Tuesday, February 07, 2012

Esther's Birth Story: it's a long one

On Wednesday evening, the 15th of June, I began to feel pressure in my belly that I recognized as labor, although I couldn't tell you what it was that made me certain. Still, since I wanted Jacob to get a full night's sleep, I kept my suspicions to myself and we kissed each other before heading off to our separate beds for the night. I woke up periodically, smiling and checking the clock, sleepily calculating that I was having 3 or 4 contractions an hour. In the morning, I went to Jacob and told him that he needed to call in to work because I was probably going to have this baby today. Then, I called my best friend, Susan, who lives three hours away. I told her that when she got close to Chicago, she should call to find out whether we were still laboring at home or whether she should meet us at this hospital. She was very excited and since it is part of her core nature to be excitable, I was happy that it was such a scattered conversation.

I called the midwives just to let them know to expect me at some point and they were also excited. My midwives always make me feel like a rockstar. Then, as Jacob got on the computer to pass off his work projects and go on paternity leave, I called my younger brother Daniel and my parents, basically crowing that Grandma was going to love me best because my baby was going to be born on her birthday.

Yeah. These things have a tendency of biting one on the ass.

It was a gorgeous Chicago summer day. Not very hot at all and brilliantly sunny. Jacob and I went for a walk and then settled down to labor in the house. Contractions were between 7 minutes and 13 minutes apart and, although painful, they didn't quite take my breath away yet.

Susan called from the hospital, asking where we were because it turns out that in her excitement at receiving my phone call, she forgot our previous conversations about laboring at home and didn't really listen to the current conversation with my instructions to call when she got close. Her adventures at the hospital would make for an essay all it's own.

We labored together some more.  Susan brought ice cream at my request. We gleefully picked out episodes of Firefly and Buffy to watch and reveled in the strength of those women.  Contractions continued to be about 7 and 13 minutes apart.

We moved into the evening and Jacob and I had a fight about something. I remember saying tearfully, "We are not going to fix that part of our relationship right now!  That's going to have to wait until after the baby is born." He went for a walk and I told Susan that if he pulled that shit in the delivery room, she should kick him out. Looking back, I'm not sure who was right in that situation or even what the issue was.  The anecdote illustrates for me that my mindset was still set in early labor mode. I knew that I was still having it pretty easy and that there would come a time when I would have to focus everything on the baby.

We realized that we should probably go to bed rather than waiting up for active labor to start. To be honest, I can't remember who slept where.  Did Susan go on the couch? Did Jacob come back to the marriage bed so she could have the guest room? I think I remember verbally directing her to clean sheets with a sense of comfort that we had that kind of friendship.  Actually, now that i'm reconstructing it in my mind, we went into the hospital to get an Ambien at the suggestion of the midwife before we went to bed. That helped for a few hours but otherwise it was just short naps between contractions. While we were in the hospital with the midwife, she swept my membranes but said I was a little less than 2 centimeters but most of the way effaced. This was about the 24 hour mark.

This is where things start to get really fuzzy in my mind, where I wish I had an easier delivery so that my recovery would have been faster and I could have written this down while it was still fresh.  

I think I called into the midwives on Friday morning, just to check in since my contractions were still 7-13 minutes apart.  I think I talked to Gina, who always gave me a hug after every check-up. She told me to stop timing the contractions, to treat myself gently and to do things that were relaxing, like taking a bath.  She said that vigorous activity to speed things along would be counter-productive.  I think I cried a little in relief when she said this.

So, as much as I can remember, I spent the day eating ice cream and watching TV.  My brother, his wife and his daughter came over to keep us company and we went on a walk.  (This may have happened on Thursday, though.). We walked to the nearby dog park and back and I watched Susan charm my 14-month-old niece. Shashi communicates quite clearly with gestures and at one point when Susan and I were trailing behind the pack, she turned around and patted the ground while looking right at Susan.  My sister-in-law explained that she did the same thing when she wanted the dog to come to her. A rare honor bestowed upon Susan.

