An eclectic, rambling journey through the ups and downs of life as a fish out of water-- a birthkeeping, Flamekeeping Goddess worshipper who happens to be an obstetric nurse in the Bible Belt.
Wednesday, July 20, 2011
"And it came to pass, when she was in hard labor, that the midwife said unto her, Fear not, thou shalt have this son also. And it came to pass, as her soul was in departing (for she died), that she called his name Benoni: but his father called him Benjamin."-- Genesis 35:17-18
I have three children, but in my mind, I've only given birth once. While I'm forever grateful for that birth, I still haven't come to terms with the delivery that preceded it. Today is the ninth anniversary of an ill-advised induction and rather sad VBAC attempt-- I look back with some bitterness and much pity on that woman, who thought she was prepared and so clearly wasn't. Gareth, my first son, will be nine tomorrow, and I will celebrate him, all the wonderful things he's brought to my life. Today is my griefday, the day I try to find some peace for myself.
Like every attempted VBAC, this story begins with a cesarean. In 1999 my dd arrived via a prudent, respectful, and not altogether horrible (though not conclusively necessary) c/s in Boulder, Colorado. She was a double footling breech with a triple nuchal cord-- I'm not convinced she was unbirthable, but in my ignorance and lack of initiative, I opted for a planned surgical delivery. My midwives and OB were very supportive; their assumption was that I would VBAC next time. The recovery wasn't bad, and I was comforted by the fact that she chose her own birthday-- I went into spontaneous labor with a dramatic water-breaking event worthy of a sitcom-- but I never once considered having a repeat section. My daughter's delivery was fairly atraumatic, but it wasn't, in my opinion, the way babies ought to come into the world. I began researching VBAC as soon as I got home from the hospital.
I might've been all right if I had stayed in Boulder, but by the time I found myself pregnant again, I was in Los Angeles-- definitely not a positive move in terms of birth options. The clinic that confirmed my pregnancy for me asked if I wanted a referral to an OB "for prenatal care or for termination?" Every OB practice I called wanted to schedule a repeat section without even taking a history. I got plenty of gasps and horror stories when I asked about VBAC: "Oh, no, we don't do that anymore! I have a friend who's a nurse, and her sister wanted a VBAC, and she went to 36 1/2 weeks without going into labor and when she did her uterus split open and she DIED and so did her baby..." It was hideous. Fortunately, I had found ICAN by then, and I knew a dead baby card when I heard one. I hired and fired two OBs, an APN, and two midwives, driving up and down the Los Angeles freeways-- Ventura to San Diego County, Simi Valley to Riverside. I got more and more frustrated; my marriage, which wasn't what one could call rock-solid to begin with, became more and more strained. Finally, at 30 weeks, I found a "famous" Hollywood birth center that would take me on and allow me to have a VBAC out of hospital. The midwife I met with, Elizabeth, was a little older than me and about 24 weeks into her own pregnancy. She was just what I was looking for: passionate about birth, excited about VBAC, supportive of me and my dreams for this birth. I only had 10 weeks (plus or minus-- dd came at 39 weeks, but I was prepared to go 42 or more), but I felt I had finally found a caregiver I could work with.
That may have turned out to be true-- I have no way to know. Three weeks later, Elizabeth broke her foot and went on medical/maternity leave. My care fell to the founder of the birth center, Nancy-- midwife to the stars, self-proclaimed pioneer of waterbirth. From my first meeting with her, I knew the game had changed-- she was much more medicalized than her colleague, much less enthusiastic about my chances of a successful VBAC. I kept going to her center, though, because I had no one else to turn to. As far as I knew, Nancy was my very last chance.
I hired a doula around the same time. She was finishing her certification; she needed two more births, and she gave me a great deal, financially speaking. Unfortunately, I found that I got what I paid for: Michelle was sweet, but inexperienced; she was no more prepared to deal with single-minded medpros than I was. When push came to shove (literally), she did not have it in her to support a VBAC in the face of resistance from hospital staff.
From our first meeting, Nancy was worrying about my baby's size. She commented on my two-year-old daughter's "chipmunk cheeks" and wondered if "she was always a Sumo baby." At her mandatory childbirth prep class she told fearmongering stories about "giant babies" and bad outcomes-- shoulder dystocias, nerve damage, a death. If I'd been in my right mind, I would've run like hell-- but I couldn't do it. Instead I swallowed it all and did what she told me, slashing my carbs, trying to stick to her recommended (and quite restrictive) diet so I wouldn't grow too big a baby. I kept a detailed food journal; my net gain for the pregnancy was 11 lbs. She accused me of lying, of not writing down every morsel I ate, of bingeing on ice cream and popcorn. She kept harping on how big this baby was going to be, "at least 10 lbs, you better hope you go into labor sooner than later!" She wanted me to have an ultrasound to get an estimate of size; I refused, knowing how inaccurate late-term scans tend to be. I concentrated on trying to go into labor, as she suggested: I ate the hottest, most cilantro-filled Mexican food I could find, I walked around the Burbank IKEA until I thought my feet would fall off, I bought the homeopathics she recommended and dutifully swallowed them every 2-3 hours, around the clock. I prodromaled from 37 weeks on, but I did not go into labor. I was losing all hope for my birth.
