Monday, December 27, 2010

A very, very long post.

I’ve been wanting to write about Jack’s birth for some time.

I keep putting it off. Telling a birthing story is… tricky. Not everyone wants to hear it (please close your browser now, and I promise cute stories about Jack's growth in future posts). Birth is personal. Our language lacks the word to describe the magnitude of its highs and lows. Discussing pain is impolite at best, and inappropriate at worst. Plus, every time I read what I write, I hate it. I hate that I can’t convey the intensity of the experience without sounding overly dramatic. I vacillate between scientific exposition and the eye rolling land of cliché. I just don’t know how to say what I want to say. By telling this story, I am exposing myself, physically and emotionally.

But as the months pass and my memory of the event fades, I realize it’s now or never. Furthermore, I realize how shielded the other birth stories that I had heard were. I wish someone had told me the whole, horrific truth before I went through it myself.

It's a long story. I could shorten it, but I don't think I will. This blog is a place where I can be entirely honest, not knowing who exactly is reading and not worrying about what they might think. I'm off work this week and have time to pay attention to this blog, my public diary about Jack. So I'd like to relate everything about Jack's birth that I remember.

Inducing Myself

I was taking insulin shots for gestational diabetes and getting weekly ultrasounds and nonstress tests to make sure that the baby was OK. Every piece of evidence said that Jack was healthy, however, with severe gestational diabetes (as mine was), there is a theoretical risk to placental function, and a statistical increase in stillbirths after 40 weeks. I was informed that I would be induced at 40 weeks, no matter what.

I did not want to be hormonally induced, for my sake as well as Jack’s. Hormonal induction is a nasty business. It would have involved my checking into the hospital the night before. They would have attached something to my cervix to mechanically dilate it. After a sleepless night, they would start me on a Pitocin drip. I’ve been told that the tough part about induction is not just the overly painful contractions that Pitocin will generate (and those are supposed to be quite bad)… it is the long, exhausting, stressful wait before the contractions start. The doctors slowly dial up the chemicals until your body responds, and this is both physically and emotionally taxing. Giving birth unmedicated after a hormonal induction is nearly unheard of. Hormonal induction also carries a high risk of C-section. And C-section comes with its own host of complications for mother and child.

Desperate to avoid the induction, and hopeful for an unmedicated birth, I researched all home remedies available. Every resource I located pointed to a single effective method that can be used to induce contractions if your body is ready to go. There is no risk of early labor. I wished to avoid a particular doctor that I knew to be on call on Monday. So I decided to attempt home-induction on Saturday morning, 4 days before Jack was officially due.

Recipe for inducing labor: drink a particularly gross, indigestible concoction until you achieve a horrendous stomachache. The prostaglandins that are released from your GI tract produce contractions in your uterus, which starts the cascade of positive feedback that is birth. In addition to myself, I personally know two other women for who took castor oil, and for each of them, labor started within 6 hours.

Actual recipe for inducing labor: one tablespoon of castor oil shaken vigorously into 2 tablespoons of orange juice. Glug that foul, disgusting mixture once an hour for three hours*, locate the cutest onesie in your collection (moral support), and plan to spend the day at home.

*Actually, I was quite on the low end of the dosing spectrum, but you can go even lower (my friends were successful in the teaspoons range). Be patient. It takes 4-6 hours for the castor oil to reach the right spot in your GI tract, and all you need is enough to give yourself a stomachache. Less is more. Trust me.

I took my first dose of castor oil at 7:30am. I was miserable from about 11:00am-1:00pm, at which point I lay down for a nap. At 1:30pm, I felt my first contraction, and soon I had definite evidence that Jack would be born. Our Doula, Lizzie, a midwife in training, confirmed it over the phone: labor was happening.

