So. In slightly less than 36 hours, Jack will be two. This just kills me -- first that my itty bitty newborn is growing up so fast, second that we've kept him alive so long and third... that I'm still questioning the ways and means of his delivery.
So. Our birth story. I was pretty sure of his date of conception, which would have made his due date the 26th or so of July. On a 12 week ultrasound, the sonographer estimated August 1 or so his due date. It seemed pretty close, so I wasn't fussed.
I had a lovely pregnancy. Other than a fall off a community bus (yes, I fell off a short bus) at the beginning of my moderately hellish second trimester/working full time/taking full time classes at SFU which caused some serious back pain, and a few episodes of serious heartburn, I felt good. Pretty much no morning sickness, no spots, no waddling -- I was good. I only gained 26lbs, which made my midwives happy, and my main cravings were milk (I was buying and drinking 10+ litres a week) and a $50/week strawberry and mango habit. It could have been worse.
There were a few stressful things towards the end. I was in disagreement with my employer over the amount of holidays I was entitled to, and my auntie Joan was in hospice care having lost her battle with cancer. These things are related: I wanted a week to go visit her as I was too far along to fly and couldn't make the drive in a weekend in my state. I didn't get to see her, which still pretty much makes me want to cry. There were some good stresses too: we moved to a housing co-op in Mt. Pleasant out of our craptastic little apartment in the ugliest corner of New Westminster (a good move, but moving at 7 months pregnant with an incompetent and belligerent mover was not overall positive). My sister moved to the UK in the middle of June and I was both happy for her and sad that she wouldn't be meeting our little guy for at least a year or two.
The last two weeks of July were some of the hottest on record and the only thing that saved me is that I had gone off work a little early due to being HUGE and needing daily NST (non stress tests) in the first week of July to make sure the small fry was still going great (which he was). So, from July 6 onwards, I was off work and in the lake. Sasamat Lake in Port Moody saved my overheated bacon in a big way :)
July 26 came and went. My aunt passed away, surrounded by loved ones who weren't me. I was definitely big by my standards, and the only thing of any concern to my midwives was that I was apparently measuring 'big'. I wasn't really stressed by this: my weight gain was awesome, considering I started very overweight and sure I felt huge, but I didn't have anything to compare it to. I still wasn't waddling, which meant Jack hadn't started to descent into my pelvis, which again I wasn't super worried about. I had done a LOT of reading about natural birth and labour. I had midwives and an awesome doula, Sally, and had done the Birthing From Within course in order to learn techniques of getting out of my overly-clinical head during the birthing process. I knew that with the onset of labour, he could move into position very quickly, and I had faith that my body just wasn't ready to go into labour. I believed in the 'due month' and was willing to be patient and go past my due date if necessary.
We took long walks and short hikes, did lots of beluga-inspired swimming at Sasamat Lake and waited.
On a Tuesday, though, the 4th of August, my midwives checked in. I said I was still great, still not waddling, but I had noticed a very few less movements that day than the rambunctious tenant I was used to. They told me to go to St. Paul's for an NST, which was reassuringly fine. I was asked to come back the next day for an ultrasound, which I happily attended on the Wednesday afternoon.
Once I had my clothes all back on, June, who was one of my favourite midwives, came in for a chat. Apparently my fluid was measuring low (something I now know is pretty meaningless as a) fluid measurement is irrelevant to fetal outcome and b) it is pretty much impossible to measure properly by ultrasound or any other means). June didn't seem too concerned, though that may have been her unflappable demeanor, and I wasn't too worried until she said that Jack needed to be delivered. That meant an induction. And a go home, pack a bag, and drive to the hospital where she would be waiting kind of induction. Furthermore, a drive to Royal Columbian (in New Westminster!), since they wouldn't induce me at St. Paul's since they didn't have enough surgical staff on hand in case I needed a c-section. It was the first I had even considered a c-section as being something that could happen to me.