At 40 weeks on the dot I went to see Nancy. She checked my cervix, pronounced me "soft, squishy, almost completely effaced, maybe a fingertip dilated." Then, before I could get off the table, she brought in a sonographer and subjected me to an ultrasound I did not want and to which I had not consented. The results were predictable: "This baby is already 10 lbs. If you don't go into labor by 40 weeks, 6 days, I'm done-- I have to risk you out. I have no choice-- I can do a VBAC or I can do a big baby, but not both."
She informed me that she was scheduling an induction at California Hospital, a charity facility in downtown LA where she had privileges, and I would show up. If I went into labor before then, great. But she expected that I would end up with another cesarean. "If I'd known how big your daughter was [9 lbs 5 oz, 22 1/2"], I would never have taken you on."
I begged for an extension. It was July 12; 41 weeks would be July 19. I was moving to Arkansas July 29, driving across the country-- I told her I could not deal with a c-section.
"What you can't deal with," she answered coldly, "is a dead baby."
I went sobbing to my doula and to the wisewomen of the ICAN list. Michelle had no suggestions, beyond offering tools and tricks to deal with the induction. My ICAN friends were succinct: Get. Out. Don't go. Have a sick child, a lost cat, a flat tire. DON'T AGREE TO THE INDUCTION. Sensible advice... but I didn't listen. I asked Michelle what would happen if I waited to go into labor and showed up at another hospital-- she conceded that it was an option, but she could not in good conscience go with me, for fear of being charged with practicing medicine without a licence. I continued to prodromal, but I couldn't go into labor. I wrote a heartfelt eviction letter to my baby, pleading with him/her to come out. My sister took my daughter for a day so her father and I could engage in awkward, joyless intercourse, just for the prostaglandins. I kept taking those tiny white pills; I gulped down an entire bottle of castor oil in root beer. Nothing. And then it was Thursday night, and dh was on the phone with Michelle, arranging a time and place to meet.
At 5 am we met Michelle in the parking deck. The first thing Michelle did was apologize for not having a birth ball-- "I don't think there will be room"-- or a CD player-- "My toddler broke it." We walked into the hospital and were escorted to L&D by a security guard. Nancy arrived at 6:30, half an hour later than she'd planned. She barely looked at me as she rushed us into a small, shabby room. She handed me a faded hospital gown and pointed me to the bathroom. "Let's get this show on the road."
She had promised me I could wear my own clothes. She had assured me that I would have mobility, autonomy. "You just need a whiff of pitocin and you'll just spit that baby out." Instead, she shoved the gown into my hands and told me "get a move on." I took off my red maternity shirt-- blood-bright, it sang birthing power to me-- and pulled the thin, scratchy gown on instead. In that moment I gave away the last of my power, my self-determination. I buckled, caved.
I climbed awkwardly onto the bed, met the offgoing nurse, Catalina, who had had two VBA2Cs and saw no reason why I shouldn't succeed too, and then the day nurse (Julie? Jeannie?), who had had a waterbirth with Nancy at her birth center a year before. I got an IV, external monitor and tocometer, blood pressure cuff. They started the pit at 7 am sharp... and Nancy disappeared. I only saw her once more-- rather, I heard her-- hours later.
Labor hit hard; my concept of time disappeared. From time to time people came in-- a resident, I think, did a vag exam and said I was closed, thick, posterior. Nancy had lied; my cervix was not ready. I'd been told I could get off the monitors and go to the bathroom; when I tried, I was informed that was not possible and handed a bedpan. I could not void; the indignity and awkwardness made it impossible. I requested a Foley catheter, adding another tether to the bed. They kept increasing the pitocin, and soon added a pulse ox monitor to my lines. I think I was only about 2 cm when they broke my water, insisting that it was necessary in order to place an internal monitor, since the EFM wasn't picking up well. The ham-handed resident did it, and got the internal fetal probe hung in my cervix. That must have really messed up the fetal heartrate tracing, because two or three nurses came running in and huddled around the machine. The resident was called back, and fixed the problem by screwing a new electrode into my baby's scalp.