I was elated to have avoided hormonal induction. I told Greg the news. He proceeded to do the typical guy thing and get all excited and worked up. I remained calm and happy. We cleaned the house a bit. I sent off a work email. We went for a walk, and I took a shower. I can’t remember what we had for dinner that night or what we talked about. I’m sure that many silly grins were exchanged. From the very beginning, my contractions were coming every 6-9 minutes apart, and they were mildly painful.

Contractions had just started

The Evening of 7/17

Things started to get very uncomfortable around dinnertime. By 10pm, I was miserable and unable to do much of anything except curl up in pain. I decided to sleep on the couch: getting in and out of bed was difficult, and I wanted Greg to get some rest.

I set up camp in the living room and tried to watch a movie and sleep. This was a bad idea. I kept drifting off, only to be woken up by another painful contraction. I was in too much pain to sleep, but I was too sleepy to shift my position. I stayed in one place for too long and got very, very stiff.

By 2am, labor was massively painful, and had no other way to cope except to stumble around the house, crying and leaning against furniture. I wanted Greg to sleep as much as possible, but I needed support. Jack was turned posterior (he would be born in this direction), meaning that the back of his head was pressing against my spine. I was experiencing horrific back labor. I could handle the contractions, which came and went with a predictable and bearable rhythm… it was the intense, unrelenting pain in my lower back that incapacitated me. I stayed vertical, tried hands and knees, and rocked on the exercise ball. Nothing helped. I was overwhelmed and terrified by the amount of pain I was experiencing so early on. I woke Greg up. We tried to work through the contractions ourselves for another two hours, but we felt unprepared and scared. At 4am, we called our Doula, Lizzie, and she came over right away.

When Lizzie came, things got a little easier. She had a calming presence, and she was also able to help reduce the back labor by pressing as hard as she could at a specific point on my hips; this opened up my pelvis so that there was less pressure on my spine. Lizzie would get quite an arm workout for the next 8 hours – she kept up the hip counter-pressure until I started pushing.

Early labor was a worrisome experience. I kept thinking something was wrong – wrong with the labor for being so painful, wrong with me for being so susceptible to the pain, so unwound – but Lizzie assured me that this was all normal. With Lizzie and Greg’s support, I was able to get into a rhythm. My contractions came in doublets: two, closely spaced together, a longer pause, and then two more. I was scared, but I felt confident that my labor was progressing. We used an ipod app to track the timing of the contractions. Greg made us breakfast, although I couldn’t eat.

By 7am, I was unable to speak during the contractions and I wanted to throw the ipod against the wall. A growing urgency overcame me. I felt slightly panicked. The pace of contractions had quickened, and something felt different. We decided it was time to go to the hospital. I originally planned to walk – we are only 4 blocks away – but I was quite nauseous and did not want to throw up in public. We called the dog sitter, grabbed our overnight bag, and took a short car ride to the hospital.

The hospital: checking in

Upon check-in, the hospital required that I go through a nonstress test, where I would lay on my back and be attached to a fetal heart monitor for 20 minutes. The purpose of the nonstress test is to make sure that the baby’s vitals are good during each contraction. Its usefulness is debatable. There are alternative methods.

It’s hard to describe how lying on my back/side transformed my labor for the worse. The back labor was already incredibly painful. The contractions, which I had been experiencing in 6-10 minute intervals for 18 hours, were difficult. Being horizontal and not being permitted to move with the contractions was simply unbearable. It placed all of Jack’s weight against my spine. Before the nonstress test, I coped with the contractions by controlled, loud vocalization on each exhale. After the nonstress, “loud vocalization” became “screaming”.

A doctor came in to check me at 7:40, and it was a rude and unpleasant experience. I was 4cm, barely admittable. It was hard to believe that I could be only 4cm. In fact, looking back, I don’t believe it. I think, during the pain of lying on my back and from the forcefulness with which the doctor checked, I de-dilated. However, in that moment, the news of only being 4cm was incredibly demoralizing to me.

