Monday, December 15, 2008

Helene's birth story, Part II

[To read Part I of Helene's birth story, click here.]

There were a couple of bumps in the road, however. Unusually, there was another woman in labor at the same time. This rarely happens. It's not a problem because there are two birthing rooms, but the "family room" where relatives and friends can wait was kind of crowded. There was also a hot water issue. As in, it wasn't hot. It was barely lukewarm. Oh my hell, I had to get in that damn tub. Suzanne and the midwives marshaled the staff, and got them to start filling buckets from another sink where the water was hotter. Suzanne asked if I minded if one of the staff members came in and out with buckets of water. I didn't care who came in and out, especially if they had HOT WATER. They'd all seen birth before. Inhibitions at this point? None. While the tub filled, I got on the sofa on my knees, and bent over the sofa arm. Seth stayed right by me, and did an awesome job helping me to keep breathing deeply through each increasingly strong contraction. Seth made sure that I set up the camera for him, and wanted to be sure the flash was on if it was dark out when the baby arrived. Suzanne said, ”Oh no. You’ll probably see your baby long before it’s dark.” So hard to believe! It was hard to look beyond the immediacy of all this physical effort and remember that there would be a baby, a little tiny wiggling breathing baby. Finally, the tub was full. I could not peel off my clothes fast enough. I dropped them on the floor, and staggered to the tub.

I couldn't get comfortable at first. It didn't feel great to be on my back, so I tried flipping over to hands and knees. I didn't think I could sustain that, so I went back to lying down, and trying to move my hips back and forth.

I also had to have IV antibiotics, as I had tested Group B Strep positive a few weeks before. One of the midwives, Ebony, came in to do my heplock and IV. For whatever reason, she had a hard time finding a vein. After stabbing me a couple of times with no success, Ebony fired herself and got Lisa Uncles, another midwife to try. Seth said later that he would have been pretty upset at all the needle sticks I got to get that heplock in, but in the throes of labor? It really didn't matter. The IV was finally in, and the antibiotics started.

The water was pretty warm, but not that hot. More staff members had been recruited by now, and they were rounding up whatever receptacles they could find to ferry hot water to the tub. Pots, pans, buckets, recycling bins - they were all in use. There was a regular parade in and out of the bathroom as women came in to refresh the hot water. Someone thought of the brilliant idea of heating water on the stove in the family room, so staff members were soon carrying steaming pots of water in with potholders and pouring it in the tub, like I was a giant pot of soup, simmering away. Contractions were more intense, closer together, and despite the hot water, I would shiver and shake from time to time. I suppose this was "transition," but I was never conscious of it being different; it was just more intense. I felt sort of burpy at times, but thankfully I never felt nauseous. Seth or Suzanne would hold my water bottle to my lips periodically to get me to drink. Midwife Lisa Ross stayed vigilant, sitting on the closed toilet lid.

We’d been hearing occasional noises from the woman laboring in the other birthing room. At some point in here there were three midwives in the bathroom with me, as well as Seth and Suzanne. Suddenly, we heard what sounded like a blood-curdling, long drawn out scream. Seth said, “Was that screaming?” Midwives Ebony and Lisa Uncles glared hard at him and said, “Oh no. That had to be the wind. It’s very windy outside. Definitely the wind.” Seth started to say something like “I don’t think so” but was silenced by the looks from the midwives. [Ebony and Lisa, thanks. I knew that it was the woman in labor in the next room screaming, but I appreciated your efforts.] I wasn’t going to scream – I’m just not a screamer. It also seemed like a dramatic waste of energy.

I started feeling intense pressure with each contraction that felt like it was in my rectal region. The contractions were so intense now; it was all I could do to keep breathing and gasping and rocking my hips through each one. I kept gasping “The pressure!” and sometimes “It hurts!” Seth was right there, holding my hand, and telling me I was doing great, and offering me sips of water. Lisa asked if I was into a water birth. I said it sounded good to me. It was hard to imagine getting out of the tub at this point. Suzanne and Lisa asked if I felt like I wanted to push. “I’m not sure. I just feel so much pressure.” They advised me to try with the next set of contractions. I think they could see me hesitating or holding back, so they broached the whole poop subject. Yes, I did want to know what they did when, um, other things came out during pushing. Well, they have a little fine mesh net on a long wire handle; the kind you would use to scoop goldfish out of an aquarium. And the offending matter, like dead goldfish get scooped out and then flushed. Brilliant. That question was answered; I was at ease. I could try to push.

