Part 6

Oh no! Is she still talking about this?


One last thing about the birth story, and then I'm done with it, honest.

Last night was the reunion of our Bradley class. Our teacher always has her previous students come in to share their birth stories with her current students. I thought it was great to hear birth stories when I was a student, but I liked last night's class even more, because I got to hear the stories of people I'd gotten to know over the course of the twelve-week class. It was wonderful to hear from the women who had had relatively short labor and got to experience natural childbirth. I had wondered how hearing their stories would make me feel. To my surprise, I was only a little bit envious and not at all angry or bitter. I was afraid I would be horribly jealous. Mostly I just felt happy for them. It was amazing to hear how everyone--those with relatively simple births and those who had faced more complications--told their stories with such humor and grace. I loved hearing the stories of other women who would characterize their labors or births as fun or enjoyable, because I did love the experience of laboring at the birth center and it's nice to know that others had similar experiences.

I hadn't planned out what I would say when it was my turn. I just started talking. And talking. And talking. I maybe told too much, but perhaps the expectant couples learned something from my experience that could help them. But I think I learned something from telling the story. Writing it all out had definitely helped me process everything that happened. Then there was the time between when I wrote that and now, and something happened in that time: I began to accept things. There are still things that I will always wonder about--just last week I was saying to Brian that I was disappointed that I'd gone for the epidural when I had, as there were so many relaxation techniques that I hadn't tried. I was wondering yet again whether I gave up too soon. Last night I realized, by telling my story and listening to others', that I hadn't given up too soon. I did what I needed to do. Things happened that were beyond my control, but I think I did have an unusual amount of control over the birth compared to some people, because we had prepared so well. I did what I could, and not everything went as planned, and I'm (mostly) okay with that.

Besides, I'm sure it's not the first time things with this girl won't go the way I expect.



Could somebody please send some hair product?

Adriana's birth story, part 5: Reflections

Or, What the hell, let's just go for a nice round 10,000 words



Why does it matter to me so much that I ended up with a hospital birth and a c-section? It wasn't what I'd wanted or planned for, but in the end I have my baby. I wish I weren't so upset by it. I wish I didn't need to write an 8,000-word birth story to help me process what happened. I wish I understood why after 8,000 words I still can't articulate what it is that's bothering me.

I have spent a lot of time over the past three weeks thinking about Adriana's birth, about how it all went. The experience of her birth was not what we had planned for at all. I know that the end results--a healthy mom and a healthy baby--are what really matter, but the experience of getting to that end was important to me too, and I didn't get what I wanted, what I had planned for so carefully for so long.

Sometime in the week before she was born, I came across the expression "People make plans, and God laughs." I don't remember where I read it, or what context it was used in, but the line has certainly replayed itself over and over in my mind since January 11. I had planned so much. We didn't just have plans, we had contingency plans as well. I had written not one but THREE birth plans (one for the birth center, one for a hospital transfer, and one for a hospital induction). It's funny to look at my hospital transfer plan now. My expectations for that were perhaps a bit high. I think it was good to have, though; anyone at the hospital who might have read it would have known what our ideal birth would have been and realized our mental and emotional states given what was actually happening.

Looking back, I don't think I could have planned any better for what happened. I didn't know what labor was really like, and I didn't know what our particular circumstances would be.

But I keep wondering about everything that happened. If there was a way to avoid the c-section. There are so many what-ifs:

• What if I hadn't had the stretch and sweep? Maybe I wouldn't have gone into labor that night. Perhaps when I finally went into labor, the baby would have been in a better position.
• What if I hadn't tried the evening primrose oil? I wonder sometimes if that contributed to my upset stomach, which led me to have so little fuel for labor.
• What if I had gone in earlier for the Ambien so I could get some rest? Would that have given me the energy I needed?
• What if I had been willing to try the Nubain to get some rest at the birth center?
• What if I had gone for the IV fluids at the birth center? Would I have moved further along on my own?
• What if I hadn't gone to the hospital? Could I have gotten the baby out on my own at the birth center, given enough time?
  
• What if I had fought the Pitocin at the hospital? Perhaps that moved the labor along too quickly, so that the baby didn't have time to turn. Or at least I might have avoided the internal fetal monitor.

What if, what if, what if....

The day after we were discharged from the hospital, Marsha came to our house to check on us. Toward the end of the visit she asked me how I felt about the way the birth had gone. I began to cry, and told her some of my what-ifs. She stopped me eventually. "Posterior baby. Bad positioning of the head. Nine pounds, eleven ounces. She was not an easy baby to get out." She assured me that she thought I had done all I could. She reassured me again yesterday at a post partum check-up, as I continued to express my doubts and regrets.

I still have my doubts and still regret that I wasn't more alert for some of my choices, but it is nice to have Marsha's reassurance.

***

Pam, our birth assistant, visited us in the hospital the day after Adriana was born. She had stayed behind to clean up at the birth center on Wednesday night, and I spoke with her briefly on Marsha's cell phone on Thursday when I was in the recovery room (I remember that I had the conversation, but I don't actually remember the conversation). We talked with her a little bit about how things had gone. She told us that after we left the birth center, she and Regina were talking. They knew then that one of two things would happen: either the car ride to the hospital would somehow jar the baby into a better position and I would get to the hospital and have the baby, or I would have a c-section. I found that strangely reassuring. As with what Marsha said to me, it helps me realize that there was only so much I could do. The choices I made were mine. I don't give up responsibility for them. But there are only so many choices out there.

Still, I wonder what would have happened if Pam and Regina had said those things to me before I made my decision to go to the hospital. Would I have made the same decision? I just don't know.