The hospital: laboring

Lizzie, helping keep me calm between contractions

We were admitted to a labor and delivery room, and Lizzie joined us. The nurse was amazing. She was incredibly supportive of my wish for an unmedicated birth. She asked me if I wanted to be asked for any pain relief during labor. I said “no”.

I kept changing positions with each contraction. Upright, leaning against a wall, sitting on the birthing ball, holding a birth bar, hanging over the edge of the bed, in the shower. Nothing helped. The contractions radiated from my back to my entire midsection, and the pain I was experiencing did not dissipate for a single moment. Each one consumed me to the point that I couldn’t process anything except how unbearable the situation was. I imagined I was being tortured: I would have said or done anything to escape it.

I felt certain that I would not be able to deliver Jack. I kept saying that out loud: “I can’t do this. I can’t do this”. Lizzie and Greg tried to convince me otherwise: “You are doing this”, they said. Secretly, in my head, I was begging for a c-section. Externally, I just cried and said disparaging things about myself.

I’m not sure why I didn’t ask for an epidural. I think my mental stubbornness was the only thing I had left.

At 9am, they checked me again. Unbelievably, I was 8.5cm – having dilated 4.5cm in less than two hours. Just goes to show you that cervical progression is a load of crap. While checking me, the doctor accidentally broke my water, and we learned that there was meconium in the amniotic fluid. At that point, an epidural was no longer an option. I felt some fear – that I couldn’t get pain relief even if I asked for it – but I also felt some excitement – I had gotten this far. Needles brought Jack into my body, and needles kept him healthy while he was there, but I would give birth naturally.

From 9-11am, I experienced “transition”, which is the most difficult period of labor, during which the baby begins to descend through the pelvis. I do not remember much from this period of labor.

I was so pissed at Greg for taking a photo of me so deep into labor -- I was in pain, for goodness sake! But I'm glad he did capture this moment

The hospital: pushing

At 11am, I started feeling the urge to push. I was nearly 10cm and the nurse gave me the go ahead to follow my body’s cues.

I pushed for an hour and a half. Pushing was a mixed experience. Compared to the horror of transition, pushing came with a degree of relief. Many women say that pushing through the contraction helps take away the pain. For me, each contraction was different. Occasionally, a push would feel right, and my physical effort would transform the pain into something my mind could work with. Most of my relief came from the 2 minute “naps” I had between each contraction. When a contraction came on, Lizzie and Greg would lift me up so that I could push. I distinctly remember the feeling of growing dread that came with the start of each new contraction, and the weird relief of falling back against the bed when it was over.

One of the most shocking parts of labor was the realization that even though “I” was pushing (as in, my conscious self was choosing to bear down) my body would push whether I made the effort or not. The only experience I can think of to compare it to would be forcefully throwing up – when you know it’s going to happen, and you know you can facilitate it, but you’re dreading it, and your body will do it whether you like it or not. For the last hour of labor, I would start pushing as a contraction came on, and then suddenly my body would take over and every single muscle in my body would seize into action with far greater strength than I was able to muster through my conscious effort. The way that my body would take over was violent. I felt violated by the contractions. This aspect of labor was terrifying to me, but, in retrospect, I can see how my body was functioning exactly as it should.

There was one position that worked well for me. I was up on the bed and they wrapped a sheet around the “squat bar” (this is a bar that you can hang on to, to support your weight). I leaned back against the bed and wrapped the sheet around my hands. Then, with each contraction, I pulled as tightly as I could. This position was helpful for me, because it made me feel like I was doing something, and my arms were the last part of my body that had strength left in them. My arms were incredibly sore for days after!

People – the books – say that during labor, every woman reaches a point of realizing that they baby has to come out one way or another, and that’s the point at which she works through the pain and pushes with full force. For me, this happened about 30 minutes before Jack was born. I was entirely convinced that my body was splitting in two. I was scared, and I was starting to hold back. Lizzie assured me that I was not ripping. From that moment on, I reached down for every spec of energy I had left. Originally, I didn’t want to look in the mirror, but they showed me Jack’s head and I became desperate to push him out. I roared and I screamed and I finally didn’t focus on the pain: I just pushed. And out Jack came.

