Monday, 28 February 2011

Our birth story

On the eve of her turning six months old, here it is. I had a hard time getting it out there because I don't think all the words in the world can accurately convey the powerful emotions that surround the birth of one's child. I still don't think I did that day(s) justice, but here goes. And thanks to Lamb, Steve, and one of the midwives, Mary, for wonderfully taking pictures throughout. It means the world to me to have those.

Friday, August 27th. Steve worked that Friday, five days past my due date. Marmousch came over and spent the day with me. She had been doing that whenever Steve worked for the past week, since I was miserable from PUPPP and both of them had an absurd vision of me driving to pick up Steve from work if labor started. We had a relaxing day at home and in the early evening headed to a downtown Vero thing put on by local businesses. It turned out to be fun with cupcakes, popsicles, and open-mouthed stares at my massive belly. Marm dropped me back off at the house just before Steve came home. To him I casually mentioned a recent increase in discharge which I didn't think was a big deal but he insisted I call our midwife, Tammy, about. She affectionately calls Steve her 'radar' and had been saying that I was the kind of mom who wouldn't call her 'till I was on the toilet and pushing, not wanting to bother anyone before. She's probably right, I hate inconveniencing people.

But I did call Tammy, more to make Steve happy than for anything else. She asked me to do a fetal kick count and then text her back, which I did, and everything was great. Then about an hour later she texted again asking if it was okay for her to come over; she wanted to make sure I wasn't leaking amniotic fluid. It was about 11:30  pm and reading this message I was suddenly wired. Although I felt badly about her having to drive an hour each way for what was sure to be a false alarm, I did want some peace of mind that everything was okay. Steve laid down for a nap, still thinking he would be going to work in just a few hours. I made granola in an attempt to distract myself. Didn't work.

Tammy arrived and almost immediately swabbed for amniotic fluid...lo and behold, its color indicated that my bag of waters had indeed broken. Since we didn't know how long fluid had been leaking (although I was pretty sure it had only been going on that day), labor now had to be jump-started. Suddenly everything started happening very quickly. Steve made a coffee and mountain dew run for himself and Tammy, who would be settling in for the long haul. Meanwhile my membranes were stripped (yeesh), I was given a black cohosh mixture to drink (blech), and evening primrose oil was inserted with me having to lie down for at least 30 minutes to let it all take effect. I remember lying in bed, in the dark, sadly thinking that this wasn't at all how I had pictured my labor beginning. What happened to contractions waking me up in the middle of the night, lovingly whispering in Steve's ear that today was the day, and our excitement gradually building? And I was annoyed that our baby was going to be sharing a  birthday with our nosy neighbor and I was going to have to hear him gloat over that fact. Petty I know, but this is what was racing through my mind. But I was going to have to let go and accept this new course. I didn't have time to dwell on it for very long anyway. After the membrane stripping I was dilated to 2 cm and 80% effaced. I called Marmousch and Lamb to let them know this was going to be the day, but not to come until morning since it would probably take awhile for things to progress. It was around 1 am by now.

Tammy suggested a walk around the neighborhood so Steve and I headed out into the muggy night as the birth pool was being filled up. My contractions were coming 3-4 minutes apart and for really intense intense ones I had to stop and sometimes crouch down. Looking back, we must have been quite a sight to all the night owls driving by at 2:30 in the morning. One poor neighbor got vomit on his lawn--not once, but twice-- while I leaned against his mailbox for support during difficult contractions both at the beginning and end of our walk.

Upon returning Tammy suggested I take a long, hot shower doing a few things to further intensify contractions. Things were definitely upping in intensity but manageable, I was breathing through them, and all was going really well. You've got this, Tammy said. It was encouraging to hear. At the end of the shower Tammy checked me and I was 3-4 cm, then I headed to the birth pool and spent what felt like an eternity in there. (It ended up being my favorite place to labor and at that point didn't yet look like a war zone.) I asked Steve to go ahead and have my mom come over since I was 99.9% sure she wasn't getting any sleep at home after my phone call. (I was right and true to form, she had been cooking.) Around 5:30 I was 6 cm and our midwife suggested we call Lamb to have her leave Jacksonville now since things were progressing quickly. We texted our family and close friends letting them know I was in labor and asking them to keep us in their thoughts and prayers today. My mom came in true Italian style with a ready-to-be-plugged-in bread machine, pasta dish, coffeepot. The smell didn't bother me at all, although I definitely wasn't partaking. I was still vomiting during intense contractions. See the silver bowl designated for puking in the second picture? :) In fact, soon after I got an IV put in providing dextrose for hydration.