***

I was afraid of c-sections, and of surgery in general. There was an exercise during one of our childbirth classes where we all given slips of paper with goals on them to rank. We were told that the ones that said "healthy mom" and "healthy baby" were our top goals, but it was up to us to arrange the rest of them: "avoid internal fetal monitoring," "avoid c-section," "avoid episiotomy," "wear my own clothes"--there were probably two dozen different things. "Avoid c-section" was one of my top goals. When the instructor asked what I was doing toward that goal, my only answer was that I was receiving care from midwives and planning an out-of-hospital birth.

In the end, though, the rough part wasn't the c-section itself. I was nervous during it, but I managed okay. The worst part was the recovery. It wasn't until two days after Adriana was born that I was able to go to her bassinet and pick her up, rather than asking Brian or a nurse to bring her to me. We got home on Sunday afternoon, and I went upstairs to bed. It wasn't until Tuesday that I came back down the stairs, and even then I was still too shaky to carry the baby down with me. I had to have Brian do it for me. I felt guilty for the Percoset I had to take in order to cope with the pain for over a week, as I wondered how much of the drug was making its way into my milk and if that's why Adriana was such a sleepy baby. A nurse friend reminded me that if I was in too much pain it would interfere with my milk production and reassured me that it was fine to take the meds as long as I needed them. Still it was a relief when I felt well enough to switch to regular Tylenol.

I still don't feel 100% myself, and that's the most frustrating thing. I know I would have had to recover from a normal birth as well, but I don't think it would have taken this long.

***

The other night Brian asked whether I'd rather have a three-day labor or have a c-section. In spite of the fact that after 24 hours of labor I opted to go to the hospital for pain relief, I told him I'd take the three-day labor.

"You're a bad-ass," he said.

"No, recovering from surgery just sucks that much," I told him

***

When we took Adriana for her first pediatrician visit, we briefly outlined how the birth had gone for the doctor. "C-section, failure to progress," she murmured to herself, as she made a note in the medical record.

Failure to progress. Somehow just hearing those words depressed me.

***

Brian asked me the other day if I thought that our experience was an argument for or against out-of-hospital births. Without having to think I told him that it was an argument for the care we received. My experience at the birth center was wonderful. I look back at laboring in the bedroom at the birth center, surrounded by people who were focused on me and supported me completely, with nothing but awe. Up until the point where I couldn't handle the pain anymore, my birth experience was nearly exactly what I'd wanted. When I came to the realization that I couldn't go on any longer without some rest from the pain, I had the support I needed to make that decision without fear. It was my choice to make, and once I made it, everyone did what they needed to do to support me. If I were to do it all over again, I would do that much the same way. Just without the back labor. Especially 24 hours of it.

One of the more disappointing aspects of how everything turned out is that now I am unlikely to ever have a birth the way I imagined. If Brian and I ever decide to have another baby, a midwifery practice like the one we used for this pregnancy is unlikely to accept us as clients. VBACs are becoming more and more common and accepted, but they are done in hospital settings, not by midwives at birthing centers. That's disappointing to me not only because of the birth experience I would love to have, but because of the prenatal care I received from my midwives.

During my first pregnancy, before we had completely made up our minds about whether to use an OB or a midwife, we scheduled prenatal visits with both a doctor and with a midwife. Our first visit was with Regina, who spent an hour with us and answered all of our questions. Our second visit was with an OB, who rushed through the appointment and hardly gave us time to get a word in edgewise. Our minds were made up then, but the midwives did nothing except continue to reassure us about our choice by their actions. When I miscarried the first pregnancy, Regina was on the phone with me as it happened, talking me through the pain. When I was pregnant again, she and her colleagues were just as supportive. Around the time I was reaching the second trimester, we heard about a birth that had gone badly from a friend (baby was fine, but mom had a rough time of it). I was less concerned than Brian, and at our next appointment, which was supposed to last about 20 minutes, he spent a lot of time questioning the midwife about our friend's story and how the practice would handle it. Erin patiently answered his questions, explaining the practice's protocols in various circumstances. The visit lasted over an hour and we never felt hurried. I truly believe that I received the most outstanding prenatal care possible, and I hate that in the future that exact same care won't be available to me.

***

I know someone who had an unplanned c-section a few years ago. She regrets how long she labored before having the c-section. She wonders what was the point of that long labor, if she was just going to have surgery in the end. I find myself having the opposite reaction to my own experience: I'm glad I labored as long as I did. I tried as hard as I could, and I know that.

***

In spite of all my worries and doubts about the way things happened, there is one thing that stands out in my mind about the entire birth experience, from the time I spent at home, denying I was in labor, to the birth center part of my labor, to laboring at the hospital, and then dealing with the c-section and recovery: how essential Brian was to me throughout all of it.

We took a twelve-week Bradley course to prepare us for natural childbirth. Bradley called his method "husband-coached childbirth." To people of our generation, I think the idea of the father not being at the birth is somewhat foreign; of course Brian was going to attend the birth of our daughter. But the classes taught him about birth and about what kind of support he could provide for me during the birth.

Still, I don't think it was the classes that did it. It was Brian just being there, being himself, loving me, that made everything better. He pushed on my back, helped me in and out of the shower, reassured me when strong contractions made me start to panic. Mostly, though, he was just there, looking into my face, holding my hand, giving me whatever I needed. I needed Pam and Marsha and Marisa, as well, but not the way I needed Brian.

One week of our birth class was devoted to hearing the birth stories of students from the instructor's most recent group of students. Several of the couples noted how much closer labor and birth had brought them. I believed them, but I didn't understand, not really. I needed to see how much harder contractions were to deal with without Brian, to cope with pain by tuning out everything but the sound of his voice, to lean into his arms during a contraction as we paced the birth center hallway, to have him beside me through the surgery.

