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.