February 5, 2010, at 4pm, I sat on the end of my postpartum-room bed, cradling my hatted, swaddled, 8-hour-old baby, framed by a window filled with white light as the first flakes of twin record-breaking, city-paralyzing blizzards began twirling down the sky.
February 4, at 9.30am I went to my 41-and-a-half-week prenatal checkup. The OB estimated that I was at a “tight 2 cm,” about 50% effaced, and she stripped my membranes. I had asked my doula about having that done, and she said go for it. I was eager to do anything minimally invasive that might bring on my labor. I had had mild, irregular contractions for about a day and a half and I was scheduled for induction on February 9, the 42-week mark, if I didn’t go into (real) labor on my own before that date. I had been sticking evening primrose capsules up where the sun don’t shine; drinking cup after cup of raspberry leaf tea; I’d had an acupuncture treatment the day before, in which I was poked in all the places you’re not supposed to poke a pregnant woman unless you want her to go into labor. On having my membranes stripped: it HURT.
After the appointment, my husband R and I went to lunch and I had a grilled-cheese sandwich and black bean soup. (The black bean soup is an important character in the story). R dropped me off at home and went to work. I went to the bathroom to poop and as I pooped my water broke. I had to stop and think about what was going on — it felt like a rush of menstrual blood, but it was clear. I put in a maxi pad and got on the phone with R telling him to be on standby and with my doula, who said what I thought she would say, which was that I should call the doc, and the doc would say go to the hospital. She was right about that. I took about an hour and a half to wait for R, gather my things, call my sister, eat all the good stuff I could think of (chocolate milk, apple, granola bar, Luna bar) walk up and down and up and down the stairs, trying to get my labor going. It did not go. In the hour after my water broke I had only about three contractions. Very frustrating. (I was, and still am, unclear on the connection between having my membranes “stripped” and their apparently spontaneous rupture about three hours later. It feels as if the first intervention in my intervention-heavy birth story was the OB’s tiny but fierce fingers in the office that morning.) So I turned myself in at the hospital like a convict awaiting imprisonment. I had had a very flexible birth plan — basically to labor at home, maybe in the tub, with the help of a doula, for as long as I could, and then go to the hospital under the care of a practice with a relatively low c-section rate and maybe seek pain relief, maybe not. The first part of the plan went out the window right away, with induction at the hospital from just about scratch. As we drove there I was grouchy, scared and trying not to be snappy with R, since I knew this was it, this was the big day (right?), and I could see and hear myself being negative but couldn’t pull myself out of it.
We went to Labor and Delivery and they admitted me without an exam, based on my report that my water had broken, I suppose, but even more on the fact that I was 41.5 weeks and they were eager to “get me delivered.” I had the good sense to request one of two rooms with a tub and was given one. I later regretted my request when I learned that once on the pitocin drip I would be on a continuous fetal monitor which would not allow me to labor in the tub. This meant I was monopolizing a tub-room which someone else could have used. It also happened to be the first room on the hall past the nurses’ station, which was loud. All night on the drip, I heard doors slamming and carts wheeling and people erupting in laughter down the hall, audible even with the door closed. There was small consolation in the nostalgia brought on by the fact that it reminded my of my noisy freshman dorm.
By 4:30pm I was on the drip. Pitocin in the IV, a fetal monitor and a contraction monitor around my belly, a blood-pressure cuff on my arm. The most uncomfortable thing was that I was leaking amniotic fluid and soaking pad after pad under me on the bed. Any angle other than standing or sitting on the birthing ball caused the uncorking of the cervix, and every time I had a contraction I would squirt fluid. It was unnerving to be constantly “wetting myself,” and knowing that the baby’s environment was deteriorating and that my body would not be able to replenish the lost fluid at the rate at which I was losing it. So I stayed on that ball. From about 5pm to 11.30pm, I labored without drugs. From the moment the pitocin drip kicked in I was having contractions every two minutes. For the first three hours, the contractions were not much more painful than those I’d been having at home — just much more frequent.
