelly over the mother’s taut abdomen to form a seal around the monitor microphone to enhance transmission. As the monitor begins to pick up the fetal heartbeat, a pen on a nearby console inscribes the rate on a long strip of graph paper.

Above the jagged line that is Tanner’s changing heart rate, a second pen charts the variations in uterine muscle tone, drawing a picture of each contraction.

The nurse turns up the volume as the monitor picks up the sound of Tanner’s heartbeat. From inside the mother’s body, it ker - thumps and whooshes, ker - thumps and whooshes.

“There’s that washing machine,” says Tom Roberts. “Doesn’t he sound great? It’s supposed to be a boy. That’s what they said.”

Tanner’s world is not a silent one. The most familiar sounds are a muffled version of his mother’s voice and the sounds inside her body--the gurgling, rumbling and slurping noises of her internal organs and vessels as they pump, vibrate, murmur and digest.

Because fluid is a great conductor of sound, Tanner’s fully developed hearing registers noise from outside his mother as well. Tanner is especially attuned to--and easily stimulated by--his father’s distinctive baritone and the sweet, little-boy voice of brother Kevin.

Now, a new sound booms through his world: The echo of his own heartbeat. As broadcast by the sensitive fetal monitor, it is an imposing sound.

With each contraction of the uterine walls, Tanner’s heartbeat jumps from its resting rate of about 140 beats per minute to its “stressed” rate of 160 to 170.

When the cervix is dilated to more than 4 centimeters, or almost half open, Tanner’s mother is given her first medication. As Demerol begins to drip into her vein, Cindy relaxes.

Tanner, heart rate dipping to 130, then 120, begins to fall asleep.

‘Breathe, Cindy!’

“Breathe through it, Cindy. Breathe! The baby needs you to BREATHE. . . .”

Contractions are coming every 3 to 4 minutes, each one lasting 25 seconds. The Demerol does not stop the pain, Cindy growls. She hugs her husband’s old blue bathrobe tight against her chest as nurse Cindy Cox urges her to “relax those muscles. Breathe deep. Relax. You’re almost done, almost done. . . . Done.

“Pretty soon,” Cox announces, “you’ll have him in your arms.”

“He’d better be,” snaps the exhausted Cindy.

Tanner’s nap is over. With each contraction, his heart rate soars to 160, 170, 180 beats per minute.

Blood cells rich in oxygen-loving hemoglobin supply the oxygen-heavy blood Tanner needs to cope. Without these specialized cells, interruptions in the fetal oxygen supply would be damaging indeed.

While each contraction cuts off Tanner’s only source of oxygen, the minutes of rest between each contraction resupply the deprived placenta and umbilical cord. The mother’s deep breathing during contractions helps rush the fresh blood to the fetal heart and brain.

During a lull between two particularly intense contractions, a new sound is heard: metal instruments being lined up on a sterile-clothed bedside table.

Clank, clank. Tanner’s heart rate leaps for a moment and then returns to its normal pace.

The Doctor Arrives

At 8 a.m., the Verdugo Mountains behind the hospital are still pink from the sunrise. Cindy Roberts’ obstetrician, Dr. Wayne Furr, arrives and determines her cervix is almost completely dilated. But the “bag of waters” still has not ruptured.

Using a tool made for the purpose, the doctor reaches into the birth canal and tears the diaphanous membranes of the amniotic sac. About half a liter of clear fluid spills out.

Before he leaves the room, the doctor tells Cindy her labor is progressing well and she can have that epidural anesthetic now. Between contractions, Cindy sighs , “Thank you.”

Tanner is startled by the rush of the escaping fluid. And, with the next contraction, he is startled again by the impact of the loss. No longer are the contractions diffused across a watery bed. Now Tanner’s head, knees and shoulders are pressed hard against the muscular uterine wall.

Because the spinal anesthetic acts only on the mother’s spinal nerves, the 8 cubic centimeters of Marcain have no direct effect on the fetus. But for the next 30 minutes, the drug eases the frequency and intensity of contractions. It also reduces the mother’s blood pressure and slows her breathing.

After 30 minutes, contractions resume with as much or greater force. They are coming every 2 minutes now. Each one lasts a full minute. Between spasms, the mother sleeps. But not Tanner.