I was pretty quiet still, even during contractions (aside from retching noises). I could hear snippets of conversations going on, and songs from my birth playlist in the background (some of my favorites: Turn! Turn! Turn! by The Byrds, Rascal Flatts' Bless the Broken Road, and Sarah McLachlan's Ice Cream) but I was removed from all that in order to focus on getting through each contraction. Lamb finally arrived and after another dilation check Tammy announced I was 9 cm. There was just a lip of cervix left.

Oh, transition. How I hate thee. This was around the time that Steve got in the pool with me and was applying strong pressure to my lower back with each contraction. It was suggested I labor on the toilet, and with each contraction I would cry out for more lumbar pressure--that felt so unbelievably good. Steve, Marmousch, and Lamb were all taking turns sitting on the birth ball directly in front of the toilet as I sat on it backwards to try and open up the remaining cervix. I played musical chairs of different labor positions going from the toilet to the bed to the pool to the birth ball for what felt like hours. Actually, it was hours. Before going into labor I had read everything I could get my hands on about what to expect; I knew this part was the most difficult but for most women, the shortest. Unfortunately, in my case it ended up lasting hours. I asked my midwife to check me again, and I was still at 9 centimeters. Of all the places to stall out! Being so close to full dilation, I could feel a tremendous amount of pressure, but the midwives (assistants had arrived by now) were asking me not to push, rather, to breathe through those contractions in order to get to complete. Talk about impossible. That right there was the hardest part of all. I would try with everything I could at the start of each contraction to just breathe, but at its peak I couldn't help but give into the pressure, feeling like a big fat failure with no end in sight. That's when I started to lose it. Just take me to the hospital noooooooow, I said. I tried but I just can't do it anymore. To my poor mother I kept wailing, please help me please help me please help me over and over--she told me that if she could, she would take the pain away and give it to herself. There is no one like your mother in times like this. My midwife was steadfast and firm and just kept telling me how I was already doing it, how I was strong, how this too shall pass, how I was so close. At one point she came over to me in the pool and read me this verse from Isaiah, verse 66:
My holy city is like a woman who suddenly gives birth to a child without ever going into labor. Has anyone ever seen or heard of such a thing? Has a nation ever been born in a day? Do not think that I will bring my people to the point of birth and not let them be born.




After an eternity I finally reached completion. After all that time begging to push, it felt surreal to finally be given the green light. We were back in the pool. It was such a tremendous relief to push. It's funny how before going into labor I had pictured myself being a quiet birther, stoically breathing through even the toughest parts. But when it was really happening, I was loud. LOUD. I could have cared less if my irritating neighbors heard me (for the record he is really, really irritating; he even knocked on the door asking if he could mow the lawn in the middle of all this...thank goodness for diplomatic midwives.) Everything else fell away. After a few pushes Tammy told me I was close, really close. She could feel the baby's head (although  it turns out what she was feeling was actually caput, swelling of the baby's scalp). She wanted me to feel too, and I did, but honestly was just like fine, fine, let's get on with this. I want this baby here already.

Now it was just a matter of pushing the baby's head under my pubic bone. Unfortunately I wasn't one of the three-pushes-and-baby's-out kind of women. After not making much progress lying in the pool, Tammy wanted me to go to the bed. They told me to take a huge breath in, bring my chin to my chest and push with everything I had with each contraction, then quickly fill up with air and push again until it was over. And not completely relax in between lest I undo the progress that had been made during the pushing. I had to be reminded to relax the tension in my face. It helped when they would put their hand exactly where I was to push against, and after awhile I got the hang of it although Tammy knew how to motivate me when she would say C'mon Tania, you're not doing anything! I said PUSH! After each push I would yell out whatever was left in my lungs--how the police were not called by our neighbors on charges of domestic violence I have no idea, because those were blood-curdling screams. The midwives would tell me to breathe it away instead in order to save my energy and to channel it towards the pushing.

I wasn't aware of it at the time, but later I would find out that the baby's head had been occiput posterior, head down but facing my abdomen rather than back as is typical. Sunny side up. The midwives knew this but didn't want to worry or discourage me, since having the baby in this position makes it more difficult for its head to descend past the pubic bone. 

