A Rough Start

With my daughter's first birthday fast approaching, I have been thinking a lot about her dramatic entry into the world. Since I have referred to her birth several times on the blog, I thought I might take a moment to reflect on it here.

This is not one of those sweet, blissful, tears-of-joy birth stories, nor is it a minute-by-minute timeline of events. Instead I intend to paint broad strokes, zooming in only on those points which remain magnified in my mind.

My husband Paul cradling our newborn Josephine Marie.

Labor started hard and fast. None of this early labor, is this the real thing confusion. The second contraction hit a mere two minutes after the first, and the gap between them never expanded beyond that. We were leaving my in-laws house in the beginning of rush hour, and what is typically a twenty minute drive without traffic stretched to an eternity while we jolted through the stop and go mess on the freeway. When we finally got home, my husband called our doula and midwives to let them know. I labored at home for about four hours before the doula came, and another couple of hours before we packed into the car for the short trip to the birth center.

My labor must have been abnormally intense, since I appeared to be in transition for hours. Contractions lengthened, the gaps shriveled and soon enough the contractions were coupling, one piggybacking on another in an endless chain. At one point my midwife was certain it was time to push- instead I was still several centimeters away. I have never felt so crushed.

I abandoned myself to three more hours of this all-encompassing pain. The crazy thing about this kind of pain is that you have to let go in order to progress- it takes a very intentional and focused will to relax entirely while the waves of mind-numbing pain wash over you. When the midwife finally checked me again I had progressed by only one centimeter. In what felt like a last ditch effort, she was able to stretch my cervix, inducing the first huge push and allowing me to reach nine centimeters. She had to stretch it continually through each push, but at least we were able to move forward.

I had expected to be so excited at this point. I was so close to finally meeting my sweet girl! Instead I could not think about a thing except reaching the end of the finish line. It turns out I was still quite far away though, since the pushing phase lasted an agonizing three and a half hours!

Nothing smells better than brand new baby!

This was perhaps my most transforming phase of my labor. I had no idea I possessed such strength! As a long time distance runner, I thought I had pretty well tested and trained my endurance and willpower, but with each new push I surpassed all previous effort. Each push was long and hard, and at the end I would think, "that's it; that's all I have to give." Then the next one would come and, to my disbelief, there was even more for me to give. As I continued, my midwife urged me on- "okay, next we are going to do three in a row, no waiting in between." I used every ounce of strength I had on the first one, then without pause I pushed again and again, with more force than the first. My wonderful husband, present and supportive through the entire nineteen hours, said later that he could not believe how I continually had more to give.

I know some women say that they like the pushing phase of labor, because they feel strong and feel they are making progress. While I definitely did not enjoy this prolonged and exhausting torment, I did discover that I am capable of surpassing any limit that is placed upon me, whether by myself or by somebody else. There is more strength available to me than I ever thought possible, which turned out to be crucial in the final minutes of delivery.

Our first family photo, reunited in the NICU.

With much pain and effort, my girl's darling little face appeared. What followed were the most terrifying three and a half minutes of my life. There was a long moment of eerie silence as my midwife tried several maneuvers to get her free. "Where is my baby?", I thought. "Shouldn't she be out by now?" My midwife asked her assistant, "what time are we at?" That's when it struck me- Josephine was very dangerously stuck with shoulder dystocia.

I had read about shoulder dystocia during pregnancy in a couple of books by Ina May Gaskin, famous midwife and namesake of the Gaskin Maneuver. It is an emergency maneuver onto hands and knees in case of shoulder dystocia. Considered the most dangerous of sudden obstetric emergencies, it is when the baby's head is born but its shoulders prevent the rest of the body from emerging. Blood flow from the umbilical cord is cut off and the baby is deprived of oxygen.

My handsome and heroic husband holding Josephine in the NICU.

