Postpartum and NICU
professor & maman de DS1 (6) & DS2 (1)
finished the hiking trip
a few weeks later
a few weeks after that
The first thing I did upon seeing the positive pregnancy test was run into the bedroom to tell DH. The second thing I did was start emailing local midwife practices.
Because I’m type 1 diabetic, none of the Toronto practices I approached would take me, claiming I risked out of the scope of their practice. Here at MDC I PMed Carolynn, a MW who appeared to be from my province, to ask her if I should give up looking. It turned out her practice, though technically outside the city (so I hadn't considered it in the first place) was only 30 minutes from my house and they would be happy to talk to me. Her practice has a different philosophy: their aim is to provide midwifery care to women who want it, not just women who meet certain medical/demographic criteria.
I didn’t even completely understand how they were able to sort out the fact that I ended up with a midwife and a perinatologist (high risk OB.) Apparently they bent the rules a little for me. I was so happy to have the midwives. They were the only people in my health care team who acted as though I were having a baby, not just a pregnancy.
I really wanted to work with a midwife because if I weren’t diabetic, I would have planned a midwife-assisted homebirth. A few years prior, I had a group assignment for one of my graduate classes: research a topic to do with the role of hospitals in health care. My group chose to use the context of birth, and it was from there that I learned all sorts of things I hadn't considered about the societal default of birthing in hospitals. I thought back to a women's studies course I took as an elective during my engineering undergraduate degree, where one of the older students in the class mentioned once how she had a homebirth. I was 19 years old at the time. I remember being shocked and asking her why she didn't go to a hospital -- she looked at me, a little annoyed, and responded, "Because I wasn't sick."
Although I technically risked out of midwifery care and homebirth, and while my disease put me and my baby at higher risk for a few complications, I was confident that I could still have a normal pregnancy and birth. I went into pregnancy in good health and with excellent glycemic control.
My pregnancy was very healthy. All tests (and there were a lot of them!) came back normal, my belly grew right on schedule, and aside from the nausea of the first trimester and one bad episode of hypoglycemia in week 14 -- not unusual in women who maintain tight control over their blood sugars -- where DH had to call the paramedics out to our house, I felt good all the way along.
I worked incredibly hard to maintain excellent glycemic control throughout the pregnancy, which was challenging with the ever-changing hormonal cocktail in my body and unpredictable demands of the growing baby. My HbA1c's (a measure of average blood glucose) were consistently between 5.6% and 5.8% -- nondiabetic levels. I often tested my sugar 20+ times a day and was extremely thankful for the flexibility afforded to me by my insulin pump. I remember how happy I felt after the second level 2 ultrasound came back and all organs looked great -- it meant that in addition to a little luck, the hard work of the previous months was paying off.
another pregnancy photo
I was not thrilled about the idea of giving birth in a hospital. From what I already knew, and what I continued to learn, I didn’t think they were the best environment for birth. I worked through the hypothetical situation of accidentally birthing at home with my midwives, and was seriously considering that. I really appreciated their openness to that since it could have put them at risk professionally.
In the end, I gave up that idea because no one there would have had experience managing blood sugars in the baby of an insulin-dependent mom. Because of my diabetes, even with my excellent glycemic control, my baby was at considerably higher risk for neonatal hypoglycemia. DH and I were nervous about the risks of sudden crashes that can cause seizures and brain damage, especially after I consulted with the hospital neonatologists, who were not encouraging when I asked about going home as soon as possible, monitoring the baby's sugar ourselves, and returning to the hospital if we had any readings below a threshold they suggested.
I couldn't quite understand how testing the baby every four hours in the hospital might be less risky than testing every one or two at home with a more stringent cutoff, but in any case, DH and I decided that if I birthed at home, we would take the baby into the hospital for his or her first 24 hours just in case. (Now, after having experienced how they handle such issues, there is no way I would make the same decision. But that was our understanding of the best decision at the time.) Carolynn advised that if I was planning for the baby to be a patient, it would be in my best interest to be a postpartum patient as well. Because I was not technically eligible for midwifery care, Carolynn would not be able to care for me at the hospital, but would be there in a support role.
