Wednesday, September 25, 2013

The Longest Birth Story Ever Written

Seriously, this birth story will take longer to read than the actual birth took. But it was therapeutic for me to write and I'd like to have it for my kids to read someday, so I didn't want to leave out anything. Kudos if you make it all the way through. My husband can't even be coerced into reading it. :) 



The Holy and the Broken: A Birth Story


“And even though it all went wrong
I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah”
–Leonard Cohen, “Hallelujah”

Almost two months after the birth of my second child, I’m still struggling to write the birth story. For one thing, the event was so overwhelming and powerful I find myself at a loss to recount it adequately. Second, I’ve only done academic writing for years. I’ve spent hours planning how to structure the birth story, how to conform the story to an outline I would use for an academic paper. I’ve tried in vain to examine the birth from every perspective and derive a thesis, a theme, an angle for my story. Simply telling the story feels uncomfortable, but I finally decided to do just that before more time passes and the memory fades.

So here is my thesis statement, if I’m going to have one: This is a story about bovine noises, and the Force, and how I found peace with two births that did not go at all as planned. How I found unspeakable gratitude for two births that did not go at all as planned.

I’ll get my disclaimers out of the way first. This is excessively long, in the grand tradition of birth stories (especially VBAC birth stories, which are often a two-for-one package). Please ignore any grammar or mechanical errors; I rarely get more than four hours of sleep per night these days.

This is the story of MY journey, which includes a cesarean birth and a vaginal birth after cesarean (VBAC). I am not interested in judging or speaking for other mothers who chose cesarean or VBAC deliveries. Each circumstance is unique and each set of parents needs to make the best decisions for their family. My feelings about my experiences are mine and I am not interested in defending them.

I am a hospice nurse by profession. I’ve worked long-term with pediatric hospice patients, their parents, and their siblings. I’ve fretted alongside parents when no combination of medication seems to be making the seizures stop. I’ve tried my best to explain to elementary school-aged kids what it will look like when their sibling is at the end of life. I’ve passively stood as the punching bag when parents are rightfully so angry and need somewhere to release it. I’ve felt tremendous guilt when I bear witness to the struggles these parents face every moment of every day and know I’ll be going home to my own healthy child.

I’m not sharing this to say I fully understand the depth of tragedy these parents have faced. I’m trying to say that, more than many people, I’m always mindful that life isn’t fair. No mother gets any guarantees her kids will be healthy or live long lives. Some parents don’t even get moments with their kids because of miscarriage or stillbirth. Some parents never get to be parents because of infertility. I get it. I’m lucky to have my babies, no matter how their births happened.

Still, many women who have had unwanted c-sections (myself included) have a visceral reaction when well-meaning people comment “At least you have a healthy baby. That’s all that matters.” Nope. The healthy baby is, by far, the most important thing, but it isn’t the only thing that matters. For some women, giving birth is a rite of passage. The experience can be a very significant initiation into motherhood. It’s not unlike planning a wedding day, even though the bride knows the marriage is the important part.

During my first pregnancy, I prepared so I could have an intervention-free birth by practicing childbirth hypnosis for hours every night, reading everything I could about birth, practicing “correct” postures and movements to keep the baby in optimal position, and eventually following a very limited diabetic diet. When I didn’t experience the birth I had worked so hard to achieve, I felt traumatized. I felt I had given away my power and not trusted my own parenting instincts when I should have. From the moment my son left my body, my first thoughts as a mother were of doubt in my own parenting skills because my judgment had been so faulty.  



“I know the things you wanted
They’re not what you have”
–Guns N’ Roses, “Don’t Cry” alternate lyrics

Like every VBAC birth story, mine starts with a c-section. I’ll share the key points leading to the cesarean: I was diagnosed with gestational diabetes when I was about seven months pregnant. My midwife informed me that labor would likely be induced if the baby wasn’t born by 39 weeks’ gestation because of increased risk to babies of gestational diabetes moms. It was standard practice at that office. I was uncomfortable with this because first time moms who are induced are more likely to end up with a cesarean delivery than first time moms who aren’t induced. Additionally, the information I found indicated the risk of harm to the baby was not significant if I avoided the induction.