I needed to cry with him once he and Adriana and I were all back together in the maternity ward, to see the way he holds her, to have him take her from me in the night after I've fed her, so he can walk her to sleep. I needed all of these things in order to understand what they meant. And I know that no matter how much I write, or how I try to describe it, I can't make anyone else understand this new closeness.

Adriana's birth story, part 4: Recovery

I was being wheeled back into the labor and delivery room where I'd spent the night when I woke up. Marsha was there, but Brian wasn't back from the nursery with the baby yet. Marsha and Barbara began getting me settled. I couldn't stop shaking and they wrapped me in heated towels while I faded in and out.

I was a little more alert when Brian returned with Adriana, or maybe it was their return that woke me up a bit. He placed her beside me on the bed. Marsha used our camera to take a few photos, and Brian said that the baby's blood sugar was low, something common in large babies, and they had wanted to give her something in the nursery, but he had convinced them to let him bring her to me to try to nurse. Marsha was also encouraging me to try to nurse, which I wanted more than anything, but Barbara was reluctant. She wanted to make sure I was okay first. But when it neared eleven, she let us try, because that was when Brian had promised to have the baby back in the nursery. They helped me turn to my side, and Marsha tried to help the baby latch. We were fairly unsuccessful, but we'd at least tried. And when Brian got back to the nursery and they checked Adriana's blood sugar again, it was well within normal range, and he brought her back again soon.

At some point, my friend Becca called from London, checking on me because I hadn't answered email in a couple of days. Marsha answered my phone and let me speak to her for a couple of minutes. I told her briefly what had happened and how big Adriana was. Becca exclaimed over the size of the baby--only three ounces less than her daughter had weighed at her six-week check up the week before. I was hurried off the phone, but it was good to have announced the baby's birth to someone.

There was talk of something being wrong with one of my ureters, a tube that connects the kidney to the bladder. The doctor wanted to make sure that it hadn't been damaged during the surgery and wanted me sent down to x-ray for an intravenous polygram: they would run some sort of dye through my system and take x-rays to make sure everything was all right. When it was time to go, Brian and the baby were sent to our room in the maternity ward, and Barbara accompanied me down to x-ray.

As we waited for the radiologist, I asked Barbara about VBACs. I think she was amused that three hours after a c-section I was already wondering about the possibility of having a normal birth in the future. She advised me to find a good, open-minded OB well in advance of getting pregnant again, as many midwives, including the ones I had been seeing throughout my pregnancy, wouldn't do VBACs.

The radiologist finally joined us and while the technician was asking me various health history questions (I was of the mind that if I had no idea what the condition was that he mentioned, it was safe to say that I'd never had it), I heard the radiologist telling Barbara that the dye they were going to use would get into my breastmilk and I would be unable to nurse for 48 hours. I tuned out the technician's next question and stared at the doctor.

"What?" he said, looking surprised.

"I heard what you said." He looked at me blankly. "About breastfeeding." He seemed unconcerned, but I could tell Barbara understood. She came over to me as I asked the doctor if there was a different dye they could use. He said there wasn't another dye, wasn't another test. I had a feeling there were other questions I was meant to ask when faced with the need to consent to medical procedures, but I couldn't come up with them. I thought about declining the test, but then I wondered what would happen to me if something really was wrong. I talked with Barbara for a few minutes, and we decided that we could syringe-feed the baby formula for two days while I used a breast pump to get my milk to come in. I hated the idea, but I didn't know what else to do. I dreaded telling Brian--I knew he would be as disappointed as I was.

It took about ten minutes for the dye to run through my system, and then they began taking x-rays. The x-rays seemed to go on forever, with long pauses in between, but my concept of time was fuzzy, and I kept dozing off. I was there long enough that there was a shift change and a new technician took over toward the end. It was a relief to finally be wheeled back up to the room where Brian and Adriana were waiting for me. I was right about Brian being disappointed, but we had the nurse bring us a syringe and some formula, and he got to feed Adriana for the first time, while I sipped some cranberry juice, relieved to finally be allowed to have something other than ice chips.

Various people were in and our of our room, including the attending physician and a resident and medical student that he works with. The resident found out the name of the dye that was used during the IVP, so that I could ask the lactation consultant when she came in the next morning. They brought me a breast pump to use during the night while Brian continued with the syringe feedings. I was given antibiotics because I was running a fever, and two units of blood because I'd lost so much during the operation. I did try pumping once, and I intended to do so throughout the night, whenever Brian was feeding the baby, but he let me sleep for six hours straight, which I probably needed to do after the long couple of days I'd just had.

In the morning they removed my epidural. It wasn't until afternoon that I'd regained all the feeling in my legs, at which point the nurse came to help me to the bathroom, I was shaky but okay, and spent some time sitting up in a chair. That afternoon the lactation consultant came rushing into my room, declaring that the dye used during the IVP hadn't entered my GI tract and had a short half-life, so breastfeeding was fine. It was fine all along, which made Brian and me mad--we felt that we'd lost valuable time establishing nursing. But I realized that there wasn't really time to be mad, I just had to start now. The lactation consultant helped get Adriana latched for the first time, which was a relief.

