I hope I never forget the last part.
I have given birth five times now, and one thing I have noticed is how quickly the sensations fade from memory. Probably some protective evolutionary feature: I joke that if women did not forget the pain of labor, none of us would ever want another pregnancy. But it's true; it fades. Already it is hard for me to remember exactly what it felt like to be heavy and lumbering, even though the weight of a swollen abdomen was (must have been) the dominant sensation for months. Already it is hard to find the words to describe the pains of early and active labor, although they occupied all my attention at the time. Even the fear and worry that marked almost every moment of the last week of my pregnancy -- even that has faded into the background, and what seemed so urgent now seems foolish, as if it was a foregone conclusion that all would end happily.
I hope I never forget the last part.
Because when the pushing force flooded me, I knew instantly that it would all be over soon, and it thrilled me. I stood, leaning on my fists on the children's bed in our room, gasped all I could ("Here we go...!"), and pushed. I don't remember (damn!) if I expended any conscious effort or if my body just took over, but I do remember that I felt the baby's head descending through me already, and I could tell it was moving fast and I was opening up, and that it would be only a moment.
I didn't bother to warn anyone or to worry about catching. Two midwives were behind me somewhere, and one of them would catch. Mark seated on the bed, several feet away, watching but staying out of the way; three times we've had dystocia, this is what midwives are for.
Three shoves. Down, and down, and... Out. No burning, no moment of crowning; the baby's head filled me, and then the sweet release; and the second thrill was to feel all the rest of him following, bumpety-bump, no sticking place at all, and despite all the other sounds in the room -- the whir of the space heater, the shouts of children downstairs, the murmuring of the two midwives -- I heard over all that the tiny gasp, the first breath, and it rang in my ears. And a moment later I held him in my arms, gasping myself:
"You're... you're beautiful."
+ + +
This story starts a week earlier, when I was waving goodbye to Mark and the bigger kids as they finished loading the minivan with skis and boots and helmets, headed to the local hill. I was not quite 36 weeks along, and as I turned to close the door, thinking about making a snack for my three-year-old, a gush of fluid soaked my pants.
I opened the door, called to Mark: "Can you come back in for a few minutes?" And when he came back in: "I have to call the midwife. Because, um, I think my water just broke."
+ + +
How to describe the week that followed... It is very hard now. Because now I know that the ending is good, that we stayed in my warm house, that he was born quickly, that he breathed. But then, I didn't know. When I was waiting for the midwife to call me back, going over the facts in my mind --
-- it isn't 36 weeks yet
-- that fluid coming out of me is definitely not urine
-- labor usually starts within 24 hours of membrane rupture
-- this baby is not ready yet. I am not ready yet
-- anytime after 34 weeks the standard medical advice post-rupture is to induce labor to avoid infection in the sac, and let the NICU sort the babies out
-- the midwives typically don't attend labor at home before 37 weeks
-- if I go to the hospital they WILL do a manual check of my cervix, and that is what will start the Infection Clock and therefore the It's-a-good-idea-to-induce-labor Clock, but I'll also get IV antibiotics which will most likely solve the infection problem, while creating others, and the baby will likely be taken to NICU because of being born preterm
-- if I don't go to the hospital I can improve my chances of never getting an infection, but I can't eliminate the possibility, and I'll be saying no to antibiotics, and if against the odds there is an infection, I will know my decision played a part in the outcome --
When I was waiting all this flickered from one to another in my mind in an endless loop.
The midwife called, and agreed that labor was likely in the next day or two, but that Mark and the kids could go skiing since it wasn't very far away and since the midwife was only a few minutes' drive away. So they went. I stayed home and fretted. Labor did not start that evening. Mark came home. And then the long vigil began.
+ + +
Days went by, punctuated by leaks and gushes. Each time I froze in place, waiting to see how much would come out of me. Is that "the rest of it?"
The midwives said, "Sometimes it seals back up."
I did not seal back up.
No choice seemed good.
I could go to the hospital if I wanted; it's less than two miles from my house, one of the best NICUs in the state and a labor and delivery ward steps away.
But if I went there it would be an induction before term, and I feared for the baby.
I could stay home if I wanted, and wait and let the baby mature, which everyone said would be reasonable as long as I had no signs of trouble.
But although the midwives and Mark and the few friends I confided in assured me that it was reasonable, I still hated that idea too; because I always tell people who express worries to me that of course I am confident in home birth... because I am low-risk. Everything in my pregnancies has always been in conformity with Being A Good Candidate For Home Birth.