After refusing induction at 39 weeks, I went along with it at 40 weeks despite my research. I remember thinking, “What if my baby is that one baby in 1000 that dies because I didn’t go through with this induction? Can I live with myself?” So I showed up at the hospital at 7:00 a.m. on a Monday morning, full of resentment and disappointment. In case you missed the point, I did my homework and still chose to go ahead with the induction. I am fully accountable for my decision and I can’t plead ignorance. I live with that every day; it was one of the most difficult aspects of my son’s birth.

Twenty four hours into the induction, I was exhausted and dilated to only one centimeter after hours of hard contractions and back labor. Hypnosis had been helpful until that point but took energy and focus to maintain. I was so tired I was no longer able to focus on the hypnosis. Despite my desire to have an unmedicated birth, I began asking for an epidural. It wasn’t because the pain was unmanageable, it was because I was so tired and just wanted to sleep. Nate (my husband), my nurse, doula, and midwife all tried to remind me of my wishes, but I continued to request the epidural. (A proud moment was when I said, “All the other girls get epidurals, why can’t I have one?” in the whiniest voice imaginable.) An anesthesiologist eventually came and administered my epidural. I believe this was the point in my labor when I “checked out” emotionally. I dilated to 10 centimeters after a few more hours and pushed for two and a half hours without any luck. I was already so disappointed in myself for caving and requesting the epidural that I agreed to a c-section for “failure to descend” without much thought. I was beyond exhausted and just wanted the baby out so everyone would leave me alone. I later learned my baby was asynclitic, which means his head was tilted in a way that his ear was touching his shoulder. This is probably why he didn’t come out despite my prolonged pushing.

I didn’t feel involved in the surgery at all. To my everlasting irritation, a Justin Timberlake song was playing in the OR when the surgeon removed my son from my abdomen. I had hoped my child would be born to a kick-ass song, maybe AC/DC or something. In my book, Justin Timberlake music is not something I want to remember in conjunction with an awesome moment. I’m still annoyed I didn’t think to ask the staff if I could provide my IPod dock or at least choose the radio station. When someone (I don’t remember who) announced “it’s a boy!” my husband was so excited. I didn’t feel any joy at learning the gender or even knowing my child was born; I only felt a pervasive numbness.

My first meeting with my son was the classic upside-down-blue-disposable-cap-wearing-mom moment, captured in several photographs for all posterity. In other pictures, my husband is holding our son and looking utterly captivated while I’m in the background (still upside-down), looking somewhat resentful that my husband is holding the baby before I can. Is that petty? Probably.

My physical recovery from the surgery was incredibly easy. Emotionally, I was completely defeated and grieving. The way I saw it, I didn’t give birth to my son; a
doctor cut him out of me. And how bitterly I resented having to give credit to the very establishment that pushed me to go against my already-present maternal instincts and induce my labor. The establishment that aided in my overwhelming feelings of failure as a mother on the day my child entered this world. I wrote in my journal, “My legacy now, since Van’s birth, seems to be fear, self-doubt, shame, disappointment, failure, resentment, and apprehension. I have something to prove to myself and nobody else now. I failed at one of my very first tasks as a mother by ignoring my instinct to refuse the induction.”

I can understand how some women think my reaction was melodramatic. Those same people may have difficulty seeing how a healthy baby isn’t the only measure of a “good” birth for some women. They may not see how the birth of a child is not necessarily the same thing as the birth of a mother.

For those people, here is my poorly constructed metaphor: Imagine you are the pitcher in a World Series game. You’re walking one batter after another. The game is close, but you are tired, and it’s showing. The coach pulls you and has another pitcher take the mound. Your relief pitcher is a success and your team wins the World Series after several strikeouts. Are you the kind of person who can feel excited about winning the World Series and forget how you personally didn’t live up to your hopes and expectations for yourself, forget that you only won because someone else bailed you out? I’m not. For me, the end usually doesn’t justify the means. Memories of that World Series wouldn’t be victorious, they would be memories tainted with shame and self-doubt and embarrassment. To compound those terrible feelings, I would feel horribly guilty for looking at my World Series ring, my reminder, and feeling anything other than unmitigated joy.



“Emancipate yourselves from mental slavery
None but ourselves can free our minds”
–Bob Marley, “Redemption Song”

When I learned I was pregnant with our second child, I immediately went to an International Cesarean Awareness Network (ICAN) meeting to find support in planning my VBAC. A woman named Kimberly, who was a doula and a midwife in training, was speaking at the meeting. I decided right away I wanted Kimberly to be my doula, based on her extensive knowledge and her assertive, yet gentle, demeanor.