Back a few months earlier, when we were doing the hippie-dippy prenatal classes (which I loved, by the way, birth art and all), we were given the assignment of drawing our worst case birthing scenario. I drew the aftermath of a dead baby. Every single other couple drew a c-section. Funny, huh?
Gayle and John picked us up at home and drove us to Royal Columbian. We checked in and were given a tiny room off the nurse's station, where June fussed over us for a few minutes and left. At around 8pm, Cervadil (prostaglandin gel)was inserted by my cervix to try and get things started, but my cervix was still relatively closed (1cm) and high up. We were on our own for the night and told to rest while we could, and June was going home to do the same thing.
I felt strongly that laying there was not going to accomplish anything. If I was going to manage to have this baby, I needed to get him DOWN and I could only do that with gravity. I was up and walking for most of the night. I did feel contractions which I could walk and talk through to start with, but eventually had to pause and breathe through. Hours later, when I was found by a nurse to basically not have progressed, they started the Pitocin IV. The only complication of this was that I was told I had to lie in bed wearing the fetal heartrate monitor for 20 minutes. Those 20 minutes were unpleasant, but when I went to get up, I was told by the nurse not to. I had known about this possibility and demanded the 'telemetry' FHM which was wireless and which I could walk around while wearing. I was told the nursing staff weren't prepared to find it for me and if I wanted it, it would have to be my midwife who put it on. We called Commercial Drive Midwives, and Corrine was on call. This was a little disheartening. We had met all three midwives: Grace, June and Corrine, as is standard, and had decided that we hoped to get anyone but Corrine. She was nice enough, but a little blank/unresponsive/unengaged and she was the only one who had never had her own baby.
When Corrine arrived, sometime around 6am, she was MAD. Mad to be there early, mad the nurses wouldn't arrange the telemetry machine, just plain mad. We were a little taken aback, but frankly were more concerned with other things. Sally had also arrived (before our midwife) and was fantastic -- a calm and reasoned presence. We felt more confident standing up for ourselves while she was there, and in fact I eventually ignored the FHM nurse and just got out of bed to walk some more. Once the telemetry machine was in place (a stupid little webbing belt with several large plastic monitors attached to it), I went back to walking. I don't know how much I walked that night, but I still never waddled.
Eventually, the doctors on staff changed shift. Instead of the dark-haired female OB, it was a man. At 10am, he decided to check my progression and I was maybe at 3cm and still far back. He offered to break my water in order to get things going. Even knowing how one intervention can lead to another, I agreed. The thought of the past 14-16 hours resulting in a whole 2cm change was daunting. He actually offered to do a csection right then and I must have looked at him like he grew a second head. He backpedaled a little and basically said he was fine with me trying labour. He broke my waters which hurt like a motherfucker. I thought being checked for dilation was painful (I'm pretty sure I begged him to stop in the middle) -- I had no idea. I immediately asked if the fluid was clear and... no. No, they weren't. Now I was even more anxious. I knew that meconium in the water would limit the amount of time they would let me labour even more than the clock that started ticking when the induction started. I felt immense pressure to get this baby moving, so I was back on my feet, wearing horrible plastic mesh panties and a giant pad to hold the green liquid I was oozing. Ugh.
I stormed up and down the halls for what seemed like hours. Every so often a nurse or Sally or Corrine would mention that the nurse was getting a little frantic when I went to the bottom of the hallway as I would get out of range of the telemetry machine and it would go all crazy. I felt like I was slowly being corralled, my leash was being tightened closer and closer to that little room where I didn't want to be. Eventually some lucky mother had her baby and a bigger room opened up, one with a big tile tub, which they wouldn't let me into because of that IV in my hand. I think I asked at one point what would happen if I just went over to the bathtub and filled it and got in, and no-one answered me. Sally might have wished I would try, I suspect, but my midwife didn't encourage it.