The hospital: Jack arrives

The moments immediately following Jack’s birth are a very confusing time for me to explain. Let me start with my expectations.

I expected that once Jack came out, the pain would subside a little bit. I knew that some women were permitted to reach down and pull their babies directly onto their chests – I hoped that would be me. We had requested that the umbilical cord be left intact, so that the cord blood, rich in stem cells, could make it into the baby’s tiny body. I assumed that Jack would be placed against my skin. I thought we would lie there for a while, that I would deliver the placenta, and that they would stitch me up.

The part about having Jack on my chest was very important to me, for purely selfish reasons. There are many physical and emotional discomforts to being pregnant. IVF is an intensely physical and emotional process in itself. At every moment of mental hesitation – whether it was giving myself an intramuscular shot of progesterone, turning down the food that I enjoyed, or feeling my skin rip as Jack grew – I daydreamed about one thing. I pictured the sensation of having my baby placed on my chest immediately after birth. It was impossible for me to think beyond birth, because I could not imagine what being a mother would feel like… but I could imagine the baby outside of my body, and I could imagine the warm weight of a newborn infant against me. It is hard to describe how important that moment became to me.

So what actually happened? A number of things that shouldn’t have.

There was meconium in the fluid. Here is the proper medical protocol. If the baby doesn’t cry immediately, the doctors suction him to make sure he doesn’t inhale anything when he does cry. If the baby cries right away, nothing should be done, because suctioning at that point provides no benefit and could cause damage. There are many scientific studies to back it up: if a baby cries, he should not be suctioned.

When Jack was born, he cried. I remember his cry so well. It was the most beautiful sound I had ever heard. I remember the rush of emotion, the realization that he had arrived, that it was over, that it had begun. I remember his perfect face. I remember Greg exclaiming. I remember this as the most intense moment of my life. I can hardly write the words to explain its beauty.

And within 5 seconds, the doctors clamped the cord, cut it, and took Jack away from me. They suctioned and intubated him.

And then my doctor began pulling on the umbilical cord to force early delivery of the placenta.

And then I began to bleed.

And then they hooked me up to an IV and a Pitocin drip.

And then they refused to let me have my baby. I asked again, and again, and again. I will never forget the calm reaction of the doctor. To every request, she replied, “No, not yet.”

Jack was fine. He was gorgeous and perfect and crying and blinking in the bright light. Greg unbuttoned his shirt and held him close the entire time, providing him with some of the benefits of post-delivery skin to skin contact.

I was not fine. I was aching for my child. I was frozen in the intense pain of childbirth, and completely helpless to do anything but lay on the table and watch him from across the room. I was shaking violently and hyperventilating. I was hysterical, but I was so physically incapacitated that I couldn’t argue. Greg was worried for my health and could not do anything except take care of Jack. Lizzie held my hand and communicated her confidence and compassion for me with a steady gaze (as a Doula, she was not permitted to intervene with the doctors on my behalf).

I asked the doctors for my baby at least 5 times, but they wouldn’t let me have him. I still don’t understand why.

For 20 minutes, they worried about the bleeding. They reached back up inside my uterus to search for torn placental tissue. They turned up the Pitocin (synthetic oxytocin) drip, to produce contractions that would hopefully tighten up the blood vessels that were broken. I find the situation to be incredibly ironic – here was my baby, 5 feet away from me, the most perfect, whole source of the oxytocin hormone in existence, and they hooked me up to an IV to give me synthetic oxytocin. Then came 20 minutes of stitching, where they repaired some minor (let me emphasize the “minor” part) tears and cleaned me up. During this entire time, Jack was in Greg’s arms, not mine. None of it makes any sense to me.