I interviewed some different midwives and doctors, but everyone paled in comparison to my original midwife, so I returned to the same practice for prenatal care. With my team in place, I decided to work on myself. I sensed I would need to get out of my own way to have my successful VBAC.

I felt amazing throughout my pregnancy. My diet had improved drastically since my first pregnancy, and I was far more physically active. In my journal, I described my emotional pregnancy experience as “a sense of realization of my purpose in life. A feeling of completeness and wholeness. Connected with so many women, past, present, and future, that I’ll never even know. Primal. In connection with my own spirit. Satisfaction and fulfillment. I think the best word is full. This is the way I’m supposed to be. This is God’s gift to me and what he meant for me to be and to do.”

I followed the exercises in the Birthing From Within book and listed all my fears. Although I acknowledged them, I refused to give them power by fixating on them, which was very different from my attitude during my first pregnancy. One of my greatest fears was another gestational diabetes diagnosis, so I meticulously followed the diabetic diet from my first pregnancy. My attention to nutrition paid off and I passed the gestational diabetes screening.

I listened to my hypnosis tracks occasionally. Although hypnosis had been a useful tool for the first 24 hours of labor with Van, I wanted other tools at my disposal in the event I lost focus again. I didn’t construct a birth plan this time. With my first pregnancy, I labored over a birth plan that ultimately ended up being the exact opposite of everything that occurred. For this pregnancy, I decided to go with the flow and let things happen as they happened.

Because I was feeling so well physically, mentally, and emotionally, I wasn’t in a rush to deliver the baby, which was different from my first pregnancy. I tried not to let the constant “you’re still pregnant? When are you going to have that baby?” comments get to me. Braxton Hicks contractions had started around 32 weeks but really intensified as time went on. They got quite uncomfortable at times, but I felt so excited that my body was “warming up” for birth and doing its job.

The last few weeks of the pregnancy were incredibly exciting for me. I’d never gone into labor on my own, so each day was filled with anticipation and the realization that I could spontaneously go into labor at any time. (I refused internal checks at my midwife appointments, so I never had any idea if I was dilated. Not that dilation is an indicator of anything at all.) I really don’t think I can articulate how exciting each day was for me; I was so filled with gratitude that my body was being given the chance to do its work naturally.

On Sunday, July 21, I was scheduled to work from 8 a.m. to 8 p.m., as usual. I woke a little before 5:00 and decided to watch Mass on television because I would be working and unable to attend. I was at 40 weeks and six days at that point, so I also figured I’d be having a baby that week and wanted to start the week on the right foot from a spiritual standpoint. One reading was about Abraham and how he had a visitor who foretold he would have a child in the next year. I remember thinking, “If Abraham and Sarah could wait as long as they did for a baby, I can be patient a little longer for mine.” I took it as an omen of impending labor when I heard the gospel reading was from the gospel according to Luke. Luke was the name Nate and I had chosen if our baby was a boy (which I was very certain our baby was).

I felt fortified by my experience with the Mass and went on to have a good day at work. After work, I went home and helped Nate put Van in bed around 8:00. Van was behaving horribly, worse than ever. Nate and I joked that “maybe the baby is coming soon and this is like all the animals going crazy before a storm.”

Here’s where the story starts going not at all as planned.

Around 8:45, I started to feel some contractions that didn’t feel like Braxton Hicks. They had a pattern of building up, reaching a peak, and decreasing in intensity. I didn’t get too excited, because I’d had these same contractions about three different nights in the past week, and they always tapered off around midnight. After just a few contractions, though, I reluctantly said to Nate, “These are kind of different, they’re pretty regular and close together.” I didn’t want to time them because I didn’t want to get my hopes up, but I couldn’t help noticing they were about seven or eight minutes apart (there was a clock right across from me).

I decided to go online and read some stupid Yahoo questions and answers because I read (I think in an Ina May book) about how laughing helps labor to progress. I was sitting on the couch, reading questions and answers aloud to Nate, but I’d only get through maybe one question before I’d feel a contraction and get up to pace around the house. I strongly felt the need to move when a contraction came, almost as if I was trying to escape it. I may have looked crazy… cracking up at the Yahoo answers, breathing deeply, pacing around the house… Repeat cycle.