The next couple of days were a long blend of people coming in and out of the room, taking my blood pressure and temperature, checking the baby, giving me more pills to take. Adriana and I struggled to figure out nursing, and I dealt with getting my body back to normal. The first night after the epidural was out, Brian headed home to pick up a few things, and I had to call a nurse to help me get to the bathroom while he was gone. It wasn't that I couldn't walk okay on my own; I just couldn't figure out how to sit myself up and get out of bed, given the pain in my abdomen from the surgery. The nurse showed me how to pull myself up to a seated position and then turn my body to get my legs on the floor. After that I was fine on my own. On Saturday, I even felt confident enough to pick Adriana up out of her bassinet on my own a couple of times, rather than asking Brian to bring her to me.

We'd been told we would be discharged on Monday, but on Sunday someone said to us, "So, you're going home today?" Confused, we corrected her, but the nurse checked our chart and the doctor had written the day before that we could be discharged on Sunday. Nervously, we decided that was a good thing, and got ready to go home.

My real frustration with recovering from a c-section began once we were home. In the hospital it was easy to let Brian and the nurses do things for me, but once I was back in my own house, I hated feeling like an invalid. If I wanted something and Brian wasn't in the room, I talked to him through the baby monitor. At first I couldn't manage the stairs, so we ate our meals upstairs in our bedroom. It wasn't until two days after we came home that I went down the stairs for the first time. I made Brian carry the baby, but it wasn't as hard as I thought it would be. I took prescription pain relievers for the next week, feeling guilty as I wondered how much codeine was getting into my milk, but accepting a reminder from a nurse friend that pain would interfere with my milk production. Nursing was slow and frustrating at first, but Adriana and I were learning, and now she eats like a champ.

I'm still tired a lot of the time, but that's the normal tiredness of caring for a newborn, I think. I still think a lot about how the labor and delivery went. Recovering from surgery is something I wish I weren't dealing with at the same time as dealing with a new baby, but I try not to dwell too much on it. I know, after 8,000 words you don't really believe that I'm not dwelling on it, do you? It's actually easy not to focus on all of that too much, as I'm awfully busy dwelling on how overwhelming my love of Brian and Adriana is.

Adriana's birth story, part 3: Transfer for maternal exhaustion

Marsha said that they could hook me up to IV fluids to see if that would help with my energy level, since food and drink weren't staying down. I pushed the thought of the hospital to the back of my mind and agreed, all the while knowing that Brian was getting more and more worried. I don't know who went to set up the IV, but then Marsha was calling me over to the side of the tub, and I saw Pam with an IV pole in the doorway. As I moved toward Marsha, another contraction hit. I tried to stay calm, but throughout it all I could think was that I couldn't handle any more. I didn't have the strength. As it ended, I told her that I needed to go to the hospital for some pain relief.

I don't remember what Marsha said at the point, but whatever it was and whatever tone she took, she didn't make me feel guilty for my decision. In fact, once I made the decision, I felt relieved. I was finally going to be able to get some rest. I would go to the hospital, get the epidural, sleep for a while, and then have them turn off the epidural so I could get the baby out. It seemed simple and clear (although clearly naive), and I was more emotionally prepared to handle contractions while Brian loaded our things back into the car, and Marsha called the physician to let him know we would be going to the hospital.

Pam stayed behind to clean up the birth center, and we followed Marsha to the hospital. I concentrated on her taillights as we drove, because otherwise I concentrated on the clock and how long it seemed to be taking to get there (it was only about 20 minutes).

At the hospital they got us quickly into a room, and I was hooked up to IV fluids. I remember telling the nurse that I didn't like needles in the back of my hand, and asking several times how long it would take for the bag of fluids to be emptied so that I could receive the epidural, and then how long it would take for the anesthesiologist to get there. At that point I no longer cared about giving up a natural birth; I only wanted to rest and escape from the pain. A resident checked my cervix and said I was between six and seven centimeters.

The anesthesiologist arrived. He asked Brian and Marsha to sit down while he put in the epidural. Both protested, and while he still made Brian sit, he allowed me to lean forward into Marsha's arms as he put it in. I complained of pain in my neck just after it went in. Puzzled, he removed the epidural and was surprised that that seemed to help relieve the pain. He replaced it and the pain came back. It wasn't a severe pain, just a sort of sore, stiff feeling on the left side of my neck, and it eventually eased on its own.

I don't remember lying down in the bed or trying to sleep. It simply happened. The cramping pains that I had been feeling in my low back for more that 24 hours were gone and I could finally relax. Brian settled down in a fold out bed beside me, and Marsha dozed in a chair.

Sleep was easy, but it was easy to wake up, too, and I did wake up on and off as people came and went from the room. Various things happened throughout the night. I was given some Pitocin. I was alarmed when I realized that was happening, but Brian and Marsha reassured me, saying that they had explained it and it was necessary. Later we woke when the resident was explaining to us that they wanted to use an internal fetal monitor. I protested this, saying it wasn't something we had wanted. But the baby's heart rate had dropped significantly for four minutes, and they wanted to monitor her more closely. Feeling tired and stupid, and beginning to regret the decision to come to the hospital, I consented. It was for the baby. Anything for the baby.

At some point during the night, I asked Brian if he was okay. He had to remind me of this, but I do vaguely remember it. I remember chuckles from other people in the room, who were apparently amused by my concern for him. But I knew that it was probably distressing for him that we were so far from our planned birth, and it had to be hard for him to see me in the bed, hooked up to monitors and IVs and oxygen.

I woke up around six in the morning when the attending physician who backed up the midwives came in. I'd met him at some point during the night. He checked my cervix, and told me that I was at only an eight or a nine, after several hours of Pitocin, and encouraged me to consider a c-section. I looked to Brian and Marsha, but couldn't read their faces. I realized that a c-section might be necessary, but I wasn't ready to accept that yet. I told him so and asked to keep on trying. Maybe if I got back up on my hands and knees I could get the baby to turn. I don't think I really believed there was any chance of that. The baby was already at +1 station, I knew. It was probably too late. But I felt that I needed to try a little longer. The doctor agreed to let me, and said he would be back in an hour. Brian helped me get up onto my hands and knees.