Now I was pushing the envelope of the obstetrical paradigm, which holds that avoiding infection is better than avoiding preterm birth, that the womb with ruptured membranes is a dangerous place for a baby to live and grow. Even though I know that the medical paradigm is based on the idea that immediate preterm birth problems can be solved by applying more medical paradigm in the form of NICU, and also on the blithe idea that those obstetricians won't be the ones to deal with the long-term problems that may occur, even though I really do know all these things; the obstetrical paradigm has sunk into my psyche anyway.
I felt: I am a dangerous place for my baby to live and grow.
I felt: I am an open wound that at any moment might fester.
And I kept thinking:
...Right now my baby is fine. His heart beats, he moves. I can walk out the door and I can be in the hospital in ten minutes. And if I go there they will (eventually) give me my baby, whole and breathing. Probably.
And if they don't it'll be on them, not me.
No, I know the answer to that, too.
+ + +
Here is what one does if one is a ruptured-waters mother and one does not want to fester:
-- Immediately swear off putting anything in the vagina.
-- Stay home. Avoid having visitors.
-- Take oral temperatures at least twice a day to be sure there is no fever.
-- Stay out of pools and bathtubs. Take a lot of showers.
-- Have a bathroom all to oneself, a bathroom kept scrupulously clean.
-- Take megadoses of vitamin C.
-- Have the midwife come every day to listen to the baby and palpate to see that some fluid is still in there. (That last part was my idea, not theirs.)
-- Pay attention to the color of the fluid. Be suspicious if it ever turns away from clear.
I did all these things. It had been the Fourth Sunday of Advent when Mark dressed the kids for the ski outing and my water broke. We would not go to Christmas Mass this year. We would not see the trees lit in the sanctuary at all that season. We stayed home.
We did have visitors once. H. and the rest of her family came to keep me company one evening. We ordered from the local taqueria and feasted, while I confessed my fears over and over.
Day after day I broke down in tears, those tears alternating with fragile hopefulness, only to have the hopefulness shatter when I would feel another gush of fluid.
One midwife said, "This is the longest I have seen someone go without going into labor after a membrane rupture."
The other midwife said, "I have seen people wait as long as a month."
They both said: "Right now you're fine. Right now there are no signs of trouble. You can keep waiting. It is your choice."
Mark said: "If you decide you want to go in, we can do it. But if you are comfortable waiting, I am comfortable too."
+ + +
Eventually we made a plan. Full term for me -- 37 weeks -- would come on Tuesday, December 31.
I would hang in there, monitoring all the signs, until then (or until the signs went bad). Only on the 31st would I consider going in to the hospital. When I was at term.
On second thought -- I would wait till the holiday was over. Who wants to be induced on New Year's Eve? With all the people trying to get their tax deductions and clock-watching doctors wanting to get to the holiday party?
I pushed my interior deadline to Thursday, January 2.
Once I had the "deadline," as I thought of it, I felt a little bit better. I had a plan. I could change it if I wanted. But I had a plan. Knowing there was an "end" in sight helped me wait out the days and hours.
+ + +
In the middle of the night, about 2:30 in the morning on the last Saturday of the year, I turned on the bathroom light to check the color of the fluid on the pad, and found it was no longer clear. It was pink.
In previous pregnancies I might have fretted about whether to call about such a small thing or whether to wait till morning. Not anymore. I picked up the phone and I called the midwife.
First she took a minute to wake up. (Even midwives have their limits). Then she said: Maybe something is getting ready to happen. No contractions?
All right. Go back to bed. Call me in the morning, or if there are any contractions, or if the fluid changes again.
Across town on the other side of St. Paul, she was writing in her notes:
"2:30 AM call -- concern about fluid color -- after talk determine some pink -- this is good -- perhaps labor close"
I went back to bed. You might think that I would have had trouble sleeping, but exhaustion overtook me.
+ + +
It was still dark when I woke up with a strong, painful contraction radiating from under my belly, at the crease between belly and lap. I reached up to the shelf and found my phone, checked the time: five-something in the morning. Dozed off again. Another contraction woke me; I still had the phone in my hand, and I checked the time. This went on for a while; I thought about waking Mark, but it was close enough to morning that I waited; and while I waited, the contractions slowed and stopped. I fell back to sleep.
+ + +
We woke up together much later. I felt rested and glad to be spending a Saturday at home. As we puttered around the kitchen, making breakfast and getting the coffee started, I had a few contractions, similar to the early-morning ones, but stronger and still irregular. As they went on they started to get my attention more and more.
I got some paper and pencil for Mark to keep track of the time between them (I never can do it myself; something about having contractions makes me incapable of managing numerical data).
+ + +
+ + +
+ + +
By now I was leaning on the arm of the rocking chair, unable to speak during the contractions.
"Let's wait to call until we've timed them for an hour," suggested Mark.
At an hour they were five minutes apart.