With each contraction that came now, I tried to push. I was blowing too much breath out, breath that could be focused downward to push the baby out, so Suzanne helped me to breathe and focus the energy of my pushing with each contraction. My water finally broke with a pop and a gush after a couple of pushes. It was relief, but not as much as I had hoped. I don’t know how long I pushed. I know that after several contractions, I started wondering when I would feel the head moving down, feel the burning of my flesh stretching, feel the baby turning to emerge. I felt like I was pushing well, but felt impatient that not enough was happening. “Tell me I can do this,” I said to Seth and Suzanne. Sometime in here, Seth said I looked like I did at Mile 20+ of the New York Marathon – he knew I was strong and I was going to finish. Midwife Lisa said that she wanted to do an internal exam to be sure I was fully dilated and that there was no lip of cervix in the way that would interfere with pushing. I’d been hesitant to have unnecessary internal exams, but decided this was probably the time to be sure. Lisa came to the tub to check me. First, she listened for the baby’s heart rate with a Doppler. She found the heartbeat higher in my belly than she’d expected; the baby should be further down. But the heartbeat was regular and strong. After some long, uncomfortable seconds, Lisa announced that I seemed to be the full ten centimeters dilated, and that there was no cervical lip. But… but… “I’m not feeling the back of the baby’s head. I’m not sure what I’m feeling and I want a second opinion.” I thought that maybe the baby was flipped over “sunny side up” or that she was brow or face first, and thought, that’s OK, I’m sure I can still push her out. I can get out of the tub, I can squat to open my hips, I can do it.

Midwife Lisa Uncles came in, and asked me to get out of the tub and onto the bed so it would be easier for her to do the internal exam. Everyone helped me up out of the tub and got me over to the bed. It was excruciating to lie down on the bed, after being able to float a little in the warm water. Lisa U. asked me not to push while she did the exam; I had to puff and blow out my breath. Not pushing was incredibly difficult; I was fighting against the powerful ripple of the contractions, against everything that my body wanted to do. It was agony while Lisa U. poked and probed. Seth was next to me on the bed. The other midwives were gathered in the room. Lisa U.’s brow furrowed. After what seemed like long minutes, she announced, “That’s a butt. This baby is breech.” There was a shocked silence in the room; I saw the shock and disbelief on the face of all the midwives and Suzanne. “What?” I gasped. “How is that possible? She was head down for weeks.” I waited for someone to tell me differently, to tell me it was OK, to tell me it wasn’t really true. Seth’s head collapsed onto my shoulder. In a soft voice, Lisa U. said “We can’t deliver breech babies here.” I started to sob, because I knew that already. I knew what a breech baby meant. There was one option, and only one: a transfer to the hospital for a Cesarean section. It was one of my worst fears, my worst labor nightmares. It was everything that I had chosen midwives and a birth center to avoid. The midwives hustled into action, and hurried out of the room. “We need a plan,” said Lisa Ross.

I wanted to collapse and give up. I wanted it to be over. I wanted the contractions to stop. Someone told me not to push. It was horrible, fighting against the downward tide of those strong contractions. Since I knew what was inevitable, I wanted the epidural or the anaesthesia, now, now, now, so I wouldn’t feel anything, so they could just get the baby out.

Suddenly the midwives were back. Lisa U. was giving me a shot “to stop the contractions.” “Terbutaline?” I whispered. She nodded. I felt it work almost immediately, the contractions slowing, slackening. It was a relief. Ebony was at my side, talking to me calmly. “We’ve called an ambulance to take you to the hospital. It should be here in fifteen minutes.” Midwife Lisa Ross would ride in the ambulance with me – only one person was allowed, and she wanted to be there in case the baby did come out during the ambulance ride. Seth and Suzanne would drive separately. Someone gave me my shirt; I didn’t know how I would possibly put on pants. Suddenly, the ambulance was there. There was a whirl of people around me, paramedics with a stretcher, Ebony wrapping my naked lower half in a sheet and a blanket, snapping at the paramedics that it was freezing outside. Lisa Ross was in coat and winter hat, at my side, my file tucked under her arm. They rolled me down the hall, through the big double doors that I remembered hearing about during my introductory session at the birth center. “If we need to transfer you, the ambulance backs up to those double doors, and we can get you in and to the hospital quickly.” I remember thinking I was glad they were there, but I was sure it was only a very remote possibility that I would use that particular feature of the birth center. Then I was in the shining, bright stainless steel interior of the ambulance, Lisa at my side, calm, her hand gently touching my leg. I don’t remember if they put the siren on. I just remember wanting to cry, having to fight the contractions, wanting to be numb, flashes of cold blue November sky and DC rowhouses at the ambulance window, the heat in the ambulance on too high, stifling. I went through all that for nothing, I thought as I quietly sobbed and huffed through another agonizing contraction.