I estimate we made it through four Yahoo questions and responses before I told Nate, “I don’t think I can do this right now, they’re getting pretty intense.” I called Kimberly and let her know contractions had just started and were seven to eight minutes apart. I told her they probably wouldn’t amount to anything but I wanted to give her a heads up anyway. She said that was fine and requested I let her know if things picked up because she was with another laboring client (who was using her birthing pool) and needed time to get a backup pool from another doula. My plan was to labor at home for as long as possible so I could labor in water, which I wouldn’t be able to do at the hospital. I hoped to show up at the hospital pushing because I really didn’t want to labor at the hospital.

I decided it wouldn’t hurt to pack for the hospital, which I’d been saving for a distracting labor task (as I assumed my labor would be very lengthy again). I went into our bedroom and started packing but had to stop a few times for powerful contractions. They were becoming so intense it was a little frightening, so I put on a hypnosis track as I was packing. I remember getting on the floor on my hands and knees at one point. Then I, hoping the water would give me some relief, decided to get into our tiny bathtub.

I called out to Nate that he should call Kimberly again and ask her if she could bring the birthing pool now. I felt really guilty for even asking, because it was still super early in my labor, but my contractions were pretty intense. I filled up the bathtub and hopped in. Looking back, I can see how absurdly small the tub was for a pregnant woman. I had to roll onto my side to submerge my belly halfway, and it didn’t really provide much relief.

Nate came in to tell me Kimberly was picking up a backup pool from a doula friend and would be right over. I asked him to reference my hospital packing list and resume packing where I’d left off. He came into the room a few times, trying to help, and I think I snapped at him that it wasn’t a good time. I’m a little surprised, in hindsight, that I didn’t rely on Nate the way I thought I would during this labor. In every aspect of my life, Nate is my sanctuary, my battle partner, my compass. During my labor with Van, I fell in love with him all over again because of his amazing support. Therefore, I fully anticipated I would be dependent on him and probably very clingy as I labored this time. Conversely, I wanted to be alone in that bathroom to focus on getting through the contractions.

I was still not interested in timing my contractions. For each one, I’d roll to submerge as much of my belly as possible. I focused completely on vocalizing through low moans. I’m fairly certain I sounded like a demented cow, but it HELPED SO MUCH. I am sure my vocalizations (okay, cow sounds) were the most helpful tool in my entire labor. As each contraction would increase in intensity, I’d start to feel anxious. Being able to focus on and control the sounds I was making made me feel as if I had some control over the experience. (Aside: We are so lucky to have a champion sleeper for a child. I was laboring and mooing the entire time in a room about five feet away from where Van was sleeping, and he never even stirred.)

Around this time, I started to understand what the Birthing From Within book meant when it urged the reader to surrender to the sensations of labor. I’d really struggled with understanding that during my preparations, but it made perfect sense when I was in the moment. I didn’t try to escape the pain or the fear. I’m not sure if I should credit my hypnosis preparation from both pregnancies, but the pain of this labor was completely manageable. I would sometimes envision strong female Olympians to help empower me to be strong and get through each contraction. Other times, I’d pray to St. Mary. After each contraction, I’d say out loud “that is one contraction I’ll never have again” and focus on how good every part of my body felt at that moment.

Kimberly arrived before too much time had passed. Right away, she asked Nate to call Van’s nanny, Jenny, who had agreed to be “on call” for when we needed her to watch him. (Kimberly told me later my contractions were coming about two minutes apart when she arrived.) While we waited for Jenny to arrive, I positioned myself on my hands and knees in the tub, and Kimberly poured warm water over my lower back. I asked her to fill the birthing pool but she wanted to hold off, saying we may need to leave for the hospital before she had time to fill it up.

Jenny arrived and I asked Kimberly to check my dilation (she’s a monitrice and RN, so she’s qualified to do that). She tried and informed me she couldn’t even guess
centimeters “because the baby’s head is right there.” She said it was definitely time to go to the hospital. Kimberly helped me into my sports bra and one of Nate’s wife beaters. In a moment of absurdity, I told her and Nate I would just wear a towel instead of pants because I didn’t feel like putting them on. Somehow they convinced me to wear shorts and we set off for the hospital.