Pushing from the traditional lying-down position wasn't getting me any further, so Tammy wanted me on my hands and knees. Which I initially protested against but soon didn't care what I looked like. No real progress there, either. Then squatting on the floor. Back to the bed. If this sounds long and drawn-out, that's because it was. Hours of pushing. To me it didn't feel that long, though; I was in a time warp. I was just focusing on each contraction as it came and time fell away. But when I started pushing there was still light streaming in through the windows and by now it was pitch black outside. One of the assistants, Mary, spotted the rosary hanging from our bedpost and asked if I was Catholic, and soon she, Marmousch, and Lamb were all saying the Hail Mary out loud during my pushes. That was one of the most powerful moments of the whole experience. I couldn't join in but I was saying it in my head to get me through.

Finally after one contraction Tammy turned to me and said "Tania, if the baby doesn't come out in the next three contractions, we're going to the hospital."

I thought she was joking. Either that or she was mad at me for my earlier defeatist statements back during transition when I had been begging for a hospital transfer. But now? Now I was in this. I had this. I was giving it everything I had with each push and knew that sooner or later my efforts would be rewarded with our baby. There was no need for a hospital now! Compared to the hell of transition, this was a cakewalk. All right, maybe not a cakewalk, but I could definitely keep going. But no, she explained--it was dangerous to keep pushing without further progress being made.

I was devastated. As Tammy and the other midwives were getting all their equipment together to load us into the car for a hospital transport, I stood in the bathroom with my mom, both of us sobbing. My eyes fill with tears just remembering that moment. With each contraction I was still pushing (I am going to get this baby out by myself, damnit!) and Lamb came over to us and was like, why are you crying? This is the safest thing to do. It's just too risky at this point. In my heart I knew she was right but it was still heartbreaking nonetheless. Our plan for a home birth had failed. I had worked so hard and given everything I had, but it wasn't enough.




The other thing that scared the bejesus out of me was envisioning a bumpy car ride with this baby's head literally in between my legs. I somehow put on the dress I had started out in 22 hours ago, didn't bother putting on underwear, and Steve helped me into the passenger seat of our SUV.

He drove, Tammy was in the backseat, Marmousch and Lamb followed in another car, and the assistants pulled up the rear of our anxious little parade at around eleven o'clock that Saturday night. Thankfully we don't live far from the hospital, and at this time of night there was little traffic. I honestly don't remember much of that drive. I know I pushed and moaned and groaned with each contraction just because there was no other alternative.When we got to the ER entrance Tammy wonderfully materialized with a wheelchair before I could even get the car door opened. I was wheeled straight up to Labor and Delivery (felt every bump in those hallways!) and immediately nurses hooked me up to the fetal monitor and started prepping me for a c-section. Steve, always my biggest advocate and in this moment my voice, started arguing with the staff that we at least wanted to talk to the OB on call about the possibility of still trying for a vaginal delivery. It didn't look good, though.One of the hospital midwives said, "Look. Mom's tired. The baby's got to be tired (although said baby was looking great on the monitors, strong heartbeat). We need to get this baby out."


The obstetrician came in. He took one look at me and predicted that I had an 8 or 9 pound baby in there. All along Tammy had been predicting a smaller baby, 6 or 7 pounds. But he granted me one trial push and apparently was optimistic about what he saw, because he told the nurses to get him an episiotomy kit and the vacuum. And so I started back again in the familiar pushing, this time with Steve at my head, nurses on either side of me helping to hold my legs up and back, and the good doctor at the end. My mom, sister and the three midwives were also off to the side, watching. Hoping. Championing me on. I can do this. I got the episiotomy during one push and the vacuum suction was attempted. POP. It failed. I heard my mom gasp and I thought it was the baby's head crowning, but it was just the vacuum popping off scaring the heck out of my poor mom. "I can do the vacuum once more but that's it," the doctor said. "It's contraindicated to try more than two times." I told the nurses to hold my legs and butt up to the ceiling if they needed to, if that's what would make this baby come out. They laughed. I wasn't kidding, I was desperate.

So on that next contraction I thought for sure it was going to happen. But again that POP, and I just had to look over at my husband when the pushing was done to know that it had failed again. I'm sorry, the doctor said. We have to do a c-section. Just let me try one more time,  I begged. He agreed. I knew it was now or never, this was when it had to happen.