I got a slow ramping up of pressure and scare tactics from my endocrinologists as I went along through the pregnancy. I initially really liked one of them, Dr. AK, because she talked such a good game about how she prefers to call high-risk pregnancies "special" pregnancies, and how type 1 women usually know their own bodies better than anyone else, and how they wanted me to have a vaginal delivery. However, as time went on, it became clear that it was just talk.
By my last month of pregnancy, I really hated both endos, but I didn't know of another OB who would work with Carolynn, and to work with him, I had to consult with the endos at his hospital. The endos really wanted me to have IV insulin and dextrose during labour (despite no empirical evidence of its superiority) and to be induced at 38 weeks, which is standard protocol for most type 1 diabetics. (We also have a worldwide 50% c-section rate.)
Dr. AK referred me for an appointment with psychiatry when I cried during an appointment while discussing concerns about hospital births, namely, that I was worried about being separated from my baby.
I saw the referral note recently -- apparently she told them that I have an "excessive need for control" and I had written a "medically inappropriate" birth plan. She signed the birth plan without ever mentioning the words, "medically inappropriate," to me.
She scared me during an appointment in my third trimester by telling me to watch out for low blood sugars. I asked why; she told me that some people have theories that low maternal blood sugar can cause brain damage for the baby. I knew that there was evidence that low blood sugar in a newborn can cause brain damage, so it wasn't a completely baseless theory, but it scared the heck out of me, and looking back, I think that was probably unwarranted.
Between the two endocrinologists, I got some of the most memorable quotes from my entire life history with health care providers:
|At my 22 week appointment: "I suggest that all my type 1 patients have their hospital bag packed by 30 weeks. You're likely to end up hospitalized, and (chortling) most women don't want their husbands packing for them."
"You know, often WE'RE the ones telling the OBs what to do."
At my 30 week appointment: "About a third of women in your situation go before 35 weeks."
Me: "Is that spontaneous, or due to complications that require getting the baby out ASAP?" (Type 1 diabetics have a 20% rate of pre-eclampsia.)
Her: "A little of both."
Me: "On what are you basing those numbers?"
Her (clearly surprised that I would even ask): "Uh, there were some cohort studies."
Afterwards, I went to my lab and did a thorough search of the medical databases. I found no such cohort studies. I emailed her to ask where I might find them. She never responded.
"Our job is so much harder with pump patients." (Note: Insulin pumps make life much more flexible and provide better control for type 1 diabetics.)
"What's a correlation?" (Note: both endos are principal investigators for grants and primary authors for journal articles. In those roles, you don't have to be a statistician, but you should certainly understand one of the most basic concepts in statistics.)
Re: availability bias, a *psychological* term having to with the fact that if you've seen/experienced an event, you are likely to overestimate its probability (physicians have been shown to have high levels of availability bias that affect their decision-making): "Well, that's a mathematical term."
"You're going to have train your husband to change diapers!" (wink, wink) (Those of you who know DH and know how involved a parent he is can appreciate how offensive a statement that was.)
To DH (at an appointment she had requested that he attend): "You know, a lot of diabetic moms have trouble bonding with their babies."
In response to my statement that one of the reasons I was refusing the 38 week induction was that they raise the risk of c-section: (astonished) "No they don't!" This endo later told me -- and I was clearly supposed to be impressed -- that she originally trained in obstetrics.
I had some minor scares as we approached 40 weeks. My insulin needs started to drop (I was told again and again to keep an eye on this as it is thought to be a sign of placental insufficiency if they drop too sharply) and my blood pressure started to go up (also a potential sign of placental insufficiency.) My BP was typically 120/80 or lower, but I had a few readings in the 140s/90s, though these were always when they were taken by someone I hadn't met before, and the second reading 5-30 minutes later was always in range. My readings at the midwives office were always significantly lower than the ones in the hospital or doctors' offices.
I also had decreased fetal movement one morning. I felt no movements for over two hours, even after drinking some cold juice, which was my standard trick to get the baby moving. I had an endocrinology appointment that afternoon, and those appointments were stressful enough, so I went to triage that morning. I was still feeling no movement when I arrived, but within moments of starting the ultrasound, the baby started moving again.
I agreed to an induction at 40 weeks because of the ever-increasing risk of stillbirth were I to go past. Placentas of diabetic women, especially those like me who have had the disease for over 20 years, are thought to age more quickly than those of nondiabetic women, and stillbirth is 5 times more likely in type 1 diabetic pregnancies. I got a lot of pressure from the endo and no support from my peri to go any further beyond 40 weeks. I was so unbelievably tired of talking about dead babies at every weekly appointment.
