I'm posting this in honor of my mom's group, who decided to share birth stories. It was originally published in a small anthology for Susan Ito's ParentLit writer's class.
It Doesn't Have to be This Way
5 a.m. on June 3rd, 2009. Surfing under a light wave of sleep, a warm, liquid spurt between my legs startles me awake. Alarmed, I struggle for an upright position in the still, shadowy darkness. Spurts are never a good sign for the massively pregnant – and at 39 weeks and two days, I am nothing if not massive. And pregnant.
I stumble out of the bedroom and into the bathroom. My fiancé Jon is getting ready for work, all fresh musk and stiff white shirt. He freezes in the midst of fixing his tie. "What's wrong?"
Swabbing myself with toilet paper, I respond, "I don't know. Either I’m leaking amniotic fluid or I just peed the bed."
When he asks if I want to go to the hospital I pause again. I really don't want to go to the hospital only to be told that I'm just a big, incontinent pregnant lady. But then again, I don't want to be quietly leaking amniotic fluid. I've read horror stories about that on the internet – how leaking amniotic fluid can cause fetal distress and eventual brain damage.
We decide Jon should go ahead and go to work, and I’ll call him if it happens again. He has a relatively new job with only a few days of paternity leave so we don’t want to waste them.
Faced with an entire day of trying to assume business as usual, I set out on a walk to stop myself from reading more horror stories on the internet. I'm feeling extra sluggish today, how a hippo might feel if it were drunk.
Midway through my walk an ache starts in my low belly and builds in a rapid crescendo, to the point where I am gasping for breath and waddling as fast as I can back to the house. Moving around was a bad idea. I get some water and lie on the couch.
Though I keep waiting for that odd, quick rush of fluid again, it doesn't happen, and I don’t feel anything dramatic that might signify labor for a first-time mother. The mild ache in my belly and low back is similar to PMS cramps. Nothing at regular intervals, just a persistent, dull pressure that makes it impossible to get comfortable, so I’m constantly shifting my weight around. Briefly I try to do laundry and answer emails but I am dragging so slowly I eventually give up the pretense and drop into bed.
Tucking IPOD headphone buds into my ears I push the button on a Hypnobabies track. Easy birthing time, I tell myself. Jon and I have been preparing for me to give birth naturally, using a self-hypnosis home study course called Hypnobabies, for months now. Jon is suspicious of anything marketing itself as hypnosis, but I’m one of those meditative, semi-new-agey types, so I was intrigued and inspired by the idea of using my mind to cope with birth. The program has been teaching me techniques to self-soothe so I am not tense or fearful during labor and delivery – the idea being that a calm woman can birth more easily. In these past few months I have talked to other women who have had successful hypnobirths and I have even seen several on YouTube, so I know it’s possible. These videos begin in silence, displaying huge pregnant women lying like swollen sloths on beds at home, looking, if not peaceful, at least comatose. After a period of quiet labor the women usually climb into birthing pools, where the loudest noises emitted are from the midwives gently encouraging these women to breathe and ease those babies out.
The only potential problem is that I will be birthing in a hospital, which environment is supposedly not conducive to a peaceful hypnobirth. My Hypnobabies study book recommends taking several steps to pave the way for a successful hospital experience, the most important being: make sure your doctor is aware of your birth plan; wait as long as possible before arriving at the hospital so you are further along in labor (this will help the hypno-mom avoid potential interventions like Pitocin); get lot of rest in the days beforehand; and eat lightly at home while you labor. I’ve been preparing but still feel ill-equipped for this whole labor adventure. Other than visiting my mom when she had a hip replacement, I haven’t been in a hospital since I was born myself.
Around noon I call my OB/GYN office to report the 5 a.m. leak because I've been reading brain damage stories on the internet. "Go to the hospital!" the receptionist exclaims. "It sounds like you're in labor!"
I am skeptical. I've read (having spent most of my pregnancy unemployed, I’ve been doing a lot of reading) that women can be in labor for days with their first babies, and I've been feeling like this for days. The only difference is that today I am especially exhausted after not sleeping well and I may or may not have wet the bed.
Jon and I conference over Gchat on and off all day about whether or not to go to the hospital, and finally I decide let's just go and put our minds at ease. They will report that the baby kicked my bladder, and we'll go home and snicker at my lack of dignity.
We head out as soon as Jon gets home from work, around 7 p.m. At the last minute, I grab our half-packed hospital bag and my IPOD with the hypnosis tracks just in case, even though I don’t think we’ll need them. "What should we eat for dinner?" I ask in the car on the way. We decide something simple, maybe Moe's, is on the menu for after this quick visit.