My husband also realized what was happening. Even before the midwife called out to her assistant to begin the Gaskin Maneuver, he had flipped me swiftly onto my hands and knees. Suddenly the room was full of midwives and assistants from elsewhere in the birth center.

Three and a half minutes is a shockingly long amount of time in which to think. I thought about how it was a good thing that we had always been open to having a child with a disability, as Josephine might become severely disabled in the next few minutes. I thought about how close to happiness the three of us were, and how quickly that prospect was melting away. I thought about how difficult it would be to go back to the home I loved, full of baby items, with empty arms. I feared for my marriage- we were such a strong team, and so deeply in love- and yet tragedies like this have a way of ripping couples apart. I wondered how we could ever be open to having another baby after losing this dear one.

And I prayed. I prayed harder and more desperately than I ever had in my life. I asked every saint I could think of. When I couldn't think of any more I prayed a section of litany of the saints, "all you holy men and women pray for us!" I begged and pleaded with God not to take away His child so soon.

I thought to myself, "never in your life has it been so important that you succeed. There will never be a more important moment in your life than this." I pushed with all the effort of the previous three and a half hours in those three and a half minutes.

My sweet girl took quite the beating on her birth day.

At last she came. A soft, limp, lifeless little thing. A deep shade of lilac-blue. One of the midwives got to work straight away to get her little lungs breathing. I felt ashamed to not be able to look at her. I feared that the more I looked, the more I would love her, and the more painful the loss if she died. They revived her right before the EMTs came crashing in. Her little body flushed pink, the color spreading out from her heart to her limbs.

I reached out to grasp her little hand and immediately regretted it- it still felt so cold and heavy, unmoving and non-responsive. The EMTs were working on assessing her breathing and found that she was unable to maintain her oxygen levels without the face mask.

I called out her name and finally I saw her move. She turned her head to gaze at my fearful, desperate face with gleaming, intelligent eyes. She was quickly packed onto a gurney as one midwife tugged out the placenta and another stabbed me in the leg with a shot of pitocin. My poor husband gave me a kiss before he left with our daughter, and I told him to not hesitate on an emergency baptism if it came to that. As he was heading toward the door he heard a midwife call for another ambulance- I was hemorrhaging and needed to be transferred as well. It was only then that I noticed the pool of blood which I was swimming in.

A second ambulance came to cart me away, and my doula handed me my favorite rosary as they rolled me out the door. It was four hours until I was able to see my precious baby again, attached to a rainbow of cords monitoring her in the NICU. After three days and two nights sleeping in a hospital recliner, we were finally able to take her home.

Finally on our way home!

The thing about traumatic birth is that others often believe that once the birth is over, so is the trauma. The ongoing experience gets dismissed with a, "well, thank God it's all over now!" Yes, I do thank God every day that my baby is alright. But what you can't see, and what those less outspoken than myself won't tell you, is that there can be a lot of continuing suffering. As I have said before, one year later I am still dealing with daily pain as a result of my birth injuries. I still have nightmares (though they are beginning to slacken) of my daughter dead or dying. When she was just a few weeks old, I was startled awake by my husband gasping and clutching his chest. I was sure he was having a heart attack! He had woken and looked into the bassinet at Josephine, who was wearing a long sleeved lilac onesie. By the dim illumination of her night light, she looked the same deadly hue as when she was first born, and he thought she had died. It also took Josephine a while to recover, since the prolonged pushing and shoulder dystocia caused her to need therapy for torticollis. Just because everyone made it out does not mean that everyone is alright, or even that the ordeal is really over.

Danny the Dachshund meets his new human.

It was a really rough start to a really tough year. Thankfully all three of us are fighters and are getting through it. I never expected our family to start out with such growing pains, but here we are. One year later we are not entirely 'okay', but we are together.

*I think that it is worth mentioning that there are no warning signs for shoulder dystocia. It is quite rare and impossible to predict. Our midwives handled this emergency at least as well as the hospital, and our traumatic birth is not at all because of our choice of a birth center rather than the hospital.