Dr. AK kept telling me stories, like the one about another patient who she thought was a lot like me. She had been diabetic for “a million years,” had great glycemic control and was having a perfectly uneventful pregnancy. She came in for a BPP one Tuesday morning, everything was fine, and that afternoon her baby died in utero.
She also paraded other women through my appointments. The first one, at an early appointment, assured me that a healthy pregnancy was possible. She told me, "I didn't think I could do it. But Dr. AK said I could, and she was right!" The other, at a later appointment, was an internist who just happened to drop by Dr. AK's office during my weekly appointment and who also just happened to be a type 1 diabetic woman who had had two children. She assured me that inductions are no big deal. She had both her children via c-section.
I tried everything I could think of to encourage my body to go into labour on its own before that 40 week deadline: evening primrose oil; red raspberry leaf tea; a few other herbs and homeopathics under supervision of a naturopathic doctor; lots and lots of acupuncture (including some experimental techniques); chiropractic, pelvic tilts, squatting and tailor sitting; stretch and sweep (I think I set the record at the midwifery clinic for the most number of times having had this done); meditation and talking to the baby; lots of swimming and walking; pumping colostrum four times a day; spicy food; and a few other things that I’m not going to spell out.
I also considered using castor oil, and really struggled with that decision, but I was nervous about its effect on my blood sugars, and my second priority after the usual top priority ("healthy mom, healthy baby") was to hold and bond with my baby immediately after birth. I knew that my best chances of ensuring that were to keep my blood sugars level during labour, and I knew I would have a lot more trouble with that if I were experiencing some of the typical the side effects of castor oil.
Unfortunately, while I think some of the things I did probably helped to get my body further along its progression -- especially the acupuncture -- none of it worked well enough to get me all the way into labour.
I remember telling DH a few times, “I hate this. I feel good. I feel like I could go longer.” He kept reassuring me that we were making a rational, sound decision. (He has since told me that he was scared by the dead baby stories, and may not have been entirely objective in these conversations.) I was feeling so much pressure and I just wanted to go hide somewhere. People kept calling and calling, and finally we put a message on the answering machine that we were no longer taking calls. Some people still called anyway.
I was scheduled for an induction on Tuesday, June 27, my estimated due date based on three early ultrasounds. My peri, who went on a three week vacation when I was 38 weeks, had checked the on call schedule and thought the OB that day would be supportive of my wishes. The hospital was a teaching hospital, said to be fairly evidence-based and respectful of patient preferences, had a one-to-one nurse to patient ratio, and was going for baby-friendly certification. I met with the director of perinatal services a few weeks before my induction to go over my birth plan. She reassured me that almost everything in my plan was hospital policy anyway, although I would probably throw everyone for a bit of a loop by refusing an IV or heplock.
The night before the induction, DH and I made a conscious decision to stop worrying about the fact that my body hadn't gone into labour on its own. We took the last photos of us as two, and went out for vegetarian sushi and a long walk. (Just in case one last shot at spicy food and walking might do the trick.)
last night as two - shot 1
last night as two - shot 2
professor & maman de DS1 (6) & DS2 (1)
I woke up because I had to pee. I had been told to expect a phone call when they were ready for me to come in, and to give them a call if I hadn’t heard by 10 a.m. DH and I had some breakfast, cuddled on the futon in the office, and watched Veronica Mars, as DH tried to help me to relax.
When I called the unit at 10:30, I was told they were having a very busy day so they weren’t ready for me yet. They asked me to come in for an NST, so we went in around 2 p.m. They were still swamped so we waited in triage. And waited.
I was starting to get a little freaked out, and then I thought maybe they wouldn’t have time for me and I would have another day to see if my body would go into labour normally. It was an attractive thought, although I was really concerned about going in the next day with a potentially unfriendly doctor on call. My peri had guessed that 3 out of the other 10 doctors would be supportive of my desire for a low-intervention birth, and I was specifically scheduled for a day when one of the suspected supportive ones would be there.