When we arrive at the maternity ward, I feel like I have to offer the receptionist a disclaimer. "I'm not really in labor," I explain, apologetic. "I just want to make sure I'm not leaking amniotic fluid." She’s unimpressed either way, and we are taken to an assessment room where a nurse in blue slaps on a glove. The cervical check feels like she is trying to wedge a brick up into my uterus. I gasp. "Easy birthing time?" Jon offers.
"Well…I don’t think you’re leaking any fluid, but you're dilated to four," the nurse announces. "We're going to have to keep you."
"But…I'm not in active labor," I say. "Can't women be dilated to four for weeks, especially for a first baby?"
“You can walk around for an hour and we’ll recheck you – see if you’ve made any progress.” She nods at the large screen next to the bed. “You’re registering contractions.”
Though I am skeptical that what I'm feeling are the kind of contractions that push babies out into the world, I agree to walk around for an hour. I’m getting a bad feeling and want to go home desperately so I can rest and eat – two important steps – before having to give birth.
I’d been surprised to learn that U.S. hospitals don’t allow birthing women to eat anything at all. Nothing by mouth, it’s called, the rationale being that if a woman ends up needing general anesthesia she might inhale her own vomit – though the case of a birthing woman genuinely needing general anesthesia is extremely rare. The Hypnobabies guide relates:
Fasting causes the mother more discomfort as she cannot focus when her blood sugar is low, and further, fasting can cause ketosis, a weakening of the muscle cells, causing the uterus to work less efficiently. The uterus needs a lot of energy at this time, and without nourishment it cannot fulfill its job properly. Birthing requires the same amount of effort from the body as running a marathon, and so you need energy to remain fully functional. In Europe, birthing women eat crackers, bananas and yogurt to keep up their strength, with no ill effects and much better birthing outcome statistics.
Jon and I make so many laps around the maternity ward the nurses start joking that the baby’s going to fall right out. I wish she would, so we could go home (we’ve kept gender a surprise but are convinced it’s a girl). My discomfort level is low so we talk easily, sure we’ll get to go soon. We’re both officially hungry.
When the hour is up the nurse grinds another brick up into my stomach and says I'm still dilated four, but I can't go home. It's up to the doctor on-call, and she says no.
"But what happens if nothing changes in the next few hours?" I ask.
"They can start you on Pitocin," she replies, and the word seems to leave her lips in slow motion. My readings have unearthed negative information about birth procedures in U.S. hospitals – namely that they are intervention happy and that's a contributing factor to the high C-section rate (31.1% in 2006 as opposed to 4.5% in 1965 – over the previous decade a 50% increase). In my mind, Pitocin screams C-SECTION. A definite overreaction, but I don’t want a C-section if I don’t need one.
Pitocin can start the domino effect – IV, Pitocin, external fetal monitoring, lack of mobility, diminished ability to deal with pressure waves, pain medication, weaker pressure waves due to narcotics, then more Pitocin, fetal distress, etc.
My first choice would have been a birthing center with midwives or at home like the women on the YouTube videos, but we can’t afford anything insurance doesn’t cover – and I’m sort of hoping that my books are being dramatic and birthing in the hospital will be fine. My doctor has a copy of my birth plan, so until now I’ve been fairly certain my bases were covered.
"I don't want Pitocin," I say, trying not to panic. "I've been planning a natural birth – I want the baby to come on her own. That’s why I want to go home and come back later."
"Dr. L. is coming in at seven," she says. "You can ask her to go home then."
“Like…seven in the morning?” I ask dumbly. Dr. L. is my doctor so this is supposed to be comforting, but seven in the morning is roughly nine hours from now. The idea of sitting around the hospital all night, starving and uncomfortable in a stiff, tiny bed, when I could just go home and come back later, does not sound appealing.
“Can we talk to the doctor?” Jon asks. “We live two minutes away.”
The nurse says she’ll ask, and returns to report that the doctor said no.
“But the baby’s not in distress,” I point out. “I promise we’ll come back tonight or tomorrow when contractions get more intense.” (I’m supposed to say pressure waves per my hypnosis for childbirth instructions, but I am intimidated and revert to layman’s birth terms.)
“Is there any way we can talk to the doctor ourselves?” Jon persists. “We live literally two minutes away.”
With a disinterested tone, as though she were telling us the bathroom was down the hall to the right, the nurse states the deciding factor, “If you leave, insurance will not pay for your birth."
I am lying on the hard hospital bed in a dark, hot birthing room, starving and trembling, too weak to walk the halls. It's five in the morning and I have been warding off Pitocin advances for hours. Stubbornly clinging to my childbirth goals, I try to focus on the Hypnobabies tracks so I can mentally separate myself from the discomfort. Sometime after midnight my pressure waves intensified and now feel like someone is periodically activating an electric mixer in my low belly. My body has dilated to six. The woman’s voice on the IPOD is soothing, but my strength has been steadily deteriorating.