Finally, finally, we were at Washington Hospital Center, and they rolled me through a maze of halls and doors and desks. We paused at one desk, and there were papers and a conversation, and a doctor appeared. “Good, it’s Dr. X. We like her,” whispered Lisa. For a second, I thought maybe, maybe they’d still let me try to push the baby out. But I knew better; no one delivers breech babies. And they rolled me into the bright cold white and steel of a large operating room. There seemed to be at least five people working on me. They got me onto a hard, narrow table. I had to sit, which was agonizing. Lisa got into scrubs, and stood right next to me, her hand on my leg or arm, calm and comforting, telling me quietly what would happen. They put IVs into both arms, I chugged a shot of strong antacid to counteract side effects of the anesthesia. I kept telling them when a contraction was coming, because I thought they needed to know, because they couldn’t expect me to keep still, couldn’t expect to stick needles in me while it was going on. I just wanted the epidural, whatever, as soon as possible, to stop the labor pain, to get this over with, to get the baby out, because she was ready to be born. Someone asked when I last had food or drink. There was some ridiculous discussion about how they didn’t have labels, so they couldn’t give me anesthesia yet. I writhed on the table, feeling amniotic fluid running everywhere, wondering if it would spoil the sterile environment. They wanted to draw blood for type and cross, and Lisa said impatiently that she had my blood type in the file. After more idiotic, ceaseless discussion of labels, someone could finally numb me up. A pinch in my back, and I felt the anesthesia working. I thought it was an epidural, but found out later it was a spinal block. Lisa told me that they would put up a drape, and that Seth was outside getting suited up in scrubs. They would only let him in right when the procedure began, because too many husbands had passed out just from seeing the prep. Lisa looked at me and commented that, hey, I didn’t get any stretch marks on my belly, just a few on my sides. She smiled. “At least that’s one good thing.”

They laid me on my back, and I could feel myself getting tingly and numb from the chest down. They gave me all kinds of consent forms to sign. It’s quite hard to write when you’re flat on your back and doped up with anesthesia. I’d like to see them prove in court that those signatures were legible or mine. Then I had to hold my arms out straight to my sides, palms up. The drape was put over me, right at my breastbone. A voice asked me whether I could feel various pokes and tickles. I could not. I was told I would feel pressure and tugging. Suddenly, Seth was there, by my head. I was impressed that he had remembered to bring the camera. They had already started. I didn’t even know. Pressure, tugging, athletic wrestling, it seemed so rough. Suddenly, I guess she was out, and Seth raised the camera, clicked the shutter. “The flash,” I whispered, because there had to be photos, because I could not see. Lisa heard me. “She wants you to turn on the flash.” Seth did. “Can I take a picture?” he asked the doctors. “Sure.” He took a couple of shots. I saw them days later – our little baby, bloody and wet, twine of umbilical cord still attached. I can’t even see my own body in the photos. I’m glad we have them, so I know what she looked like, because I missed it. Someone said, “5:26 pm.” Then, I could hear the insistent cries of a baby, somewhere across the room. They went on and on, so loud. I knew it was our baby, but it was so disembodied and far away. I didn’t feel anything. My body was numb. Everything was numb. Seth said, “Where’s my baby?” and left my head to go over to see her. She kept crying and crying. I wanted to see her so badly, wanted to touch her, wanted to hold her and stop her cries. But I was immobile on an operating table, hands pinned by IVs and the drape, still peeled wide open, doctors and nurses still working on me, examining my uterus, looking at the fibroids in there.

I was glad Seth was with the baby. He said that he gave her his finger and she grabbed it tight, and seemed to relax when he talked to her. I think someone announced her length and weight. I could hear the shutter click as Seth took photos. I saw later how her legs were folded straight up to her ears from being stuck in the frank breech position, a little yogini. Seth told me the nurses had a hard time swaddling her, because her legs kept popping back up to her ears. Then, Seth brought her to me, wrapped in a blanket. She seemed impossibly clean and tiny. I could only look at her, upside down. Lisa Ross took a couple of photos. In them, I am smiling. I know I didn’t get to see her long enough, right then.