Contractions continued as before.  When walking, I would stop and lean on something. When home, I think I grunted a little at the peak of the waves. I know we ordered in a lot of food throughout the laboring and that  I ate some of it. At bedtime, I took anoth Ambien but this one did no good. Again, I can't really remember where we all spent the night.  Bedtime marked 2days of labor.

I can't tell you anything at all about Saturday.  Trying to write out this timeline is actually making me realize it was much more grueling than I acknowledge when I tell people how long it took. Usually, I laugh and make empathetic noises when other people express shock.  But no. Really. It seriously sucked.

I just asked Jacob if my mom came to visit while were laboring at home and he said, "Oof, you'd have to ask Susan that." In consultation, we think maybe she did come by.  Before I went into labor, my dad specifically requested that I not have the baby on Saturday since he had been invited to play golf at his favorite course and he didn't want to have to cancel.  Little did when know when laughing about this together how it would actually play out.

On Saturday evening, we were watching the new BBC Sherlock Holmes. When  I went back to watch them again later, many visuals were familiar but I couldn't remember the plot at all.  I think is shows my mental state pretty well.  I was absolutely present in the moments without any sense of narrative: past and future.

As we watched, I began to feel like I had gas that I couldn't pass.  Evil, malicious gas.  I know there was a lot of loud groaning and I kneeled on the couch with my ass in the air trying to pass it.

When Jacob suggested that he go down to the Walgreens and get an enema for me, I actually considered it.  In a final triumph of squeamishness, I said, "Let's call the midwife first." In retrospect, I can hear her laughing when I earnestly described the terrible gas that was filling my pelvis.  To her credit, I felt nothing but grateful relief that she was taking the decision out of my hands when she suggested that I come back in for evaluation first.  And if she had actually good-naturedly laughed at my naïveté that could not equate pain in my lower abdomen with a baby moving down, I would have felt embarrassed. Since I wasn't, she was probably very kind.  Anyway, since we had been stuck in this fugue state of 7-13 minutes contractions with almost no sleep, I think we all kind of forgot that things would progress eventually.

The drive to the hospital is only 15 minutes.  It was brutal. The meanmean gas made every tiny bump feel gigantic and I believe that I fantasized out loud in a demanding way about the features of the next car that we buy so I would not have to experience this gauntlet of a journey again.

My midwife was so good to me once we got to the hospital.  In general, I loved all 8 midwives in our practice during our pre-natal check-ups because they gave me information to make my decisions and then supported my decision.  In the condition I was in when we arrived on Friday night (3 days of labor at this point), I really wasn't able to come up with my preferences for, well, anything.  I was both disengaged spiritually to avoid the trauma of extended pain and engaged purely in the present minute because the pain required it of me.  My midwife knew this and started by making a recommendation rather than asking what I wanted. I remember the exact words:

"I think we should administer some IV drugs so you can sleep."

Yes. Yes. Yes.

She said I was still only 2 centimeters and when she swept my membranes, I went up to 3 centimeters so she could admit me to the labor and delivery floor.  I had been warned that manual exams and membrane sweeping could be really painful at this point but, honestly, I barely noticed that those things were happening.  I think that must be telling of how much my contractions hurt.

When I woke up after a few hours, I feel like the first thing I said to Jacob was, "I want to talk with the midwife about getting an epidural.  Is that OK?". I was getting disappointed vibes from Jacob and spent a whiff of thought to realize that normally I would stop to figure out what was bothering him but a second breeze of thought came along that I had other things that were more important to do right then.  After Esther was born, he explained that since I had asked him to take responsibility for encouraging me to remember that I wanted a non-medicated birth, he felt like he had failed in that role.  He must have pulled it together like a champ, though, because he was nothing but supportive after that.

When I did the math in my head, I examined the assumption that an epidural would make me less spiritually present for the birth of my child.  I still believe that would be true for a labor than lasted less than 24 hours, like I was expecting.  I had also considered negative health outcomes for myself and the labor of future children when making the decision to try for a non-medicated birth.  Given the new variable of a 3 day labor, I realized that an epidural would actually help me to be more spiritually present and that this was worth the medical risks at this point in order to have the best possible birth experience.