There was a wrinkle, though: gas. This was the revenge of the black bean soup. (No beans in third trimester, ever again!) In addition to the searing pain of the contractions, which were like slow, hot knife-slices to the bottom of my uterus, I was having gas pains throughout my torso because the contractions were squeezing my already-squeezed intestines. It was shockingly painful, and it took a little while before I could really let go and try to fart it out with the doula and the nurse hovering. I wasn’t allowed to walk ten feet to the bathroom to sit on the toilet to try to fart and poop because of the monitor, so I had to use a bedpan and it was a messy, demoralizing affair, with contractions and amniotic fluid leaking through the whole thing. From that low point, 9pm, until around midnight, when the gas, thank God, was over and I could focus on just getting through each contraction, my sister, the doula and R were all there to help with hand and foot massage. That and sitting on the ball helped a lot.
A note on that particular night at the hospital: apparently people were going into labor left and right on account of the massive low-pressure system that was moving in and would dump the first two feet of snow on the city the next day. There were also people coming in who were scheduled to be induced in the next few days and wanted to get it done before they were snowed in because the forecast was so dire. My OB had four patients on the ward that night.
And on the exams: The OB verified the 2, maybe 2.5 centimeters when they started me on the pitocin, and then I was not examined again for many hours, because of the risk of infection every time someone reached up in there. So at around 11pm when I was rating the pain of contractions at 7 to 8 and starting to lose my grip on coping on my own, I had to make a decision about an epidural without knowing how far along I was. I had thought they’d examine me, give me a number, and I’d make a decision based on that. But they were actually waiting for the opposite, which was a pattern of very strong contractions that satisfied them that I was progressing — the very sort of strong, drug-induced contractions which I was less likely to be able to handle without drugs — before they examined me. So they kept ratcheting and ratcheting. I started to realize there was no scenario under which I would not want the epidural. If I was at 7 cm, then hurrah, I would have made it all the way to transition and I’d have survived that long. (By the way a clue that I might be at transition was the powerful urge to vomit). If I was only at, say, 4 cm, then I was going to start committing murder and suicide if I had to go all the way to 10 cm in like fashion. So at around midnight I got the epidural.
The OB came and examined me and I was at THREE CENTIMETERS. Maybe 3.5. It had taken SEVEN HOURS for my cervix to dilate one centimeter. She said I was completely effaced, though. So obviously the vomit-urge was drug- or pain-induced and had nothing to do with transition. Once the epidural was in — and a “window” in my left groin was resolved with a dose adjustment — things changed a lot — no more pain, and it became night-time, sort of, with R napping and the doula napping occasionally. My outfit of tubes and wires and catheters grew: I now had the saline and pitocin in my IV, the fetal monitor around my belly, the blood-pressure cuff on my arm, a heartrate sensor on my finger, an oxygen mask on my face, an epidural in my back, a urinary catheter, and an intra-uterine catheter with a monitor on it to measure with more precision the intensity of my contractions which I could now not feel. I did not miss them. I felt no sadness, no loss of contact or control, not to feel my evil, evil red-hot-knife-stab-every-two-
I did not sleep all night, with the monitors beeping and clicking, the blood-pressure cuff coming to life every ten minutes, the nurses and technicians partying down the hall, the nurse coming in to take my temperature. They were vigilant about my temperature because of the possibility of infection through the cervix. Here was the trouble, the pitocin paradox: whenever a really strong pattern of contractions got established, the baby’s heartrate would dip a little bit. I started to recognize exactly when the nurse was going to come in, look at the printout, and turn down the pitocin drip. All night, the drip got adjusted — turned off entirely for fifteen minutes or until the baby’s heartrate normalized, and then turned back on at half the previous dosage. I learned the different songs the machine sang, depending on whether the the pitocin was on or not. My labor progressed and stalled at the mercy of machines. It was maddening — would I EVER deliver the baby at this rate?