I climbed into the backseat of my car and hovered on all fours because that position felt the best to me. It was around this time, I believe, that I started mentally repeating the mantra “Use the Force.” (Yes, I’m a Star Wars fan, no shame here. Use the Force… Moooooooo… Use the Force… Moooooo.) Nate was calling Laura, the midwife on call, to let her know she needed to get to the hospital. She must have been having difficulty hearing him over my moaning, because he kept repeating “Mercy Gilbert. Mercy Gilbert.” I could only imagine how freaked out Nate was because I started grunting and pushing a little in the car. I remember saying “Just drive safe. I’ll hold it in until we get there.”

We got to the hospital around 11:30 and went through the emergency room. I must have been quite a sight to people in the waiting room. My hair was completely soaked from rolling around in the bathtub, I was kneeling on the seat of a wheelchair and hugging the back of the chair because I couldn’t stand the idea of sitting, and I was swaying my hips from side to side (while mooing) with my rear end in the air. Kimberly and Nate answered four thousand questions, then we were off to labor and delivery. I remember Kimberly getting annoyed and saying to someone, “Can we do this in a room? She’s pushing.”

For about an hour, I’d had my eyes closed constantly. I remember doing that during my labor with Van, too, maybe to help me focus? Because I had my eyes closed, I’m not sure if it was a nurse or a physician or who that informed me on the way to the elevator  I’d need to change into a hospital gown and provide a urine sample when I arrived at my room. I’m not sure if I laughed out loud, but I remember feeling more amused at that moment than at any other moment in my labor experience. I told him “I’m not sure I can give you a sample right now.” (Hello, understatement. I was kneeling on a wheelchair and trying to push out a baby.)

Nurses started an IV (I think two or three attempts in all because of my movement), blood was drawn, and they started running my antibiotic because I was positive for Group B Strep. More questions were asked and I was surprised I could answer clearly. I’ve read in birth stories that women become very focused inward toward the end of labor and aren’t always able to communicate with others. I remember feeling very aware the whole time. At one point, the baby’s heart rate dropped and I could hear it on the monitor. When the nurse asked to put oxygen on me (presumably in response to the drop in heart rate), I immediately agreed, saying “I know, I heard it.”

In total, I pushed for two and a half hours. Quiet in the room during my pushing stage was a very high priority to me, and I believe everyone respected that. If not, I must have blocked out any noise because I don’t remember any. I do remember asking Nate once to stop making conversation with someone, and I asked a nurse to stop directing my pushing when she tried counting at me, but otherwise, I think everything was pretty darn quiet, just as I’d hoped.

However, so many things didn’t go as I’d envisioned…

When I’d visualized my ideal birth, I’d hoped to start having contractions in the morning, after a good night’s sleep, so I’d have lots of energy for labor. But here I was, in the middle of the night, laboring after working a 12-hour shift. Things were going much more quickly than I ever imagined. I hadn’t had any time to bring or even think of using any of the music or inspiring imagery I’d planned. I didn’t have time to work on a labor project. I didn’t whine, complain, verbally abuse anyone, or really even use (excessive) profanity. I never experienced “transition” as so many women describe. I kept expecting it and it never happened.

I didn’t ask for pain meds, which I’d feared I might do. A nurse asked me if I wanted an epidural at one point. I said, “Isn’t it too late for that?” She responded, “No, it’s not too late.” I paused and probably looked like I was considering it, but this is what I was actually thinking: “I thought I was at ten centimeters. You can’t have an epidural that late in the game. I must be at two centimeters or something and they’ve been lying to me all along. Why am I pushing????” I managed to ignore those thoughts and refused the epidural.

My water didn’t break early in labor, which I’d worried would happen. Instead, the midwife, Laura, asked if she could rupture my bag after I’d been pushing for about an hour and a half. I agreed to this, hoping to expedite the process. I didn’t use thoughts of solidarity with other laboring women to inspire me, which I thought I’d do. And I didn’t get to use my This is Spinal Tap quote when the nurses asked me to rate my pain on the zero to 10 scale. You know the line… “These go to 11.” Nobody ever asked me to rate my pain (and I was totally ready with that line, too!). 