When the midwife arrived, I said, "I would like to talk about getting an epidural." She said, "Would you like to talk about it or would you like an epidural?". I smiled and said, "I would like an epidural, please."

And with that, the waiting ended and it felt like everything shifted into drive after we had been sitting in the driveway, letting the car warm up.  She suggested a little pitosin since although it was good that I had gotten to 5-6 centimeters while I slept, I still needed to get to 10.  I quickly agreed.

My parents had been in the city on Saturday night and when they called to check on me after their dinner, we were headed into the hospital. I think they must have come over but I was asleep by the time they got there. When I woke and felt so much better because the sleep and the IV drugs had cleared my head, I remember explaining to my mom about wanting an epidural: "I thought it was going to be all girl power and hot baths. . ."

When the anesthesiologist arrived, he announced that he was on Hour 18 of a 24 hour shift.  I think Jacob blanched at that but the implications barely registered for me.  When we tell this story, Jacob also points out that the doctor had to leave in the middle of set up because he had done so many epidurals that night and ran out of a necessary supply.  This was when we really realized that the hospital was over capacity for mothers that night and continuing into the next morning.

I slept again and when I woke, it was morning. Total labor: 3 and a half days.  My parents had gone back to our house and slept. Jacob slept in the awkward reclining chair for partners and Susan had another slapstick comedy trying to find a comfy spot on the floor.  

I felt amazing.

If I have another child, I will try again for a non-medicated birth. However, I will not pretend that an epidural is not magic. Seriously.  Abra-cadabra.

Oh, it was weird.  No doubt. My legs were numb and my feet were cold.  I asked someone to put on the fuzzy socks my other sister-in-law gave me. The right side of my body wasn't totally numb at first but my awesome labor and delivery nurse knew to turn my body so that the drugs could flow to that side like sand in an hourglass.

Have I mentioned how awesome Barb, my nurse, was? She consumes the same media that I consume, so we had that common ground and was just all around laid-back, cool and a little sarcastic while being utterly warm and competent.  She also laughed at my jokes. Susan has said since then that it must have been God who wrote the nursing schedule that week.  Barb had a trainee who was also very nice.

So, the sun is shining in the windows, my contractions no longer hurt, my brother, sister-in-law and niece joined my parents and we are all listening to my Delivery Mix on my laptop.  James Brown's "Get Up Offa That Thing (And Dance 'Til You Feel Better) is a decent example of the playlist.  Barb liked it.  I definitely heard someone on staff admit that we were breaking some rules by letting Shashi be there but I think they were smiling while they said it.  So, basically, we were having a party with my most favorite people surrounding me. It's all like some wonderful dream in my memory.

I was told that I was 10 centimeters and completely effaced and could vaguely feel the contractions that I saw on the monitor but I had no urge to push at all.  They say that the urge is unmistakable, like having to vomit. I was not overwhelmed by said urge.  So, we made the decision to harsh my mellow by turning up the pitosin (I think it was only at 2 or 3 at that point) and turning down the epidural.  I assume that this is when my family disbursed to the waiting room, leaving Susan, Jacob and I to work and wait with Barb and her trainee.  Barb reminded our midwife that the anesthesiologist would need to be called back to turn the epidural down even though they could turn it off entirely without him.  She then asked again what the midwife recommended.  It was a subtle bit of advocacy that I was grateful for later since I can’t imagine what delivery would have been like with no epidural at that point.

There were other babies being born in every other room on that floor.  We could see their fetal monitors on our computer screen for some reason and I remember we had sympathy for one of the moms and were excited when Barb came back from a short break to tell us she had a healthy baby.  Our own monitor continued to show that I was having “good” contractions that I was now beginning to feel more and more sharply, but still no urge to push.  Since our midwife had at least one other birth to attend to, we actually waited 3 hours from the time I was declared to be 10 centimeters to the time we started just giving pushing a try, like it was a lark our something.  That was how casually Barb suggested it.