Then at 4:15am, Dr. Maroon-Scrubs came. Dr. Maroon-Scrubs was a resident who had come by once before to introduce herself as the resident on the floor that night and to ask if I had any questions about anything. She was a stiff little thing stamped out of her med school with absolutely no interpersonal skills; she held her hands awkwardly at her sides, she moved her head like a marionette, she spoke her lines as from a script. She came to tell me that the baby’s heartrate continued to dip because of a combination of factors including the pitocin and the deteriorating amniotic environment, which was contributing to what she suspected was an umbilical-cord-around-the-neck situation. She would send another bolus of saline solution through the catheter into the uterus to try to plump it up and relieve the falling-inward of the uterine walls, which was the probable cause of the cord-wrap. However, it was very likely that they would decide it was best for the baby to perform a c-section if the situation didn’t improve. They were preparing the OR and she wanted me to be ready for a c-section at 5am. “Do you have any questions?” she asked. I shook my head no. Whatever questions I had she couldn’t possibly answer. I did ask only that my OB come and discuss it with me before they wheeled me away. The doula hadn’t heard the whole conversation so I filled her in; I woke R and told him; I called my sister and told her not to bother coming back for the birth because I was probably going to have a c-section in 45 minutes and if she could even get here in time she wouldn’t be allowed in the OR anyway, so she might as well get some sleep and come a little later in the morning to meet the baby. I cried tears of resignation into my oxygen mask as I entered the final act of my little birth-tragedy, in which all the fates had lined up to ensure this end, including my own decision to have a hospital birth, and to hop on the intervention-express with my epidural. I hadn’t, however, chosen the fact that my baby was a week and a half late or that my water broke early or that I would be on pitocin all afternoon and evening. Now it seemed obvious and inevitable: how could this profoundly medical procedure not become surgical? There could not be a ratcheting up of pitocin without a ratcheting up of every other intervention. I wasn’t a woman about to give birth; I was a patient, an anesthetized slab upon a table.
About ten minutes after Dr. Maroon-Scrubs walked out of the room, my OB poked her head in the room. “Did Dr. Maroon-Scrubs talk to you?” she asked. “Well, she was in the wrong room, talking to the wrong patient. Disregard everything she said. You’re doing fine, I’m totally happy with your progress.”
A brief pause to take it in.
Fortunately for me, no scalpels were unsheathed in the making of that medical mistake. Unfortunately, while I had escaped, someone else on the ward had been snared. Dr. Maroon-Scrubs came back hours later with another resident to observe me and make notes in her notebook, and she said nothing to me about her mistake. No acknowledgement whatsoever. If there’s a next time, I hope I will have the courage to call a doctor on a mistake and say “Hey, you really scared me. I know you’re afraid to say anything because you think I’ll sue you, but do you have a form I can sign which will release you to be human for ten seconds and say you’re sorry?”
At 7:20am my OB came back to examine me and asked “Do you feel like pushing?” I was at 9.5 cm, another miracle. The creepy visit of Dr. Maroon-Scrubs had been a bad dream of the long night, and I could now see it as a blessing: I was given a close encounter with the feeling of loss and sadness that having a c-section can inspire. What I felt I had lost, for the ten minutes I thought I was going to have to have one, was the last shred of participation in the birth. I was transformed back from patient to person, from lying inert while being poked and pierced and eventually cut open, to doing the work of pushing my baby out. I was profoundly grateful for that.
I remember with stunning clarity Jonathan’s face as he came out at 8.05am; but I remember with equal clarity his genitalia — one of the unexpected consequences of not knowing the sex in advance. I had had a strong hunch we were having a girl and nope, what a boy was he! He was healthy, whole, heavy — 9 pounds — and so beautiful. I was totally unprepared for how much I would love him, how dopey and weepy and insomniac with adoration I would be.
A note on the aftereffects of a mere twenty minutes of pushing, particularly with an epidural: I had profound muscle pain for days and days, the worst muscle pain I’ve ever had, plus plus plus. Like I had moved a house with my butt muscles. And those are big muscles, without which there’s not much you can do. I couldn’t sit, stand, walk, lie, step or turn without gasp-inducing pain. The intensity of the pain didn’t compare, of course, with contractions — and it was a pain I could, to some extent, control, i.e. by not moving. The upside, I suppose, was that this major muscle pain reduced the more superficial tissue injury, like perineal bruising and one small labial tear, to the level of mere annoyance. Helping me through all the after-pain was pride and gratitude for my wonderful body, which did this most wondrous thing, got to work right away healing itself so beautifully, and still left me with energy enough to wade up our street through the amazing snow.