Understanding it all

Jack, where he should be

Eventually, Jack was in my arms. It was startling to see him, to see this little being out in the world, his eyes open and looking into my own. It felt perfectly confusing and perfectly normal at the same time. I had never experienced a transition so abrubt: one moment Jack was an idea, a part of my dream, and the next moment, he was there, alive and in the world all his own.

I wouldn’t say I felt love, but I did feel shock and awe and infatuation. I felt obsessed from that moment onward. I wanted to absorb every single feature of his tiny face. I wanted to envelop his fragile body in my arms and hold him close, to never let him go. I placed him on my chest. Even after 40 minutes away from me, Jack knew exactly what to do. He hunted around and latched on without any help. He wanted to suck and he wanted to sleep.

Speaking of sleep, I was exhausted. After holding Jack for about 15 minutes, I needed to sleep. I gave him to Greg, and I drifted off. Greg took Jack to the nursery for a bath, and we were reunited in a room upstairs.

I was so fortunate. The postpartum period was a beautiful time for me. I had so much energy and felt so good after birth. The recovery was physical, and the adjustment was emotional, but it was a good time.

We never did get a picture of the three of us facing the camera, right after birth. This one will have to do.

Still, it took me a while to process birth. I don’t like anticipating things, and so my way to prepare for childbirth was simply to not think about it. That may have been a mistake, because I never truly prepared myself for how challenging it could be. The last piece of advice I received was actually from my boss, who told me as I was leaving the office: “I hope that birth is the most traumatic thing you ever experience, as in, I hope you never have to go through anything more traumatic than this will be”. I remember brushing off his comment, but now I understand it. Birth is very violent, and I felt... tricked... to find out that we enter the world through such violence. Nobody warned me that life began with such horrific trauma. For a while – weeks – I felt foolish for my choice to give birth naturally. What was I thinking? How could I have been so stupid? Something must have been wrong with the birth. Why does it have to be that way?

I had read so many natural child birthing books, where they try to convince you that you can do it. They talk about how you can deal with the pain, how birth doesn’t have to be painful. But they missed the point. It is indescribably painful. It is incredibly violent. It is overwhelming and terrifying. It is the most biological powerful process I can imagine. Giving birth is not something you do. It is something that is done to you.

And in its own way, birth is beautiful. The moment that I pushed Jack out of me, that I saw his face and heard his cry, I thought, “I’ve got to do this again”.

Crazy, right? No, that moment and that thought felt more right to me than anything else in my life. I do believe there is something about natural birth, about the flood of hormones, the contrast of the extreme trauma with the beauty of life… it is how it should be. As one friend put it, "This is how we enter the world: intense pressure, and then release. What more important lesson is there?"

Giving birth to Jack was not empowering or strengthening. Perhaps it is more appropraitely summed up as humbling and life-altering. Many people have asked me if I was glad to have given birth without medication. Initially, I wasn't sure. I would mumble something self deprecating about my foolish choice and sum up my confusion as "I'm not sure". Now I am sure: yes, and I hope to one day give birth naturally again. In no way do I think an epidural is a bad choice. If anything, experiencing birth has taught me how varied our experiences are. If anyone had even hinted at the possibility, I would have taken one. If I had not dilated so quickly, I would have taken one. If Lizzie and Greg had not been there, I would have taken one. However, by the same token, I do not regret the natural birth. I am, in a strange way, grateful for the experience. I believe it was the right choice for me, and although I cannot be certain, I believe it was the right choice for Jack.

Jack, born on 7/18, 8lb even

And so Jack is here, and his horrifically painful birth is a memory for me, stored away in the back of my mind and forever clouded by my tangled emotions and muddled recollection of the postpartum days. Much remains for me to process and understand. There are lessons in the experience. Perhaps, given a lifetime, I might learn some of them.

For now, there is simply love, existence, and movement towards each new day.

How I will always picture my baby

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