So when I started feeling a contraction (or seeing it on the monitor), I pushed.  This did seem to kick-start something and by the time the midwife was able to join us again, we were in active labor.

At some point I closed my eyes and really did not open them again until Esther was born. My knowledge of the past did not inform my experience with the present.  For instance, my hips would begin to hurt so much that I wanted to cry but I would have to logically think, "My hips are hurting so this must be a contraction." All I could register was the pain. We would try different positions to accommodate the pain in my hips but finally only being flat on my back was at all bearable.  Susan stayed up by my head while Jacob must have helped with my body's positioning.  Susan has known me for almost 15 years, compared to Jacob's three-year tenure so she knows me better than anyone but my parents and my brother; plus, our relationship has lived through any emotionally loaded fears that either of us will leave the other.  This made her the perfect person to let go with and do what I needed to do.

I won't lie: this stage of labor and ultimately delivery was violent and hard.  There should be another word for the physical sensation because it was not related to any pain I have felt in the past.  (I have never broken a bone though and I imagine that would also be pretty painful.) I think that if Susan hadn't been in my ear, encouraging me and letting me make jokes, I would have given up and needed a c-section.  After three and a half days and almost no sleep, I believe that's a real possibility.  And I'm not sure that I would have had the same dynamic with another woman or Jacob that I would want to tell jokes as a coping mechanism.  I remember thinking about Winnie the Pooh being stuck in the hole after eating too much honey, imagined Esther like that and worried that we’d passed the point of no return and that I would not be able to have a c-section.

So now, I feel triumphant and powerful that I and my body accomplished this amazing act.  In the first few months after, though, I just felt wounded and traumatized.  Luckily, my spiritual life up to this point has prepared me to respect how I feel and not to beat myself up for what comes naturally.  So I paid attention to what my body and soul were asking for and ate a lot of ice cream as therapy in the first three months and didn't worry at all about losing weight.  I told this story in an entertaining way to people who visited and called but I definitely needed to tell it in a slightly horrified and sad way once to my therapist to really face the truth of how little control I had over that situation and how bad it was.  I feel like hospitals should provide post-partum events for small groups of women to be able to do this with one another with strangers who don't need them to put on a happy but-now-I-have-this-beautiful-baby face on it.  I only needed to mourn my expectations once and now I am completely at peace with it. It was so transformative that I definitely wish it for other mothers.

So, I pushed like that for three hours, feeling rising pain in my hips, intellectually recognizing that it must be a contraction, then making the decision to push.  I remember opening my eyes at one point and realizing that I was in a sit-com.  There were literally five people around my bed, looking at me, and the one between my legs was a total stranger.  I believe that I made a joke about that.  Apparently, my blood pressure spiked, so they called in an obstetrician to help.  It was really neither here nor there to me at this point.  Most of the time, I kept my eyes closed, although I remember them encouraging me to open them at some point.  I suppose I was losing focus and they feared I was retreating mentally.  But Susan and Jacob kept me going.  At one point in the middle of a push, I asked Susan how many more, both knowing that she could not know and hoping fiercely that she did.  Whenever I talk about “living in the tension” from now on, that question is what I will remember.  When Susan told me, “Seven,” I said, “You lie!”  I think that Barb held my hands at one point and pulled away from me as I pushed the baby while pulling away from her to give myself momentum.  That helped move things along.  They asked if I wanted to touch the baby’s head but I knew that it wouldn’t be able to discern it as anything special at that point, so I declined.  I have no idea if I yelled, grunted and swore or not during this time.  I assume that I did.

How to describe Esther’s actual birth?  Think about the most difficult bowel movement you have ever struggled for and multiple that by 15.  There is triumph and severe relief after the moment of intense pain.  It feels exactly like you think it would feel except that the context for the sensation is so thick that it is not nearly as bad as you would think it would be.  Jacob actually caught Esther and I tear up a little bit thinking about it now.  I remember being angry at the time when the midwife was instructing him how to do it in the minutes before it happened.  For some reason, I thought that it was prolonging my struggle for her to stop focusing on me.  But it was totally worth it, looking back.  Also, I think probably she knew (because she’s a professional, right?) that we were in the end game and nothing could prolong the inevitable in any meaningful way.  