Finally, the perinatal director pulled a nurse out of her usual educator role to do my NST. Everything looked fine, so they sent me home to wait until they had staff and space to handle another birth. They called early that evening and asked me to come in around 8 p.m.
0 hours -- Tuesday 8 p.m.
Note: I am including my blood sugars here, because they are the numbers that guide my life, and they are especially important to this story. Nondiabetic readings usually range between 3.8 and 7.4 mmol/L. For me as a type 1 diabetic, good readings are roughly between 3.3 and 8.0, or up to 10.0 if I've just eaten. Anything in the nondiabetic range is excellent.
I was nervous and unhappy about being in the hospital, but was trying to focus on being excited about the prospects of meeting my baby. I had been checking in with him/her throughout my pregnancy. Five days earlier, I finally got the sense that s/he might be ready to come out.
I was optimistic because of the rapid progress my body had made towards labour in the previous week. I had had a lot of positive encouragement from Lisa W., my backup midwife, and Lisa D., my acupuncturist/naturopath. Carolynn was more cautious in her comments, but agreed that it was a good sign that I had gone from hard and closed to about 50%-75% effaced, 1-2 cm dilated, and soft. The baby was at station -3, though s/he had been at -1 a few days prior. S/he was anterior after being posterior in the previous weeks. I was not having any contractions that I noticed.
I had agreed to ARM (Artificial Rupture of Membranes), the thinking being that since my body appeared to be getting ready to go into labour, that might kick it into action and no other interventions would be required. I desperately wanted to avoid an IV.
The nurse who checked me in seemed reasonably friendly, although she was making disapproving noises about the woman in another room who was pushing -- and vocalizing pretty loudly as she did it. When the nurse was asking me all sorts of questions from her checklist, and I responded, "No," to, "Are you planning to have an epidural?" she gave me a hard time. "Come on, you never know …" I told her that while I would never rule anything out completely, the question was whether or not I was *planning* to have one, and I wasn't.
The resident who did the ARM was the only obstetrical staff member I really disliked. DH was not a fan, either, and thought he was kind of a jerk. When he had the hook in, I remember having a strong feeling that this was a very bad idea, but I chalked it up to nerves and/or my dislike of him, and let it happen. (As I write this, I am feeling a little sick to my stomach at the memory.) When my water broke, I was oddly surprised at how warm the amniotic fluid was, and also by the amount of it.
I started having contractions right away. I had to focus on them, but they were pretty manageable, and about 5 minutes apart. I changed into the skirt and bathing suit top I had brought with me so that I wouldn't have to wear a gown, and so that I had someplace to tuck my insulin pump.
I wanted DH and me to control my sugar as long as it remained stable. This was not a popular decision with Dr. AK, who was the endocrinologist on call, even though I was willing to discuss IV insulin and dextrose if it turned out I needed it. I thought that my best chances of having level sugars were to control them myself. I've been doing it for years and know my body. My number one priority was keeping my blood sugar at 7.0 mmol/L or below in the 2-3 hours before birth, since it minimizes the chances of neonatal hypoglycemia (low blood sugar for baby.)
I started walking. I was on continuous fetal monitoring. I had been assured that only intermittent would be necessary, so I asked about the change. According to my nurse, the on call OB and the med student, the CFM was suggested by the endocrinologist.
To this day, I cannot wrap my head around why I didn't just take the stupid straps off. I think I was just so out of my element that I couldn't think straight. It really shook my confidence that after so many assurances that I would be treated very much the same as any other woman in labour, all of a sudden people felt that my baby was in such danger that s/he needed constant monitoring.
And I felt almost as though I couldn't complain, because the monitors were telemetric (wireless), so I was not confined to bed. Still, the range of the signal was not very long, and I could only walk around the tiny little six-room unit. Around and around and around.
Tuesday 8:40 p.m. 5.2 mmol/L
Tuesday 9:41 p.m. 6.0 mmol/L
Tuesday 10:13 p.m. 5.0 mmol/L
4 hours -- Wednesday midnight
I was still walking. I told DH to grab some rest. My contractions were still manageable, and I thought he should get some sleep while I didn’t need him.
Wednesday 0:10 a.m. 6.4 mmol/L
Wednesday 0:59 a.m. 5.2 mmol/L
Wednesday 1:53 a.m. 3.2 mmol/L
Nearing 2 a.m., my sugar was a bit low, so I had some juice. I was finding the contractions a little more difficult to manage, and I was cold, so I decided to take advantage of the shower.