The doctors were still working on me. Remembering something from our Bradley class, Seth asked whether they were using a double-layer stitch to sew me up. “What, are you a doctor?” someone scoffed. Seth told me later that he was thinking, no, asshole, this is just my wife’s body. Some minutes later, one of the doctors looked at me and said ”You can have a VBAC.” I knew that was good, but it was hard to process. I think they took the baby away at this point, and Seth went with her. Seth told me later that he counted her fingers and toes. They finished me up and moved me to a tiny recovery room somewhere. Lisa and Suzanne were there, and somehow, so were all of our bags and belongings from the birth center.

Then, finally, finally, they brought her to me. Helene. I could hold her, nurse her for the first time. She latched on with total determination, right from the beginning. She had fringes of hair, soft and golden, or was it a little red, like her namesake, Seth’s grandmother Helen? She was only six pounds, six ounces, petite and perfect. How could her fingernails be so tiny? Her head was round, skin smooth, unmarred, because there was no trip through the birth canal. They let me hold her and nurse her for an hour, Seth told me, before they took her to the nursery again for more tests. It felt like a mere few minutes, not long enough.

It’s hard to know where to end this, because there was no satisfying conclusion to Helene’s birth. I didn’t get to triumphantly push her out. Seth didn’t get to catch her. She wasn’t placed immediately on my chest, for me to hold her while she was still connected to me by the umbilical cord. I don’t know whether she had any vernix on her skin. We didn’t get to see or feel the umbilical cord pulse. Seth didn’t get to cut it. I only know what she looked like right after birth from the few photos that Seth thankfully took. Seth said later that he felt like he went from an active, important participant in his baby’s birth to a guest star, costumed and hustled onto the stage at the last minute just for the big reveal.

I am comforted by the fact that she was ready to be born. It was time for her to come into the world. She decided that. I am proud that I went all the way through labor – I did everything but push her out. I could have pushed her out, had she just been turned the right way. We would have had our baby in our arms earlier that afternoon, would have gone home with her that night. She didn’t have any drugs throughout labor, her heart rate was strong and steady the entire time, there are benefits to the baby going through labor, she didn’t have any of the possible negative effects of a Cesarean. I know all of that, but I am still haunted. Because I don’t know exactly when she turned from her head-down position (sometime between our 38-week exam and 39 weeks, 5 days), or why she turned. Shouldn’t I have felt it? Shouldn’t someone have known? Could I have done something? I know that the rational answer to all of those questions is “no,” and that this was an unusual, practically freak occurrence. I am now a statistic. But none of that stops my irrational, emotional heart from wanting a different outcome, a do-over of Helene’s birth.

The days in the hospital are a blur of pain, discomfort, tears, anxiety, fitful sleep, streams of doctors, nurses, interruptions. The debilitating pain that I felt the day after the birth was so far beyond anything I experienced in labor. I couldn’t even sit up in bed unassisted to nurse my new baby. I can’t understand anyone choosing this invasive procedure without a clear medical reason. The best, shining thing in those awful days was Helene. Our reason for existing in those days was to keep her alive, warm, changed, fed, comforted, loved. She hardly spent time in the hospital bassinet, because I couldn’t stand for her to be away from me. I would fall into a deeper sleep feeling her tiny breaths against me. She comforted me with her compact warmth and the very fact of her existence as she slept in on my body, just inches of flesh and blood away from where her life had begun.


emily said...

Oh, bert. I'm sorry you didn't get the birth you had planned for and visualized so clearly. C-sections are scary, and an unexpected c-section after laboring in a comfy birth center is traumatic on a good day. You were clearly a superstar throughout all this, and Seth was a superstarlet. I finished reading the story thinking "gooooo, team!" because you had a great team there with you throughout. Now go enjoy that little baby some more and post lots of photos so we can all swoon.

Lorie said...

Wow, Roberta, you made me feel like I was there too while reading your story, and it brought me back to our own traumatic birthing experience (two months preemie, flat tire on the way, incubator for 3 weeks, baby had a collapsed lung, etc. etc.) I too craved doing it over to get it "right," (but never did). Looking back, now I feel that it actually was perfect because it was our own unique birth experience, our story, and it brought us a beautiful 'miracle baby' (aren't they all?).