Brian had helped me push the button to increase my epidural once around five that morning, but I was beginning to feel contractions again. They were long and hard, but with the epidural the pain wasn't severe and I could manage them. In fact, I found the sensation somewhat reassuring. Although it hadn't occurred to me at the time--probably because I was so relieved for the rest the epidural provided--it was rather eerie to know I was in labor but be completely unable to feel it. Feeling determined, I labored on my hands and knees for what seemed like a very short time, sometimes letting my head fall to the bed to help support my weight. Finally I couldn't hold myself up any longer, and I was so discouraged, thinking I'd only stayed up for five or ten minutes, but as I laid back down, Marsha told me I'd been that way for half an hour.

I knew nothing had happened. I knew that the doctor was going to come back and tell me I needed a c-section. I began to come to terms with the idea, and tried not to wonder what would have happened if I hadn't had the S&S, had gone to the birth center earlier in the day for some Ambien, hadn't decided to come to the hospital for an epidural, had fought against the Pitocin. I listened to the sound of my baby's heartbeat on the monitor, and told myself that all that mattered was a healthy baby. I thought about telling Brian that the doctor was going to tell me I needed a c-section, and that I understood and was okay with that, but when I looked at his exhausted face I couldn't do it. I lay there on the bed, feeling the contractions in my back in spite of the epidural, touching my belly with my hand in order to feel them there, and breathing slowly through each one.

A new nurse, Barbara, came on at seven, and I liked her immediately. A new anesthesiologist also came in briefly to introduce himself. The sky was beginning to get light as we waited for the doctor to return. Marsha sat beside me, with a hand on my belly and we agreed at one point that I was back to the run-on contractions--my belly never seemed to relax. I wondered what was going through Brian's mind. I knew he was scared and worried, but he wasn't showing it very much. I wished I could tell him something to make him feel better. I pressed the button to increase the epidural one more time as we waited for the doctor.

Just before eight, the resident came in. Although we knew the doctor would be there soon and would want to check me himself, the resident checked me. I was down to eight centimeters, she said, and the front of my cervix was swollen. A few minutes later, the attending physician entered the room, checked me, and repeated the resident's news.

"You need c-section," he said.

Whenever he spoke to me that night, and throughout my hospital stay, I had to concentrate hard to understand what he was saying through his heavy African accent, but those three words were very clear.

I looked at him, as he stood to my right, down near my knees. I glanced back up at Brian who was at my shoulder. Marsha was to my left, across from the doctor. I glanced at the clock and did the math: I had been laboring for 33 hours, if I included all those hours I didn't actually believe I was in labor. I turned back to the doctor, and told him that since the baby's heart rate was fine, I would rather just keep laboring.

Either the doctor or Marsha explained to me that I shouldn't keep going until the baby became distressed and the c-section became an emergency. It was Marsha who convinced me. When a midwife tells you it's time for a c-section, you know that you've gone as far as you can. I struggled not to cry (and completely failed at that) as I nodded my consent.

The doctor left the room, and preparations got underway. Barbara sat beside me on the bed and explained how the c-section would go, things I basically knew. I don't remember looking at Brian during this time, or anything he said to me, although I know we were both concerned about when he would be able to join me in the operating room. Barbara said that he could come along and wait just outside the room, and as soon as the doctors said it was all right, he could come in. Soon we headed off down the hall. Near the OR, Barbara handed Brian some scrubs. I was concerned about whether they would have booties that would fit over his shoes--that had been an issue when his mom had taken us to see an operation at her hospital, but here they fit with no problem. Barbara fitted a cap over my hair, and realized I was still wearing earrings. It hadn't occurred to me to take them off. Brian gave them to me for our first anniversary, and unless I want to wear something dangly for dress-up, I keep them in all the time. Barbara covered my ears with the net, but checked me for other jewelry and had me give my wedding rings to Brian to put in his pocket. I was touching my bare ring fingers with my thumbs as I was wheeled into the OR at 8:34.

Barbara introduced various people to me as they came in. The anesthesiologist was checking my IV, attaching those round EKG things to me, putting the oxygen meter back on my finger. I had a different kind of oxygen mask on now, one with tubes into my nose instead of something that fit over my mouth and nose. I kept talking to the anesthesiologist, because he was the only person in the room that had to stay right by me. I asked him about everything he was doing, and what other people in the room were doing. He patiently answered my questions, although I mostly tuned out his answers. I just had to keep talking to keep myself calm. I know that at one point I told him I was nervous about surgery. He assured me that it was a routine procedure and very safe. "Some women even choose to have c-sections," he told me. "Those women are crazy," I said to him, and went back to asking him questions about what was going on in the room, having realized that he and I had different perspectives on medicine and childbirth.

Brian was finally let into the room and came over to my side. I relaxed a bit with him there. I remember him commenting that he couldn't believe I was making jokes on the operating table, but neither of us remember what I was joking about. The last people to arrive were the pediatricians who would be taking care of the baby when she was born. I reminded Brian that he needed to go with the baby wherever she went, as it occurred to me that with a cesarean birth we wouldn't be allowed to wait until the cord stopped pulsing before we cut it, and Brian wouldn't be the one to cut it.

As the operation began, Brian began speaking to me in a soothing voice. I shushed him and closed my eyes, no longer joking around to help myself relax. I felt pressure moving slowly across my abdomen, and then a few minutes later there was more pressure further up, almost to my ribs. For a moment it felt as though someone was sitting on my chest. I didn't realize it at the time, but in addition to being posterior, the baby had also decided not to tuck her chin to send a more manageable part of her head through the birth canal, but instead had stretched out her neck, putting her in a bad position for a normal birth.