"I can't do this," I whisper. "I'm so hungry." Jon bolts up from where he'd been lying down on the short couch.
We call the nurse – a new girl, a livelier and friendlier version of the first, though her loud, peppy voice punches me between the eyes every time she speaks. She suggests Nuvain, which should take the edge off so I can get some sleep. I accept.
Two hours later, the Nuvain, which numbed my brain but not my body, has worn off, leaving me shaky and nauseated. I don’t want any more of it. Dr. L. is here now and pushes for an amniotomy. This must be merely to hurry things up because the baby is still not in distress (even though I am), and I’m suspicious because my birth plan specifically says I do not want an amniotomy unless the baby is in distress. Weakly I recall my readings…most amniotic sacs are intact until eight cm and beyond when left alone … From the time an Amniotomy is done the birthing mother is “on the clock” so to speak …
But I accept because so much has gone off course I want to hurry things along, too.
Noon. My parents are here and Jon’s are on the way. I’ve allowed my mother in the birthing room and I feel her presence in my peripheral, encouraging and positive in light of feeling as though I am trapped in an abyss of sweat and cervical checks and electric mixers. Dr. L. recommends Pitocin again, to speed up the last couple centimeters. Since my water is already broken we’ve got to get the baby out soon. Tick tock.
Somewhere in my body I am sighing, because I had known this could happen when I gave in to the amniotomy, but I agree and request an epidural first. I am still listening to the hypnosis tracks, and they are helping me breathe and stay afloat in my mind, but barely.
The anesthesiologist is busy, he'll be here soon. I lie on the bed, eyes closed, moaning. Jon massages my low back through contractions (at this point they have ceased to be pressure waves).
"I have to go to the bathroom," I whimper. Jon and my mom help me wobble to the bathroom and then back to the bed. Dr. L. bursts in and performs another cervical check. I think I may die of cervical checks.
“Know what? It’s time to push,” she says, speculating that getting up to go to the bathroom was probably what made me dilate the rest of the way. I've been here for seventeen hours.
No time for the epidural or Pitocin after all. I am half-relieved, half anxious.
Suddenly there are a barrage of nurses (three plus the doctor, and my mom and Jon, seems like a crowd) and bright light and everything feels like it's moving too fast. I don't have the energy to get in an all-fours or kneeling position (I'd been planning to birth in a gravity-assisted position, to let my body do the work and push gently with contractions, it was all in my birth plan) so I ask the nurse if I can side lie, which puts less pressure on the perineum and lessens the chances of needing an episiotomy. She says yes. Then Dr. L. comes in and wants me on my back. I remind her about the gravity, it was in my birth plan.
"No," she says. "Not for a first baby."
Though I don't have time to process, it is clear that she did not read the birth plan I had typed up, brought to a check-up and watched her run her eyes through and nod at. I am out of strength. She didn’t read my birth plan. She didn’t read my birth plan, and I don’t have the energy to argue.
From a mental distance, I watch myself assume the position I was warned about in my birth books, the one I am most afraid of for a drug-free delivery – flat on back, legs up.
The Lithotomy position (legs up in stirrups) narrows the pelvic outlet so that birthing is difficult, makes it so that you are actually pushing uphill, and increases the risk of tearing because of too much pressure on the perineum.
“Hold your butt up,” someone commands, and I do, although I don’t think it’s really me. My soul is shrinking away. All that remains is torture.
“Stop doing that,” I whisper, and Dr. L. pulls both hands out from inside me.
“Sorry,” she says. “Didn’t think you could feel that.” She takes a small needle and injects something into my vagina.
I was afraid for how frail and despondent you had become, Jon will tell me later, like you had no hope left.
“Push! Push! One, two, three…” Everyone yells, and the sounds explode in my consciousness like firecrackers. I muster all my energy and push gently with a contraction, like my birth books said to do. It is uncomfortable, but bearable.
“Not like that,” one of the nurses barks. “Hold your breath and push. You have to hold your breath. Bear down. Hard.”
I do, and it’s like being impaled on rocks at the bottom of a cliff. Impact, invasion. It feels like rape, except instead of forced entry, forced exit. Purple pushing, they call it. There is a page on purple pushing in my book.
As Transformation begins to give way to the Pushing phase, women need more than ever to simply tune in to what their bodies and babies need. Unfortunately, at this time (if in a hospital) they are usually encouraged to get into bed if they’re out of it, have the back of the bed put down flat so they are pushing uphill, pull their knees back to their ears and bear down with each pressure wave as though their life depended on it, and hold their breath as nurses or others yell at them to “Push!” The nurse then instructs the mom how and when to breathe and also counts to 10, so that the mother will hold the push as long as the breath … Pushing your baby down and out this way makes it longer and much more difficult because it causes maternal exhaustion and can cause the birth canal to actually tense up … Pressure waves are amazingly strong in most cases and are designed to push the baby out with no hard pushing from the mother necessary.