I pushed while lying on my back, which I never thought I’d do. I’d envisioned myself squatting or kneeling. To tell the truth, I didn’t want to get on my back; I felt best on all fours. But I’d been pushing for a long time and the MD on call (required to be in the hospital for VBAC deliveries) came in and started hovering after two hours (so I’m told… fortunately my eyes were closed and I had no idea she was in the room). The midwife, doula, and nurses informed me that some people push more effectively on their backs, and I went along with it. Apparently I was one of the people who pushed more effectively on my back.

I had back labor (again) because of a “sunny side up” baby, which was unexpected after nine months of religiously following Spinning Babies principles. I’m now two for two with occiput posterior babies, if anyone is keeping track. I didn’t experience the notorious “ring of fire” I always read about in birth stories. I was told the baby’s head was out and to wait before pushing more, but I don’t think I had any control. The whole baby just slid out really quickly without any effort on my part.

Here’s the part that really didn’t go as anticipated… Wait for it, wait for it… The baby was out. Someone put the baby on my abdomen right away. I assume there were congratulations and excitement, but I honestly have limited memory of those moments. Someone said, “is it a boy or a girl?” I hadn’t even thought to look. I lifted the baby up… Nate said, “It’s a girl!” I absolutely did not believe him. I double checked and triple checked. The shock of a daughter completely eclipsed any feelings I had about my VBAC victory. Every person I’d spoken to during my pregnancy, friend or stranger, was convinced I was having a girl. I was the only one who was sure I was having a boy. I believed it with every fiber of my being. Realizing we had a girl completely floored me. I’m still shocked, when I think about it.

Evangeline Rose, or Evie, was born on July 22 at 2:03 a.m., about five hours after my first contraction started. I imagine the labor would have been even faster if she hadn’t been posterior. She weighed seven pounds, seven ounces, and was 19.5 inches long. Unexpectedly, I wanted Nate to hold her right away after she was born because I was feeling so tired, but everyone wanted her to latch on and start nursing, so we went that route instead.

I found out at her first pediatrician appointment a couple days later that Evie’s head measured in the 89th percentile. That, plus the posterior presentation, makes me feel so surprised the pain seemed so manageable.  I suspect the combination may have contributed to the second degree tear I sustained. It doesn’t matter; she fits right in with all of our big-headed family.

Even though many aspects of the birth didn’t go the way I’d visualized, it’s okay. Because the birth went better than I’d ever dared to hope. The amniotic fluid was clear, no meconium (one of my fears). My placenta came out easily, intact, without any complications (another fear averted). With respect to timing, it worked out perfectly because Nate was able to go home and be there when Van woke up the next morning. I’d been so worried he would freak out if neither of us was home when he woke. The whole event was so mercifully fast and manageable. I didn’t have to wear a hospital gown; I birthed my baby in a wife beater (insert Deliverance theme song here).

I was on a birth high for approximately one week, which was a good thing because my face was a wreck (another surprise). I had broken blood vessels in my cheeks and somehow my eyes both swelled up, from the strenuous pushing, I was told. I had broken blood vessels on both of my eyelids, giving me the appearance of two black eyes. To compound the insult to my wrecked face, Kate Middleton (whatever her title is) had the audacity to birth her baby several hours after Evie was born and look amazing immediately postpartum. To quote a text I sent my sister:  “That whore princess totally jacked my baby’s birthday.”



“There’s a blaze of light in every word
It doesn’t matter which you heard
The holy or the broken Hallelujah”
 – Leonard Cohen, “Hallelujah”

That’s the story of my journey: one cesarean birth, one VBAC. Neither birth went as planned. One was the opposite of what I wanted, and one was infinitely better than my wildest dreams. Both experiences were vital to my development as a mother and a person.

I could tell you I came to value the circumstances of my c-section because it made me work harder for Evie’s birth. It made me appreciate every aspect of my labor. It’s the climb that makes you stronger, et cetera. But the truth is, I needed to value both experiences and be at peace with the unplanned nature of being a parent just because it was time. A blogger I follow named Adriel Booker said “When you are at peace, you’re free to be grateful.” Am I ever grateful. Because I have two awesome kids; the Force is strong with them. Because I look at both of those kids every day and see goodness and promise and hope, and think “God is there.”

That’s my story.

Hallelujah.



"Now I don't hardly know her, but I think I could love her"