For him, this is the start of the most stressful part of his journey.

Head First

By 9 a.m., Cindy’s cervix is fully dilated and her labor suite has been transformed into a delivery room. The upholstered rocker and blond wood furniture have been covered with sterile blue drapes. A chest in the corner has become a high-tech warming table. And doctor, nurse and father are gloved, capped and gowned for the imminent birth.

As Tanner is pushed farther and farther down the birth canal, his body stretches out, like toothpaste being squeezed from the tube. Each expulsive push by the uterus impels his head against the pelvic girdle.

His feet kick out behind him, jabbing his mother’s rib cage. The pressure on his skull is enormous from all sides as it makes its way through the narrow passage. (The skull of an adult could not easily withstand such pressure.)

But the flexible fetal skull is designed for this very event. Instead of a single fused bone, Tanner’s head consists of four bony plates. As his skull is compressed, the plates slide over one another to allow the head to pass through.

The stress of contractions is formidable indeed. Skull compression, coupled with Tanner’s increasing lack of oxygen, causes stress hormones to explode through his system. In an adult, this level of stress would mean that a stroke or a heart attack is occurring. But once more the fetal constitution is prepared.

As in earlier episodes of stress, blood rushes to the heart and head. But this time the stress is so strong, it causes more of Tanner’s system to shut down. Like sea mammals during lengthy underwater stays, Tanner’s body instinctively reacts to save itself. The heartbeat slows to a frightening 100, 90, 80 beats per minute and then leaps again to 180.

His body is compressed by his mother’s contractions and her pushes. And as he nears his entrance to the world, the compressions help press the fluid from his lungs in preparation for the first breath.

Tanner’s body, now wedged between his mother’s sacral bone in back and pubic bone in front, suddenly turns slightly to fit through.

The Final Countdown

“1-2-3-4-5-6-7-8-9-10! 1-2-3-4-5-6-7-8-9-10! 1-2-3-4-5-6-7-8-9-10-11-12!”

Tom Roberts, who as Thomas Kane makes his living as the voice for such companies as Lincoln Mercury and Exxon, booms out the numbers as Cindy bears down, down, down to push out the baby.

“Here we go. Go, go, go, go, go, go, go!” cheers nurse Yates.

“Oh!” pants Cindy as the top of the baby’s head emerges.

Tanner is squeezed tight in the birth canal as his head “crowns.” The doctor gently touches the top of his wet, curly-haired head. Over the next few seconds, Tanner’s head, face down, emerges. As his chin clears the mother’s body, his head spontaneously turns left.

His face is puffy and scrunched. Although squinting fiercely against the sudden light, Tanner’s dark blue eyes are open. His lips are fluttering and he is making tiny bubbles with the clear mucus around his mouth.

Before any more of the body emerges, the doctor cradles Tanner’s head and suctions his nose and mouth. Tanner takes his first breath--actually a large gasp, followed by whimpering, and then a lusty cry.

The tiny air sacs in his lungs suddenly inflate and he is ready for the next gasp. After a few minutes, the big gasps will settle into routine inhalations and exhalations.

Tanner’s left shoulder is delivered, immediately (although gently) followed by the right shoulder. The rest of Tanner slides out easily.

His trunk and head are luminescent pink; his limbs are still gray-blue from lack of oxygen. His fingers and toes are gray. Tanner’s body is wet, but only slightly bloody as the doctor lifts him onto his mother’s abdomen.

It’s a Boy

“Hello, baby. Hello, baby , “ whispers Cindy to the dazed but alert infant balanced on her belly.

“He’s beautiful, just beautiful,” reports nurse Yates.

“Very healthy. A real solid guy,” adds the doctor.

“Isn’t he just great!” announces the father.

The umbilical cord, still connecting baby and mother, slows and then stops pulsing. The obstetrician clamps the cord at both ends and hands the father a pair of surgical shears. Tom severs Tanner’s final connection to that interior world.

Now Tanner’s blood flows not to his mother for nourishment, but to his own lungs, intestines and other organs. The fetal path of blood through the heart is abandoned and blood is rerouted to Tanner’s newly inflated lungs.

The baby is laid on a table next to the mother’s bed to be dried and warmed. He cries loudly as eyedrops are put in. Meanwhile, the placenta is delivered from the mother.