I counted through my breaths to keep myself calm. Finally the anesthesiologist told Brian he could stand up and look over the drape, which he did. Someone announced that it was 9:10. As we I listened to the baby being suctioned, I asked Brian if the baby was really a girl. He said he couldn't see, but someone said yes, it was a baby girl. Finally there were cries from the baby, and I began to cry too. The baby was taken over to where the pediatricians were waiting, and Brian followed. I listened to her cry as I sobbed myself, so glad to have my baby born at last. I heard Brian asking about her size, and someone said she was probably about nine pounds. It took a few moments for me to realize that I could glance back over my right shoulder and see the baby. They were holding her up at the moment that I looked, and I was amazed. She was screaming and had a head of dark hair. "She has hair," I told the anesthesiologist, who was still seated at my left shoulder.

Soon I felt a horrible pain in my right shoulder, and told the anesthesiologist about it. I heard some comment about "referred pain," which I didn't quite understand, and then I told them that the pain was also in my left shoulder. The anesthesiologist quickly gave me something to stop the pain, but I remained tense as I waited for it to return. Someone announced that the baby weighed nine pounds and eleven ounces. "I knew I was going to have a big baby," I said to no one in particular.

The doctor continued to work on me, stitching me up, I assumed. Marsha told me later that after the long labor, my uterus had trouble clamping down after the baby was out. I apparently was losing more blood that I expected. It wasn't an emergency, but I was given a transfusion that night.

Brian was finally given the baby to bring over to me. Someone helped him bring her down so I could look into her eyes, and I reached out to touch her hair. Someone took the camera from Brian and photographed the three of us together like that. I don't remember the photo being taken, or Brian and the baby leaving to go to the nursery.

Adriana's birth story, part 2: The birth center

Contractions in the car were hard, but it became easier to manage them because I knew we were on our way. Somehow the fact that they were coming three minutes apart hadn't convinced me that I was really in labor. I breathed through one as we sat at the traffic light near the Washington Masonic Memorial, and then told Brian, "It just feels weird in my low back. We're going to get there, and Marsha's going to tell me I'm just constipated and to go home." But when we arrived at the birth center, Marsha called Pam and said, "They're here. I haven't checked her yet, but she looks like she's in labor. You should come." I told her I still wasn't sure. She had me undress and lie down on the big bed in the birthing suite, while she checked me. "You're five centimeters," she said, laughing. "Now do you believe you're in labor?" She called Pam back with an update, and Brian called our friend Marisa, who was planning on joining us at the birth center, to provide support to both Brian and me. We listened to the baby's heartbeat on the Doppler, and then Brian began to bring things in from the car, while Marsha set me up on the exercise ball to labor. After awhile I got back into the shower, since that had helped before.

When Marisa and Pam arrived I was back to laboring on the bed. It was mid-afternoon, and I was handling the contractions well. When Brian needed to get up, Pam took his place at my side, applying pressure to my back as contractions hit. The rest of the time, Brian knelt on a stool at my side, massaging my low back, while Marisa lay beside me on the bed, stroking my hand during contractions, so that I wouldn't hold tension there, and Pam stroked my calves and squeezed my feet. In between contractions, I was able to talk with them and enjoy their company. After some contractions, I felt strange for being the center of attention; it didn't quite make sense to have three people so focused on me. I mentioned this and everyone laughed at me. Periodically, Marsha or Pam would get out the Doppler to listen to the baby, who seemed to be doing well. They encouraged me to eat and drink, and I managed to drink a bottle of water, which Brian then refilled with some of my sports drink. I nibbled on a couple of pieces of dried fruit, but refused everything else Brian offered. I just didn't think I could handle it. Eventually I participated less in the conversation between contractions, letting my mind float as the soft voices surrounded me. Contractions came and went, as did nausea. I had been good about trying to stay hydrated, and Marisa would hand me my drink after each contraction, but once or twice I had to throw up. It didn't occur to me, though, how little I had been able to keep down since the night before.

I think it was starting to get dark outside when I decided I wanted to try laboring in the jacuzzi. Pam or Marsha went to begin it filling for me. It seemed to take forever to fill, but finally it was ready. I let myself float around in it a bit. Brian put on trunks and got in the tub with me, holding me through contractions. Being weightless helped at first: the pain in my back wasn't so intense, and if I turned onto my hands and knees it seemed easier to breathe. Plus, when I was on my hands and knees, I could finally feel the contractions in my belly a bit. I'd been able to feel my belly tighten with my hand, but this was the first time I'd actually felt the tightening--low and strong across my abdomen. As we labored in the tub, the contractions intensified. I stretched out in Brian's arms, and felt the contractions lasting longer and coming on stronger. Soon it seemed that they never ended. Instead, the intensity just rose and fell in slow waves. I tried to control my breathing and moaned with each exhale, trying to keep the sounds low and deep. Brian sing-songed to me, telling me to relax, to breathe the baby out, to let the water relax me. My mind was divided at that point into a small part that was still very conscious of what was going on around me and intellectually aware of what it was I was supposed to do to relax, and the larger part that was consumed by contractions. The small, aware part was almost amused by Brian, but also very grateful, because his voice was calming, and the part of my mind that was consumed by contractions needed his calmness. Every now and then, when the seemingly unending contraction would peak again, I would lose control of my breathing and my low-pitched moans would become more shrill. I remember telling Brian that it wasn't fair, that the contractions weren't stopping, that I was afraid, that I hurt to much, that I couldn't do this. Then he would guide me through the pain with his soft voice, and the pain seemed more manageable as I could relax a little bit again. Pam came into the bathroom and during a low point in the contraction, she told me that I was having run-on contractions--one coming right on top of another.