6 hours -- Wednesday 2 a.m.
I laboured in the shower for close to an hour. It was tough to get comfortable; my legs were tired from so much standing and walking. I tried sitting on the bench, but that was tough to manage with the contractions. Finally, I brought the birth ball in and bounced on that for a while under the water. I really enjoyed the shower.
Wednesday 2:55 a.m. 6.2 mmol/L
6 hours -- Wednesday 3 a.m.
I was hungry, so I got out of the shower, toweled off and grabbed an apple and an oatmeal cookie. I kept walking around the tiny little unit.
Wednesday 3:59 a.m. 5.7 mmol/L
8 hours -- Wednesday 4 a.m.
I was getting really tired, and it felt strangely like my uterus was getting tired, too. My contractions had eased off. I was dead on my feet and decided to try to get some sleep. It was around this time that I started to regret coming in for an induction that started at 8 p.m. I felt trapped -- there was no going back now.
I knew it might possibly help to walk some more, but I really needed to sleep. I slept for 2.5 hours.
10.5 hours -- Wednesday 6:30 a.m.
Wednesday 6:30 a.m. 2.6 mmol/L
I woke feeling woozy and anxious (I get very anxious when my sugar is low) so I asked DH to get me some juice. I drank it in bed and waited for my sugar to come back up so I could get up without toppling over.
While I was waiting, the jerky resident who had performed the amniotomy came in and gave me some pressure about needing to get further along in the labour. He wanted to start an IV of pitocin, and when I stated that I would like to try some more walking first, he got aggressive and started trying to use big words to intimidate DH and me. He told me that because of my ruptured waters, I was at high risk for chorioamnionitis (an infection of the membranes of the placenta and the amniotic fluid -- dangerous for both mom and baby.) He seemed taken aback when I asked for the incidence of chorio. He didn't know and said he would go find out.
By the time the conversation was over, my sugar was back up, so I got up and called Carolynn, who told me that this was was one of the participating hospitals in a study that showed that with proper management the elevated risk for chorio occurs 72-96 hours after rupture.
DH and I discussed calling Lisa D., the ND who had been doing the acupuncture in the preceding weeks. I had responded really well to the acupuncture -- each time, I got 8-12 hours of good, regular contractions. Lisa had said she would be happy to come to the hospital. I felt (stupidly) like I didn't want to impose on her, and DH didn't push the idea again.
11 hours -- Wednesday 7 a.m.
Wednesday 7:03 a.m. 4.4 mmol/L
I was bouncing on the birth ball, trying to get something going. I was having no noticeable contractions.
The OB on call came in, along with two residents, a med student, and my nurse. I couldn’t tell if the OB was using it as a teaching moment (“How To Deal With A Recalcitrant Patient”) or if it was more of a power and safety in numbers thing. She talked some more about the need to get things going, and said, "I know that you're evidence-based, and I respect that, but you aren't having good contractions, and we're going to have to do something about that before too long."
I asked about walking outside the unit. Walking around the tiny halls wasn't doing anything for me. She was not thrilled with that idea. I pointed out that the original plan was for me to have intermittent monitoring, so why couldn't I leave for short periods and come back for regular monitoring? She replied that Dr. AK had really stressed the importance of continuous monitoring and the monitors only had a limited range, but she would be OK with me walking around the floor outside the unit. DH suggested the stairs; the OB was shocked and mentioned that I could fall.
At this point, the conversation was getting ridiculous. I exclaimed, frustrated, that I wasn't planning to go hiking; I simply wanted to get some fresh air and a change of perspective. I mentioned that I had taken the stairs multiple times the previous day when I was in for the NST. I was starting to cry and explained that I really needed to have the straps off my belly, they were uncomfortable and I desperately wanted to shower without them. The OB looked torn and sympathetic, and agreed that a shower was a perfectly reasonable request and that I could be off the monitor for ten minutes every hour.
I decided to call Carolynn and ask her to come. I told her, "I really need a friendly face."
I took a shower and came back to talk to DH. I was really upset, and having no contractions at all. I think I was so freaked out that my body had decided that it was not safe to be in labour. DH was rubbing my back as I bounced on the ball some more while we decided what to do. I was crying.