...I wish I could tell you that I somehow was able to push our child out in that last contraction, that in that do-or-die moment my body came through. But our story has a different ending. Now I was being wheeled to the operating room.  Steve was crying as he kissed me and told me he would soon be in there with me. My mom was crying and told me she would be right there when I got back. I met the anesthesiologist while being wheeled into the OR and before I knew it, was sitting on the gurney for my spinal. At this point I was physically and emotionally exhausted. I had been actively pushing for over 5 hours and was now trying to wrap my head around a c-section delivery. Best-laid plans, gone. I felt numb.

Steve was allowed in the room at the very last minute. The surgical team told me they were making the incision. I wasn't expecting to hear the baby's cry right away--there had been a light green stain on one of the pads I was sitting on while in the wheelchair, indicating meconium--and there were staff waiting to suction the baby. But again I was wrong; I heard that high-pitched cry immediately. Good healthy cry! And in that same instant I heard the doctor say, in my opinion all too calmly (because for me it forever changed my life),
It's a girl.  
And just like that, at 1:25 in the early morning hours of Sunday, August 29th, 2010, there was a Mila in this world. Our Mila. Our precious, perfect, amazing Mila. 8 pounds and 6 ounces (the doctor was indeed right).

 And I was chosen to be her mother. We were sealed together forever, now.


All throughout my pregnancy I had been telling myself I was having a boy. But in that moment it was like the floodgates opened and I finally let myself embrace the idea of tea parties and dolls in childhood and a best friend in adulthood. I think it's what I had been secretly hoping for all along, but never wanted to say out loud or even think it.

I had wanted them to put her on me, skin to skin, right away; the staff gently refused, saying they needed to check her over. And because of that damn blue curtain blocking my view from my chest down, I didn't even lay eyes on my daughter until she was a couple minutes old. That breaks my heart. I understand my c-section was a necessity, but I still hate the sterility of what it was. Upon seeing her Steve had immediately exclaimed something like OH MY GOD and had moved over to the bassinet where she was being examined. (He got an awesome shot--below--of her all curled up in my belly right before they pulled her out). I kept trying to push aside that blasted blue curtain to see her but instead was hitting one of the OR nurses who was on the other side of the curtain. Eventually she asked me to stop :) I couldn't help myself, I was dying to meet my daughter. Steve did come over during all this to tell me SHE'S HUGE...AND SHE'S BEAUTIFUL!!!! I write that in all caps and multiple exclamation points because that's how I remember him saying it...he was shouting and half-crying and the happiest I have ever, ever seen him.

After what seemed like an eternity they set Mila down on my chest. She was still crying. Her eyes were two huge pools of charcoal, the color of steel. We locked eyes and there she was, larger than life.
And my life changed forever.
I felt this instantaneous swelling of love so huge I swear it could power all 7 continents had it been bottled up. I felt so profoundly connected to this little person. Even in those next few weeks when sleep deprivation and hormones set in and things got difficult--I may have been frustrated at the situation, but never resented this sweet angel with the huge pleading eyes looking up at me.




And that is pretty much it. Or rather, the beginning. After that they whisked her away again, and Steve went with her, and it took another eternity to close me up (including the episiotomy) before I was finally reunited with my family which was now plus one. Essentially what led to my c-section is known as cephalopelvic disproportion, where the baby's head is too large to fit through the mother's pelvis. That, coupled with her sunny side up head position meant a losing battle for me. Do I regret having attempted a natural, unmedicated home birth only to end up with a c-section? No. The short answer is that I am ultimately so thankful for the experience and now feel as though I can do anything. But it's been a process getting to that point. Boy was it ever humbling...in retrospect a great segue into the great world of motherhood where nothing ever goes quite as planned and there are surprises at each turn. One of the midwives later told my mom that the way Mila never showed any signs of distress during such a difficult labor was a testament to how well I had kept myself and thus our baby by running throughout my pregnancy. (At home the midwives had tracked the baby's heart tones frequently with the doppler, and she never once wavered. Such a fighter! My tough girl.) I don't know if she was just saying that to be nice, but it makes me feel a little better on some level.

And I don't yet know about a VBAC for our future children. That's a personal decision that I've tabled for now and we'll have to consider our circumstances carefully when the time comes. I hated the recovery from my c-section (and episiotomy...aren't I lucky...)--but I think that is mostly because I was emotionally unprepared for it. At least next time, the possibility of surgery will never be far from my mind. I am very thankful for the wonderful OB who was on call that night. He allowed me to exhaust every possibility for the kind of delivery I wanted, so that I know in my heart we did all that we could.

I do know this: I would do it all over again, every single second of it, for our daughter. She is worth it. I love you, Mila.

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