Oh yes -- through this time, we also had a student midwife. I forget her name; I suspect I've blocked it from my mind. She was trained as a midwife overseas (the Phillipines? I forget) and was going through a program to become certified in Canada. She was horrible. She called me fat to the doctors at St. Pauls (telling them that my belly measurements, while large, were off because of the fat on my stomach). She was rude to Sally. She spent most of the time at the nurses station chatting them up. She was useless, or worse than useless. She was surprised when I said no to the c-section. I'm not sure she understood that mothers in Canada go to midwives to *avoid* scalpel-happy OB/surgeons and all those interventions.
In the middle of those interventions I had been so determined to escape, I remember asking the nurse in charge of the IV if I could have a break before she increased the dosage again. Every 15 minutes, they would turn up the drip, and the contractions were coming fast and furious, like I had no break at all between them. With infinite sympathy, she kept me at the same level for another fifteen before reluctantly stabbing the machine with a perfect fingernail. The nurses were wonderful.
I laboured on the toilet at lot. I leaked green stuff and the tiny corner of rational mind I had was completely grossed out by this. I wore a tank top and a pair of grey shorts that I thought would never come clean (but which I still have and wear). I tried the shower and hated it. I stood, I sat, I squatted, I swayed. I ignored the fussing of the nurses trying to adjust the telemetry machine. I was too hot, and too cold, and they brought me warm blankets to drape around my shoulders. Sally and Steve took turns applying pressure to my SI joints, which were on fire the entire time. Steve had brought my laptop and put on Jesse Cook, and I listened to flamenco music, every album, over and over again. *Early on Tuesday...* I got loud, and louder. I breathed, I may have swore a little, or a lot. No-one offered me any pain medication. I might have punched them if they had.
When I was checked again, sometime around 9:30pm, I was no more than 4 centimetres. Maybe five. Jack's head hadn't descended any further. In fact, his head was starting to swell from being slammed against my pelvic bone for 26 hours. A section was necessary. Corrine and the doctor agreed. Steve agreed. I agreed. I asked Sally if she could turn off the Pitocin, since being slammed by artificially charged contractions is one thing when you believe the pain will accomplish something and entirely another when you know it will not. I remember so clearly the compassion in her voice when she told me she could not, her throat choked with disappointment and concern.
Sally also did the unthinkable -- with the decision made, she asked the doctor and Corrine, who were chatting in the back of the room, to leave so she could talk to Steve and I alone to make sure we (ok, I) was truly on board with this. She was worried that I would be devasted by failure. Really, by that point, any regret I had was tempered by relief that the ordeal would soon be over. However, the doctor was offended at being 'ordered around by a doula', Corrine was shocked, and that useless student midwife told her off. Steve told Corrine that the student nurse had to go, full stop, and to her credit, Corrine sent her away. I took out my contacts, still wracked by contractions, and waited with Sally and Steve for the surgery.
In short order, I was wheeled to the operating room. The anesthesiologist was marvelous -- skilled, compassionate and funny. Now that I was back in my head, and almost out of my mind in pain, the rational side came back and I'm pretty sure I was making jokes in the OR as he did the spinal. I consoled myself that a spinal would not affect Jack in the same way as an epidural. I looked up, crucified on the operating table, and saw pretty eyes above a mask behind me. It wasn't until many minutes later when I heard her speak that I realized it was Corrine. Steve was let in as well, and squeezed my hand hard enough to take away the pain in my heart. Eventually I could no longer feel the pricks and the funny man also sat behind the curtain, watching little screens.
I felt pulling and tugging and the doctor, who may actually have been kind, was calm and deliberate. The anesthesiologist asked Steve if he was squeamish. When told no, he was invited to stand up and look over the curtain to see Jack be born. After short moments, I heard some little mewling and birdlike noises and the doctor exclaimed to my son that he wasn't to be talking before he was even born. My heart washed away, and they held up this little red blur over the curtain for me to see, before he was whisked to the little table to be suctioned due to the meconium. Corrine leaned down and said, "he's big. I think maybe 10 pounds or more." All I could think, laying where I most didn't want to be, was: "well, that explains everything."