+ + +
The notes say:
11:00 AM -- Talk with Mark -- he is feeling this is it -- not sure ready for us to come -- he will call [the other midwife, who lives closer]
11:12 AM -- Mark calls -- Talked with [the other midwife] -- they have asked her to come to check in. Share -- "Well, I think I will just come also".
11:21 AM -- [the other midwife] calls -- she is almost there -- I share will be getting in my car shortly.
I have the other midwife's notes too. They are in a fluid hand, on a sheet of notebook paper she took from my bedside table.
11:25 am she is walking when I arrive -- restless -- some cntx stronger than others -- [first midwife] on the way
11:35 fht 144-156 baby ROA, lower in pelvis leaking clear fluid cntx strong
Around this time we left the older children downstairs with strict instructions to clean up the kitchen. As I climbed the steps I remembered climbing the same steps the last time....before I had my now-four-year-old... and wondering then whether I would come down them again before I had a baby in my arms.
That time? Nope.
And now here I was climbing the same steps and wondering the same thing.
+ + +
I knelt by the side of the bed and labored there for a while. The contractions were intensely painful and entirely low under my belly, and each brought a whisper of a suggestion of opening, of descending. Someone brought me a glass of orange Gatorade and a glass of water; in between contractions I picked up a glass of one or the other and swigged it. The second midwife arrived and did a little quiet bustling around. Mark was at my side; I needed space, space to move, urgently, and I told him, "Don't touch me!"
He removed himself to the other side of the room.
In my memory the room is darkened with the shades down, but I'm not sure that it really was. In my memory the two midwives are seated on the floor watching me, and Mark is on the bed, watching. I felt sleepy and said so. Contractions are tiring.
+ + +
Somewhere in there, H. arrived. Heavily pregnant herself with twins, she greeted me, but soon got to work keeping my very curious four-year-old downstairs.
After a while I wanted to try a supported squat, so I got someone to help me assemble a sort of birthing stool out of a half-dozen purple yoga blocks that I'd bought for this exact purpose some weeks before. (Last time, my legs had given out and couldn't squat anymore just before delivery.) I settled myself down on them, my black knit maternity dress tented over my knees. It wasn't the most comfortable position for my sitting apparatus, what with the yoga blocks digging into either side of my glutes, but it was a pretty good approximation of a squat.
Ugh, though, it didn't make the contractions any easier. And what an awkward position. My sit-bones were slipping off the blocks, my back leaning against the end of the bed, the closet doorway a couple of feet in front of me.
The senior midwife came over in front of me, stepping over my ankle and into the closet. She was holding a glove, and asked if she could do a vaginal exam. I assented, feeling pretty darn sure that birth was imminent -- but after a week of obsessing about not contaminating my birth canal, my "yes" seemed to come from far away outside of me.
At least I didn't have to move, because of the yoga blocks. She put on her glove. She was gentle. I watched her eyes turn up and to the side as she felt, and thought. She withdrew.
"Six, I think," she said to me, then to the other midwife. "The floor is a little puffy, there's a bit of a lip."
FUCK THE FUCKING LIP. I doubt that I said that out loud, but I assure you I was thinking it.
"Why don't you try another position?" suggested someone. "Maybe lie on the bed a while, take the weight off your pelvic floor through a few contractions."
The yoga blocks were still hurting me, after all. I crawled up onto the bed and stretched out on my side. "Yes," I said thoughtfully, "this is what I need to be doing."
And then the next contraction started -- low under my belly -- and I immediately said, "But WOW that really, really hurts. Lying here really hurts. I mean -- " I went on talking, gasping -- "I think I need to be here, lying here on the bed right now, the rest of me -- the rest of me feels good -- tired -- but -- OH my gosh this position. Really. Hurts."
+ + +
Sometimes, when I am running, when my legs are tired, I can think to myself: it's only the legs; the arms and the breathing and the chest and the shoulders and the neck, they are all fine; they can relax and I can breathe deeply and comfortably; the legs pump away but I can pretend they are not really part of myself, and their soreness and pain don't actually matter.
I did this now; concentrating on the lovely rest that so many parts of my body were getting; the pressure of the mattress against my temple, cheek, shoulder, hip, thigh; the weight of my body sinking into it; the whirr of the space heater, the drowsing of the lids half over my eyes. It only helped a little; I managed to feel both the waves of pain and the good stretching rest.
I spent ten minutes there. I must have had four contractions or so, each time remarking on how very painful they were. And then someone suggested I go to the bathroom.
I don't remember getting up and being helped to the toilet, which is just a few feet away from where I was lying; I do remember sitting on the toilet and thinking: I need NOT to be on the toilet right now. I came back to the edge of the bed, the children's bed, and leaned on it.
Blood spattered onto the paper pads under my feet. I closed my hands into fists. I leaned forward.
"Here we go," I gasped.
I have not forgotten that last part.