They handed her up to me and I sobbed.  Susan took some pictures at that point and I have kept them private, pondering them in my heart from time to time.  They are so bloody and Esther is so beautiful.  They took her from me shortly after that to measure her and such even though we had in our birth plan a request to delay that until later.  I assume that the nurse who did that stuff was available and since the hospital was overbooked, taking advantage of her presence trumped my desire not to be separated.  Jacob went with her to the warming table and I do not think I stopped asking for her back the entire 10 minutes she was gone.  I remember feeling pretty desperate as I asked.  It’s probably more likely that I demanded, since that’s how I normally deal with being powerless when it’s important to me.  And it felt primally important.

Of course, I got her back and everything was fine and I was so tired and so proud of my little girl.  It was a little after 4:00 in the afternoon on Sunday, June 19.  Father's Day.  Jacob and I asked her if her name was any of the several names we had on a short list, and sure enough, her spirit agreed that she was an Esther and not a Golda or a Ruby.  I got to show her off to my family and Susan just beamed at me.

We stayed in that room awhile since there weren’t any available recovery rooms.  Susan went back to our house to sleep and visited in the morning before heading home.  Jacob’s brother and sister-in-law visited and brought the most amazing gift.  They stopped at Whole Foods and got a warm loaf of multi-grain bread and a half pound of Irish butter.  I needed so much nourishment and it was such a wholesome way to get it.  I woke in the middle of the night that night, ravenous and thankful for their consideration. It was all gone by the time we were discharged.

The nurses were amazing throughout our stay.  I never knew that nurses were so amazing before this.  They have to be book smart AND have the humility to clean my body of gore.  They are thoughtful enough to bring water every time they come into the room for something.  Seriously, the room was littered with styrofoam cups with lids and straws that had been full of ice and water.  

And then they cleaned them up.

I think this is an extremely rare combination of skills.  So often book smart people (myself included) think they have risen above menial tasks.  Nurses make the rest of us look selfish and small in that thought.  Or, they would if they weren’t so busy making us feel cared for.

I have such a fondness for our recovery room.  My best friend from high school lives near the hospital and visited that first night.  My other sister-in-law visited there the next day.  It was a handicapped room so I just walked into the vast shower without impediment and used the luxurious French soap my mom had brought me from her trip there.  Word of advice to pregnant moms?  Take luxurious bath gel and shampoo.  Never will you feel so much like you have earned it.  Jacob learned to love letting Esther fall asleep on his bare chest in that recovery room.  So much so that we had to scramble when we got home to figure out safe co-sleeping after vowing that we would never be THAT family when we were still pregnant.  We took as much skin-to-skin time as we could in that warm room.  We struggled to establish breastfeeding but the amazing lactation consultant was so patient and persistent.  She finally produced the magical nipple shield and gave us info on how to find more help.  Pragmatic: that’s how I like my lactation consultants.  None of that fundamentalist, judgey crap that I got later for not being “pure” in my methods of feeding my daughter.

But that’s not the tone on which to end this story.  Let’s try another one.

Birthing my daughter was the hardest thing I’ve ever done.  It is also the thing over which I have had the least control once it came down to it.  I did a lot of preparation.  I educated myself.  I found the right practitioners.  All of that helped.  But in the end, Esther came into this world as a force of nature.  Literally.  My body stumbled a little, but ultimately did what it had been designed to do.  To me, this is my relationship with God in its purest form.  I take so much comfort in the fact that I am not God: that I do not have the ability to control what happens to me.  Because if I did?  I would screw a lot of things up.  Instead, when I let God be God, I can work hard alongside her, doing what she designed me to do and I get something as beautiful as Esther not for for my efforts but as a gift.  My efforts were a gift in themself like all hard work is.  All of the things that went wrong.  All of the things that hurt.  I include them in this narrative because they make the final climax and denouement that much more satisfying.  Life is painful.  Life is also stunningly beautiful.