Tanner can see very little, mostly shadows, mostly black and white. He seems to be able to focus slightly on objects about 8 inches from his face--the distance to his mother’s face as she cradles him in her arms.

Wrapped in a white flannel blanket, Tanner, drawn by his mother’s voice, seems to gaze into her eyes. Unquestionably, he knows her.

The room is quiet now, but everything about his new environment is intense to Tanner. The baby is overwhelmed from the avalanche of stimuli--first sounds, first sights, first touches. His mother lightly strokes his cheek. “Everything’s going to be fine,” she tells him. “Just fine.”

Today, Tanner is 4 1/2 weeks old and weighs 11 pounds. His eyes are still blue, but his hair is growing blond like his mother’s.

His pediatrician, Dr. Gary Smithson of Glendale, reports that despite a brief bout of non-threatening jaundice, Tanner has been healthy since the day he was born. “He did have some of the longest fingernails I’ve seen on a baby,” says Smithson, who gave Tanner his first manicure two hours after birth.

He sleeps up to three hours at a time and is a good eater. He still responds vigorously to the sound of his father’s and his big brother’s voices. On his third day home from the hospital, his mother awakened from a nap to find Tanner’s chubby hands clutching her cheeks.

“Our eyes met for an instant,” says Cindy, “and it was like he was looking right into my heart. . . .”

The Final Countdown

During the last 11 hours in his mother’s womb, Tanner Roberts found himself in tight quarters, subjected to strange forces that would eventually push him from his home of nine months.

Stage I: 11 hours before birth

* Tanner weighs 8 pounds, 12 ounces. His head--25% of his body weight--pulls him down into the birth canal.

* His body has stretched the uterus to almost 60 times its normal size. His space is very cramped.

* Mouth opens and shuts as he swallows amniotic fluid; he practices breathing movements.

* Hormones keeping the cervix intact have stopped circulating, and early contractions begin.

Stage II: 5 hours before birth

* Labor is under way now. When contractions are 5 minutes apart, mother and father check in to the hospital.

* Mother is hooked up to a fetal heart monitor. During a contraction, Tanner reacts to the stress; his heart rate jumps from 140 to 160 or 170 beats per minute.

* Each contraction compresses the placenta and pinches the umbilical cord, depriving Tanner of nutrition and oxygen.

* When the cervix is dilated 4 cm, mother gets an IV drop of the narcotic Demerol, relaxing her and making Tanner a little sleepy--his heart rate drops to 120 or 130 bpm.

Stage III: 2 hours before birth

* The obstetrician arrives. He breaks the amniotic sac, releasing fluid. Tanner loses his in utero cushion. Now his head and body are being squeezed by the muscular uterus as he descends face down through the birth canal.

* Mother receives an epidural anesthetic, slowing labor for the next half hour: it reduces her blood pressure and breathing rate and has no direct effect on Tanner.

* Contractions resume with full force, every minute or two, lasting a full minute.

* Fetal stress hormones sustain the oxygen-deprived Tanner during contractions, concentrating the blood flow to the heart and brain and away from the limbs and non-vital organs.

* The cervix is now fully dilated. Tanner’s heartbeat soars to 180 bpm with each contraction.

* With each contraction, fluid is forced out and air is brought into the lungs in preparation for Tanner’s first breath. The body turns slightly to avoid the mother’s sacral bone.

Stage IV: 30 minutes before birth

* Tanner’s head “crowns”--only the top can be seen.

* After countless pushes the full head emerges face down. Tanner spontaneously turns his head left.

* Before the body emerges, the doctor suctions the nose and mouth to remove mucus and facilitate the first gasp.

* With the baby’s first breath, the lungs inflate. He no longer needs the placenta to exchange oxygen and carbon monoxide.

* Tanner’s left shoulder is delivered, immediately followed by the right shoulder. The rest of the body slides out easily.

Stage V: after birth

* Tanner’s circulation system begins to route blood to and from the lungs for oxygenation.

* The umbilical cord, which still connects baby to mother, is clamped at both ends. The obstetrician hands the father a pair of scissors to cut the cord.

* The baby is placed on a warming table. He cries loudly as eye-drops are put in. At this point he can see very little.

* His hearing is near normal. Placenta is delivered from mother about 10 minutes after birth.