“Push! One! Two! Three…”
For the next hour I push and push and push, and with each push I am withering, recoiling further into the dark recesses of my mind. Dr. L. grabs the scissors and makes a snip, and I am instructed to hold my pushes longer and longer. The sense of urgency is overwhelming, smothering, and I gasp for breath between pushes. We go from counting to ten to counting to fifteen, and then they tell me to push between contractions, too. I think maybe I’m dying.
“Harder! Push! One, two…”
A lightning bolt of pain tornadoes through me, and I release a primal shriek as a splitting sensation corresponds with sliding weight. Then stillness. "It's a boy!" Dr. L. announces, and amid a chorus of activity and surprised exclamations – “A boy?” – we were so sure it was a girl – I am far away, dimly conscious of Mom’s excitement and Jon cutting the slick, creamy cord. Then the tiny warble of my baby’s cries summons me back and I shout, "Give him to me! I want him before he’s dry!" I am not polite about it.
I want him before they take him away, I want him gross and wet with amniotic fluid. I want to soothe his transition between my womb and this sterile, cold hospital room. In my birth plan, I had asked to hold the baby for awhile after birth, before his being dried and weighed. My birth plan that my doctor pretended to read.
Warm and slippery, he’s a little gray at first, a tiny human body looking shocked. I look into his eyes and try to tell him I’m sorry, I didn’t want it to be this way. He looks confused. They let him lie on my chest for a mere handful of seconds and whisk him away.
Suddenly something bulky and soft is sliding out of me. I look down and Dr. L. is pulling out my placenta by the umbilical cord.
"She's shaking," Jon says. "Is that ok?"
"It's normal," says Dr. L.
Our baby boy is every synonym of incredible I can think of. He weighs 7 pounds, 10 ounces, and stretches 20 inches long. He has fine dark blonde peach fuzz on his head and deep, sleepy blue eyes. We name him Gavin. I hold him close and he and I work on nursing even though there are a series of visitors. I breastfeed in front of family and friends because, quite simply, I have lost all shame after pushing a baby out in front of my mother.
I long for a quiet, dimly lit room to rest and be with Jon and our new son, but it isn't to be. There are a series of lights, people, action. One of the first things Jon does is get me a sandwich, but I can only stomach a few bites. The nurse brings me a squirt bottle and witch hazel pads to treat the hemorrhoids that cropped up like a hornet nest, caused by such a rough delivery. Though I am horrified at the prospect of hemorrhoids – I have never had them before – I don’t really notice them because my vagina feels like mangled flesh anyway, like that electric mixer scrambled through on high speed. I am frightened of it and don’t want to touch.
Later, one of our visiting family members asks me about the birth.
"Well," I say after a moment. "I couldn’t have done it without the Hypnobabies.”
And it’s true – though a far cry from the peaceful, enlightening experience I’d been hoping for, the hypnosis tracks had been crucial to coping with hunger and cervical checks and the derailing of my birth plan in general.
“I couldn’t believe it,” Mom adds. “She didn’t even make a sound during labor. That machine was registering these major contractions and she wasn’t even making a sound.”
“But,” I continue. “I wouldn't do that again without an epidural."
"Yes," Mom nods. "Next time, epidural."
I realize I haven’t expressed myself very well, but I am too tired to decipher the raw nerves that rise in my throat like bile at the thought of how the birth went. What I meant was, I would definitely try to give birth naturally again, but I would not give birth the way I did – on my back, purple pushing – without an epidural. Drugs, I think, were created for that type of delivery.
Looking at my tiny son, I feel as though we are survivors of some overlooked, ongoing battle, especially when I start to express these misgivings and am met with, “Well at least the baby’s healthy,” a well-intentioned but ultimately dismissive statement.
In the months that follow the birth I will frequently return to my mental realm of the hospital and scan through, haunted by memories of lying on my back with my legs up, bearing down with all my might while my vagina split like a seedpod. In later conversation with my mom, I'll learn that the nurses didn't know I was going natural, and when mom told them I hadn't had an epidural, they snickered. I'll wonder why hospital policy is to treat a natural delivery the same as a drugged delivery, why my birthing goals were so unwelcome, and why our cultural norm is to interfere with the birth process regardless of whether or not it's necessary.
And in my head, I will compose letters to Dr. L. suggesting that in the future she respect her patients enough to read their birth plans and alert them if she disagrees. Although after researching, I couldn't find any medical evidence behind putting a woman on her back for a first baby, and spoke with other women who had been allowed to birth in the position of their choice with no problems.
With mind-blowing joy I recall the first time I held my baby boy, but still shudder into an emotional tailspin at the thought of his delivery.
I keep thinking, it doesn't have to be that way.