It seemed about a million hours before I heard those first big cries, and Steve and a de-umbilical'd Jack were brought back to me for me to kiss and breath on and in and fall in love with. Jack, at time of birth of 10:20pm, Thursday August 6, 2009, was 10lb 8oz, and 22.5" long. The tape only goes to 24", so I guess he was sizey. Steve was escorted with his child up to the ward, and I was stitched up and sent off to recovery where I would only be reunited with my new family after I could move my legs. Sally had apparently been waiting in the hall where she met with Steve and was able to support him in the first minutes with his son, for which I am grateful.
I hadn't been in recovery very long when Sally appeared at the door, telling Corrine that the nurses had done a heel-stick test in concerns about his blood sugar as he was so large (even though with a 26lb weight gain, there was no way I was diabetic). His sugar was a hair low, so apparently a nurse was on her way to the room with formula for Jack, even though my intention was to breastfeed. Corrine, annoyed again, milked me of several drops of colostrum into a little container which she gave to Sally to run upstairs and finger-feed to my baby.
Again, a fantastic nurse came to my rescue. I could barely twitch a leg, but she declared me recovered and sent me up to the ward to join my family, where I put Jack to the breast and he latched like a pro. Sally and the drops of colostrum had saved the day and he hadn't been given any formula. He had lots of dark curly hair, pale eyebrows, ridiculously lush eyelashes, and a serious expression. His eyes were blue as the sky and he seemed a little tanned (normal newborn jaundice which cleared with milk and sunlight after a few months, and now his skin is as porcelain as mine own). After the furor of birth, we took the time to fall in love with our newly outside person. It might have been hours before I could sleep; Sally left and someone brought Steve a cot in our little private room. I eschewed the tiny plastic bucked and settled my son beside me to sleep and nurse and marvel over.
After a c-section, the nurses have you up the very next day. I insisted they remove the urine catheter ASAP but didn't manage a shower until Saturday when I also shaved my legs (pretty fancy, me!). I changed my first diaper in my life. Steve slept with Jack on his chest to give me a break. We had visitors and midwives, and the doctor came and really was kind after all. I can't blame him for being what he is -- a surgeon. We were released on Saturday and home at last. I was told not to lift anything over 10lbs for six weeks, but I had a 10.5lb baby, so I pretty much ignored all the advice they gave. I went to the mall on Wednesday to buy some nursing clothes (funny how I was so informed and well-read about labour, and knew nothing about nursing) and went to a meeting that night. We went to Bon's on Friday, Jack's first but not last trip to the best breakfast in Vancouver. Now he eats two pancakes on his own -- crazy, huh? His 14th through 17th day earthside were spent at the Princeton Heritage Music Festival, where Steve will play again in two weeks time. I was insane. Now I would know better, but I was drunk on love and milk and fresh baby. In time, we were fine. We are fine. Jack is better than fine: he is robust and hale and blonde and still nursing, at two.
There is still a part of me, and maybe there always will be, which will wonder if the c-section was necessary. I know so much more now, about the cascade of interventions and how one little dose of cervidil can lead inexorably to a surgery. What would have happened if I had told my midwifes that my body was obviously not ready for labour and I was a poor candidate for induction? What if I had said, fluid schmuid, my NST was fine and I would rather wait a few more days? What if I hadn't let them say "oh, but now you are TEN DAYS overdue", when the ten days was based on my estimation and, according to their infallible science, I was only four days over?
With waters artificially broken, and with the augmented contractions, and with the swelled head, it is plain he never would have delivered vaginally on that day, after all that. But but but -- what if I had never walked into that hospital, never put on that gown, never knocked over that domino? Maybe three days later, I would have woken feeling a watermelon between my legs and waddled to St. Pauls where I could have experienced normal birth, normal recovery, instead of a bulge and a scar where my abdomen used to be. Or maybe I would have had a NST without a heartbeat, or a baby with an infection from meconium, or maybe I would have experienced the fear I drew.
But I will never know. Next baby, should we be so blessed, next baby will be born at home.