I can't remember what made me decide to get out of the tub. At that point the run-on contractions had eased, and I was able to get at least a few seconds of rest in between each contraction. Brian and Pam wrapped me in a big towel and helped me dry off, as I began shaking uncontrollably with cold. We went back to the bedroom and Pam turned on the space heater to help me stay warm. It was dark outside, and through the blinds I could see the lights in the trees along the street outside. We checked again for the baby's heartbeat, and it was harder to find this time; it wasn't that there was anything wrong with the baby, just that it was getting harder to find a good place on my belly to listen. Pam said she and Marsha thought I might be going through transition, and Marsha offered to check me again.

I lay down on the bed, excited: if I was in transition, I was almost there; I was going to meet my baby soon; I had successfully labored. As a contraction eased, I relaxed so Marsha could check my cervix. I tried to read her face. She looked at me seriously and told me I was at six centimeters. My good mood plummeted. I wasn't in transition. I was still a centimeter away from transition. I had been at the birth center for almost five hours, and had only gained one centimeter. I moaned through another contraction, and then Marsha encouraged me to move around a bit. She wanted me squatting, or on the exercise ball, or walking around--something to help move the baby down. Exhausted and discouraged, I agreed. I tried the ball first, because my legs felt so tired. Brian put a pillow over the footboard of the bed for me to lean into and he continued to apply pressure to my back through contractions. I was getting 30 seconds of rest between each one, and those seconds were blissful; I was surprised when Brian told me how short the breaks were, since I was able to rest so much during them. I suppose in comparison to the run-on contractions, any amount of rest would have felt good. That also gave Pam more time between contractions to try to listen to the baby's heartbeat. I was restless, though. I couldn't just stay on the ball. We got up, and I walked up and down in the hallway with Brian. He would lean on a wall and support my weight when a contraction would hit. He kept trying to get me to eat something, and I agreed to try some lentil soup. Marisa heated the soup for me, while Brian helped me walk up and down stairs. That wasn't as difficult as I thought it would be, but I was still restless and discouraged, so it was hard for me to focus on doing one thing. We went back into the birthing suite and I ate a few bites of soup and drank some water. I got onto my hands and knees on the bed for awhile, but that position was getting more and more difficult to sustain. I threw up again, and then got back up to pace the hallway some more.

Regina, the midwife I had seen the day before, was at the birth center and came up to the suite. "Some people will do anything to get out of going for an ultrasound," she joked. It was nice to have another person there to talk with when I felt up to talking. Marisa had to leave at some point. Shortly after that, my water broke. I alternated between walking the hallway and lying on the bed. My throat was getting sore from moaning out contractions. I admitted to Pam that thoughts of an epidural were crossing my mind. She didn't make me feel guilty for that, but encouraged me to go on laboring. I think there was a decision around this time that the baby had definitely turned into a posterior position, which was why it was becoming more and more difficult to find the heartbeat.

I got sick again, and I could see concern in Marsha's face. She said she was worried about my energy level. She suggested a shot of Nubain, which wouldn't really help with the pain, but would help me get some sleep. But Nubain is a narcotic, and after experience with similar drugs for migraines when I was a teenager, I declined, explaining that I didn't react well to narcotics. Someone suggested I get back in the tub, and Pam began adding hot water to it. Brian didn't get in the tub with me this time, and I didn't ask him to. I could see worry in his eyes, worry that was probably reflected in my own, although I tried not to show it. I eased myself around in the water between contractions, trying different positions. I hoped that if I spent more time on my hands and knees that the baby would turn, and being in the water made it easier to support my body that way.

After a fairly short time in the tub, Pam and Marsha joined us in the bathroom. There was talk of a hospital transfer, so I could get an epidural and a bit of rest. The idea certainly appealed to me at this point. I was exhausted and wanted to sleep almost more than I wanted to meet my baby. But I was still worried about going to the hospital, and I felt self-conscious about giving up on my natural birth. In my mind I saw the sheet of statistics from the birth center, with the number one reason for transfer to the hospital: maternal exhaustion. I saw myself getting closer and closer to being a part of that category.

Adriana's birth story: Laboring at home

As brevity is apparently not my strong suit, I'll be posting this in several pieces.


On January 9th, I went for my 41-week appointment with the midwife. We had a non-stress test, where the midwife, Regina, strapped an external fetal monitor around my belly. That tracked the baby's heart rate on a strip of paper, and I pressed a button every time I felt the baby move, which made a made a mark on the paper to show whether the baby's heart rate increased in response to movements. After about 20 minutes, we could see that the baby was indeed "reactive" and doing fine, but I got a referral for an ultrasound on Friday to check to make sure I still had adequate amniotic fluid. During the test we talked about inducing labor. The practice would only allow me to go two weeks past my due date before referring me to their back-up physician for induction and a hospital birth.

I didn't want a hospital birth, but I had spent the day before thinking a lot about the possibility. I knew that when I went through the doors of the hospital to give birth, I was putting myself at higher risk for interventions that I didn't want--Pitocin, episiotomy, c-section. Those interventions wouldn't be the end of the world, I knew, but I hated the idea of giving up our plans for a peaceful birth at the center with few or no interventions. I talked with a friend about my worries, and she pointed out that just because I was more likely to face those things in a hospital setting, I wasn't necessarily going to experience them, as I had educated myself and was making an effort not to have to go through them. Somehow, those words helped. I went to yoga that night to help me relax and by the time of my visit I was feeling better. I hadn't exactly come to terms with the idea of a hospital induction, but I felt calmer about it.