The day wore on. I tailor-sat on the end of the bed and counted myself through contractions. Michelle and my husband hovered in the background, uncertain what to do. I didn't want to be touched, effleuraged, or even talked to. I pretty much ignored everything that went on around me-- until I heard Nancy in my ear, telling me it was 5 pm, I was about 5 cm, and she wasn't going to be able to make it to this birth, "but good luck." Then she had the nurse put me on my left side-- a move I resisted. I didn't want to lie down. I wasn't given an option.
At 7 pm Catalina came back. She brought a doctor with her, a man with a thick accent and an unpronounceable name embroidered on his lab coat, above the words "Reproductive Endocrinologist." He was on call for the evening, and wanted to know a) why I didn't have an epidural and b) why I was still being permitted to labor. Catalina gave him report and told him I'd been progressing slowly but without difficulty. He recommended an immediate c/s. She told him no, I was working for a VBAC. He wanted to know, "Is her pelvis adequate?" At that point I sat up and yelled, "It most certainly is!"
As far as I can recall, he never spoke directly to me. He told Catalina, my husband, and Michelle that I was still only 5-6 cm, and he would give me 2 hours to make significant progress. Also, he insisted that I accept an epidural immediately, or he would roll me to the OR and deliver me at once. Then he swept out.
I was crushed. I had achieved a sort of "groove" with my labor, and even though the pitocin contractions were hard, unremitting, relentless-- I was coping. As soon as that doctor walked in, the atmosphere was poisoned, ruined. Michelle encouraged me to go ahead and get the epidural-- "Maybe it'll help you relax and dilate." So I agreed, and the next thing I knew, an officious and unsmiling CRNA (certified registered nurse anesthetist) arrived. She cleared the room, forcing my panicked spouse and doula to leave. She was as compassionate as an iceberg as she drove that trocar into my back three times-- three attempts to place the epidural, three misses. I'd had enough; I told her the third attempt had worked, although I still had full sensation down my right side. She taped down the catheter and left at last, allowing my support team to return.
The RE came back around 9 pm. I was "maybe 6-7," but it was progress, and he let me continue. I labored through transition-- I left reality behind at that point; I vaguely recall reciting a cake recipe. Then, suddenly, the fog lifted-- the world came back into hard focus. Catalina checked and pronounced me complete. I'd done it, I'd labored to 10 cm. It was about 11 pm.
I started pushing immediately-- coached pushing, on my side, which was uncomfortable and felt unproductive to me. But I kept going, pushing with all strength, while a tech came in and set up the delivery table. Row after row of shiny instruments, green surgical towels, a bucket-- Was this really going to happen?
I kept pushing. "I can see hair!" my husband crowed. Catalina was supportive; Michelle was excited. I started to think-- maybe--
After an hour or so I was still trying to birth my baby. Catalina was watching the monitor intently. She grabbed an oxygen mask and slapped it on me, telling me to "breathe for the baby." She reached up inside me, stimulating the baby's scalp as the strip showed a significant decel. "Push now," she told me, as if I hadn't been straining for what felt like forever.
Suddenly she was screaming out into the hallway, and in a few seconds the room was buzzing with activity. The doctor appeared and studied the strip. "You must push now. This baby needs to come out."
Catalina and another nurse got me up into that wonderful frog position, and I pushed with everything I had. They could see a silver dollar's worth of scalp, but it didn't descend. The doctor called for a crash section. Michelle leaned in and whispered, "It's time to do what the doctor says." Then the bed was rolling, I was moving down the hall, into bright lights and noise, into a cold white OR. The nurses helped me scoot over to the operating table. The doctor leaned over me. "Your baby's heart rate dropped for several minutes," he said. "It has recovered now, and there is no distress. But I cannot let you push again. We need to do a c-section now."
I was crying now as the staff fell into the practiced choreography of surgical prep. "Will you use the same scar?" I asked the RE. "I want you to use the same scar."
"Of course I will, no one will be able to see it," he said reassuringly. He thought I meant my external scar.
"No, on my uterus... I want a low transverse scar, the same as before..."
He muttered something and turned away. The CRNA came to dose the epidural, and I realized I could feel what they were doing as they washed and draped my belly. "I want general," I blurted, and she glowered at me. "Please!"
"I'm going to give you a bolus. You'll be fine."
"But-- I can-- " I couldn't get the words out. I was suddenly terrified that not only was I going to end up having a cesarean, but I would feel it. I'd read some fellow ICANers stories of surgical awareness, and I was choked with fear, tears running down my face. "Please!"
She snorted in disgust and said scornfully to the RE, "She's demanding general."
"Dose the epidural." And he kept on with his prep. I could feel pressure on my belly-- I didn't know what they were doing--
Then I heard, "Oh, shit." The CRNA held up the epidural catheter, which had apparently fallen out when they transferred me to the table. The RE said, "Put her out." A black mask came down, and everything went dark. The last thought in my head was, Oh, good, I can go now. The baby will be fine, his dad can take care of him. I honestly expected-- and wanted-- to die.