12 hours -- Wednesday 8 a.m.
Dr. AK (the endocrinologist who, according to the obstetrical team, had insisted on continuous monitoring) came in and asked how things were going. We had a short, terse conversation where she denied having anything to do with ordering the CFM. She left, and went to make a note of the conversation in my chart.
I still don't know who lied to me, but someone did.
DH and I went walking around the floor. I was having very occasional, mild contractions.
Wednesday 8:39 a.m. 6.5 mmol/L
Wednesday 9:34 a.m. 5.8 mmol/L
14 hours -- Wednesday 10 a.m.
Carolynn arrived, having taken her kids to school and braved rush hour traffic. Nothing was happening. I was completely exhausted and unsure what to do. We talked a lot -- I can't even remember about what, but I think I asked her questions about pitocin -- and eventually she sent DH to get some food. I asked for something hot; he brought me back some soup. She left around 11:30 or noon.
Wednesday 10:39 a.m. 3.5 mmol/L
Wednesday 11:28 a.m. 3.7 mmol/L
16.5 hours -- Wednesday 12:30 p.m.
I can't remember at what point I met the new OB (there had been a shift change) but he seemed OK. At this point, I was still having only a few, irregular contractions, so I agreed to start pitocin. I wanted to gather some energy first, so I slept for about an hour and a half.
Wednesday 12:41 a.m. 6.4 mmol/L
18 hours -- Wednesday 2 p.m.
I consented to a vaginal exam to get a baseline for the pitocin.
During my pregnancy, I had had no vaginal exams by my peri, only by my midwives when I asked them for stretch and sweeps. The midwives always took a moment to ask, "May I?" before doing anything, and I always found it slightly odd. I trusted them, and had asked for their help -- of course it was fine.
When I was in the hospital, I realized how much dignity that brief conversation always gave me. No one ever asked that in the hospital. Each time I had a vaginal exam, even though I consented to them beforehand, I felt really uncomfortable that everyone just assumed that it was fine to put their hand inside me without explicitly asking my permission in the moment.
I wasn't able to articulate that discomfort until now, while writing this, but it really, really bothered me at the time and continues to do so.
I was still at 2 cm. I started a low pitocin drip. The nurse knew about my problems with IVs, she called the anesthesiologist in to do it. It was definitely the least painful IV I’ve ever had.
Wednesday 2:08 p.m. 5.8 mmol/L
As soon as the pitocin hit my system, I started having very different contractions than anything I had had previously. I can't even describe how they were different -- not without using math terms, anyway. The only description I have in English is that it was like the difference between a wave that you can ride and a wall of water that takes you by surprise and pushes you under. Hypnobirthing helped a lot.
I was happy to learn that I could still labour in the shower. It was an enormous hassle to get into the shower with the IV connected and the monitors strapped to my belly, but the water certainly made labouring easier. DH stood outside the shower, talking me through each contraction. Unfortunately, the IV lines prevented me from being able to close the shower door, so we flooded the floor. My nurse assured me not to worry about it and to stay in if I wanted to, but I was getting cold and kind of queasy anyway so I decided to come out for a while.
Wednesday 2:51 p.m. 5.2 mmol/L
19 hours -- Wednesday 3 p.m.
My queasiness quickly turned into full-blown nausea, and I began vomiting like never before. With each contraction, I was throwing up with my whole body. I kept throwing up over and over, and each time I did, I peed and gushed amniotic fluid. I threw up in bedpan after bedpan, in the toilet, in the sink, and on the floor. I remember standing in the room, naked, holding on to the bed, throwing up over and over, and apologizing for making such a mess.
DH kept helping me through each one. I can still vividly remember the sound of him saying calmly, “Focus on my voice.” I vomited again and again, first bringing up soup, fruit and juice, then quickly nothing but stomach acid. My throat was burning and I couldn't keep water down. In discussing it afterwards, DH and I estimated that I threw up approximately 40 times in the first two hours. (The estimation was based mainly on his recollection of how many times he washed the set of 7 bedpans.) We lost track after that.
Wednesday 3:27 p.m. 8.7 mmol/L
Wednesday 4:07 p.m. 10.2 mmol/L
Wednesday 4:30 p.m. 9.0 mmol/L
I had a few high blood sugars, and I thought it was just that my body was stressed out by the vomiting. In retrospect, I should have suspected an immune challenge. Those types of numbers with no apparent reason are typical early warning signs of an infection for me.