We looked at the calendar with Regina and decided that the induction would probably have to be scheduled for the 15th or 16th, depending on whether the hospital would do a scheduled induction on the Monday holiday. I crossed my fingers that I would have until at least the 16th, and Regina said she would talk with the other midwives about letting me go that long--42 weeks and 2 days--but that she thought it would be fine. I could tell she didn't like the idea of the hospital induction either. We discussed more "natural" methods of induction as well, such as castor oil, evening primrose oil, and "stretch and sweep." Regina offered to do the stretch and sweep during that office visit, and I agreed. I didn't think it would actually work, but I figured it was worth a try. Regina said that it seemed most effective when done repeatedly, so I could come back in Friday after my ultrasound for a second try.

I expected the S&S to hurt, but it wasn't too bad. It was difficult at first for Regina to reach my cervix. The baby's head was low, and my cervix was still back behind it. I was about 50% effaced, and when Regina said that laughed to myself. At my 36-week visit, I had been 50% effaced, and Brian and I had become certain that meant the baby wouldn't be late after all. Regina also said I was only one centimeter dilated, but that was enough. She used a finger to pull the edge of the cervix back and try to separate the bag of waters from the cervix. I felt a bit of cramping in my low back, but not the kind of pain I had expected.

We headed home, stopping at Whole Foods on the way for a bottle of evening primrose oil capsules and some Ben & Jerry's. (What? Cookie dough ice cream totally helps induce labor. I'm sure I read that somewhere.) After dinner, I took two capsules and ate some ice cream. The cramping I had felt during the exam was mild, feeling mostly like PMS, but I had felt that way a lot over the past couple of weeks. By the time we went to bed around 11 that night, the feeling was getting stronger. I lay in bed trying to sleep as the cramping came and went. Eventually I felt a wave of nausea and got up to be sick.

I spent the next few hours back and forth between bed and the bathroom. I went downstairs and got out a bottle of the sports drink I had bought to take to the birth center for during labor. Water tasted funny and I thought I would have a better chance of keeping that down than actual fruit juice. I drank a few ounces and went back to bed, but soon needed to throw up again. I finally woke up Brian to tell him that I was sick. He got up with me for a little while and sat in the bathroom with me while I tried to throw up. We went back to bed so we could try to sleep, but my cramps kept coming. I started to wonder if this was labor, but the pain was all in my low back. Nevertheless, I started looking at the clock: five minutes between, then 30, then twelve. There was no regularity. Brian slept, and when I had a 30-minute break, I think I was able to doze too. When the cramps were particularly strong I would wake Brian and he would press on my back while I took long, slow, deep breaths.

Around four o'clock, I started to think about calling a midwife. I wondered who was on call; we had forgotten to pick up the January call schedule. Not that it mattered--I like all the midwives, and if I needed someone, it wasn't as though I had a choice of who I got. At 4:45, after getting sick one more time, I woke Brian and told him I was going to call.

When the answering service picked up, I said that I needed to speak with a midwife. "Are you in labor?" the woman asked. I told her that I didn't know. I was starting to think that I might be, but I still hadn't felt any pain in my belly, just the normal tightening of Braxton-Hicks contractions that I had been feeling for several weeks. Within 15 minutes, one of the midwives, Marsha, returned my call. I described what was going on. She asked whether my belly was tightening and whether there was any regularity to the cramps or the Braxton-Hicks contractions. I told her there wasn't, but she told me that it could still be labor. She wanted me to try to drink a little something and get some rest. I hung up the phone and went back to what I'd spent the rest of the night doing.

I did manage to get some sleep here and there. Brian applied pressure to my back and kept encouraging me to eat or drink something. The sun came up, and I know Brian was on the phone with Marsha again at some point, while I rested in bed, breathing through what I still thought were cramps, although Brian and Marsha had decided it was labor. At one point I decided a hot shower would help me relax. I was having trouble standing and breathing when the cramps would hit, so I pulled a towel into the shower and knelt on it, letting the hot water hit my low back. Finally, I found some relief.

While I was in the shower, Marsha suggested to Brian that we come into the birth center. She could give me some Ambien to help me rest up so that I would have energy for labor. But after my shower I was able to relax and doze a bit more, so we decided to stay at home. We called our birth assistant, Pam, to tell her what was going on. Brian described everything to her, and then I spoke to her, telling her that I didn't really think I was in labor, as the pain was all in my back. She suggested getting onto my hands and knees to try to ease the pain of the cramps, and to lean over pillows in that position to get some rest in between. I did what I could to relax, and eased myself through contractions with deep breaths, beginning to vocalize with low moans when I exhaled.

Finally, conceding that this might be labor and that I was too uncomfortable to stay home any longer, I told Brian to call Marsha and tell her we would be coming in. Brian began throwing the last minute items into our bags, and to move things to the car, while I breathed through contractions on my own the best I could.

I hadn't realized how much being calm and breathing carefully helped manage the pain until one hit me really hard. I didn't realize that Brian had taken a bag out to the car, and I called out for him. When he didn't respond I called again and began to panic. The pain grew worse and my breathing became more erratic. I called for him over and over until he was there, apologizing, trying to calm me down. "Where are you? Why didn't you come?" I asked him, when the pain finally subsided. He explained, and then began timing his trips outside so that he was always back for contractions, sprinting to the car with my duffel bag, returning to help me with a contraction, then sprinting back out to put my exercise ball in the back of the car. At last he helped me out to the car and we were on our way.