I woke up as they were wheeling me into recovery. I could hear voices, but they all seemed to be coming from the end of a long tunnel. I saw my husband in scrubs, holding a small blanket-wrapped bundle; someone said, "You had a boy." I thought groggily, Someone had a boy... that's nice... I felt something hot run down my inner thigh; I mumbled, "There's more amniotic fluid." Michelle appeared and said soothingly, "That's not amniotic fluid now, sweetie. That's blood."
I'm told I breastfed my new son in recovery, but I don't remember it. He was big, indeed-- 10 lbs, 5 oz. I have no memory of him in the hospital at all, though I know he was there, that I held him and nursed him. We only put him in the crib when I pushed it out into the hall and forced myself to walk in the corridors. My first clear recollection of Gareth Benjamin is when I was finally discharged from the hospital on Tuesday afternoon-- he was extracted at 1:11 am on Saturday, July 20, 2002-- and his dad hadn't installed the carseat. I struggled up out of the wheelchair and put it in the car myself, then put Gareth into it. I climbed in beside him and left the nightmare behind-- I hoped.
During my stay on the postpartum unit, I was denied pain medication after the first day. Since I didn't have an epidural, there was no option for PCA pain control. For some reason, no one would prescribe pills. I was given IM shots of morphine, which did little for the pain and made me itch abominably but allowed me to leave reality behind temporarily. I had three of those, but when I begged for a fourth, I was told, "Nobody ordered any more meds for you, that order expired." They gave me 600 mg of ibuprofen-- equivalent to 3 Advil, which is what I normally took for a headache. No one helped me clean up-- I remember having to get up about 8 hours after surgery and try to pee, since they had taken the Foley out in recovery as well. Someone helped me shuffle to a shower chair, then left me on my own. If my linens were changed, it was done while I was drifting in a morphine fog. They would not let me eat-- no one advanced my diet from clear liquid to regular until lunchtime on Tuesday, just before I left. Mostly I was ignored, left alone with my baby son, since my husband had to care for our two-year-old. The brightest spot in my stay was one evening when my sister sneaked me in a milkshake.
I went home on Tuesday, July 23. Immediately I had to deal with packing up and getting ready to move across country, since we were leaving on July 29. On Friday, I got into the shower and pulled off the peripad I'd been using to shield my incision. I screamed-- the pad was soaked with blood. My incision was open on the right side-- maybe an inch, and draining what looked like watery blood. I made my husband take me to the nearest ER, where I was told that such mild dehiscence was a "normal but uncommon result of abdominal surgery." There was some talk of opening the wound and packing it, but the Er doc finally decided to leave it alone. He told me to keep a pad on it, monitor the drainage, and come back if it started to look like pus. He prescribed a 10-day course of Keflex and sent me home. On Monday we left Los Angeles and headed east on I-40. My incision stayed open and leaked serosanguinous fluid for 6 weeks.
I barely remember my son's first year. I lived-- survived-- in darkness, only getting out of bed to care for my babies. I had nightmares, cold sweats, flashbacks to the OR. Most days I wished I had died on that operating table. I poured out my grief and rage on the ICAN list, and the wonderful wisewomen there supported me as best they could. It took years before I could talk about Gareth's "birth" without weeping, and I still can't talk long without tearing up. I hated all doctors, all midwives, all doulas. They had betrayed me, stolen my baby's birth. I was broken and defeated. I was bitter. And then I was angry. I burned in that crucible, channeled my fury into nursing school-- I refused to ever be at the mercy of medpros again. I became an RN and took a job in postpartum, so I could give mothers the care I did not receive.
I conceived again just before my last semester of nursing school; I sat my boards hugely pregnant. I had an empowering unassisted pregnancy and birth, and three years and six weeks after Gareth was surgically removed from my uterus, I gave birth to his baby brother-- in my living room, on my own terms, into my own hands. He was slightly bigger than Gareth, who was vertex but had his head cocked-- an asynclitic presentation. Rowan was positioned beautifully, in part because I had learned how much more important position is than size-- something Nancy never mentioned or, I suspect, even considered.
So... that's my story. The CBAC from hell made my career and my triumphant UBA2C possible. And of course I got the gift of my first son, my Gareth-- my gentle, angry boy. I guess I should feel some measure of peace over it now... maybe one day I will.
I gave him the middle name Benjamin for my grandfather. But it was fitting in another way as well. In the book of Gensis, Rachel dies giving birth to a son she names Benoni-- "son of my sorrow." His father, Jacob, renamed him Benjamin, "son of the right hand." In a very real sense-- to me, at least-- I died on that table. The woman I was, who trusted professional caregivers to do what they promised, went to sleep and never woke up. Instead there was-- me, angry and bitter and devastated-- and determined.