21 hours -- Wednesday 5 p.m.
A little while into the pitocin time, I started having leg pain. It was completely independent of the contractions. It felt like there was something else going on, but I couldn't imagine what. I think now that it might have been that my body was dumping waste products from the infection and it was affecting my muscles the way lactic acid does.
I was having a tough time handling the leg pain on top of the contractions and vomiting. It felt like my leg muscles were in a gigantic never-ending spasm -- charley horses in all my major leg muscle groups.
Wednesday 5:08 p.m. 8.2 mmol/L
Wednesday 5:39 p.m. 6.8 mmol/L
22 hours -- Wednesday 6 p.m.
Around 6 p.m., I asked DH to call Carolynn to come in. I still wasn't at 5-1-1 (contractions five minutes apart, lasting about a minute, for at least an hour) but I felt like I could really use some labour support. My contractions were really wonky -- I would have three or four right on top of each other, then one every two or three minutes for ten minutes, then one long one, then none for six minutes, etc.
Wednesday 6:11 p.m. 5.6 mmol/L
Wednesday 6:36 p.m. 3.9 mmol/L
Wednesday 7:08 p.m. 3.3 mmol/L
Wednesday 7:23 p.m. 5.6 mmol/L
24 hours -- Wednesday 8 p.m.
At 8 p.m., I finally told DH, “I don’t know how much longer I can do this.” We decided to do a vaginal exam to check how I was doing. I was at 3 cm. That was a huge blow.
My energy reserves were quite low at this point. I was exhausted and dehydrated from the contractions, vomiting and leg pain, and while I thought I might be able to go for another 7 cm, I was pretty sure that if I were to do that, I would have nothing left for pushing.
I decided to request an epidural to see if I could relax and get some energy back. Carolynn and Charmaine (midwifery student) arrived as they were wheeling the epidural cart in.
The anesthesiologist came in. I already liked him from the painless IV, and he was just such a mellow, calm, patient presence. He said he needed to tell me about the epidural before he inserted it, I asked if he was going to tell me more than that it involves a catheter being placed in the epidural space, that it carries small but not zero risks, such as death and paralysis (very unlikely) or headaches afterwards (more likely). He seemed a little surprised and replied that no, I had pretty much covered it.
Wednesday 8:10 p.m. 3.8 mmol/L
Wednesday 8:27 p.m. 3.6 mmol/L
I had some Life Savers for the low blood sugar, and once again got pressure from Dr. AK by phone to go to IV insulin/dextrose. I actually considered it at this point, but found out that it would require a second IV line, because they can't mix pitocin and insulin. I was not willing to have another IV inserted. I asked about continuing to use my insulin pump for insulin, but having IV dextrose to quickly correct for lows. She said that I had to choose: either both insulin and dextrose by IV or neither one. I chose the latter. She was annoyed.
24.5 hours -- Wednesday 8:30 p.m.
I had originally been really afraid of the epidural (an enormous needle in my back -- no thanks) but it was not that bad. The most difficult part was remaining absolutely still through several hard contractions while the needle went in.
Once it was in, the anesthesia hit within about 10 minutes and I stopped vomiting, though I felt very weird and spaced out, as though I could sleep for days.
Wednesday 8:37 p.m. 3.6 mmol/L
My nurse checked my vitals -- my blood pressure was fine, but I had a temperature. Things get a little hazy for me from here. Pretty soon, I had an armpit temperature of 40 degC (105 degF) and I was delirious.
I have a few weird memories from the next couple of hours. I remember them trying to get blood to do a culture, but my veins kept collapsing. After a number of efforts, apparently I refused to let them try my arms anymore. I tried to convince them to try different locations, including my ankles. I'm really sensitive about anyone touching my wrists or ankles, so after a couple of failed efforts, I wouldn't let them try any more there either. I remember the anesthesiologist was surprised I was finding the attempted ankle draws so painful, and turned up the base amount on the epidural.
I suggested that since DH and I were able to get enough blood from my fingertips to do blood sugar readings, that might be a way to get enough blood. Carolynn, DH and I pricked each finger over and over again, and managed to squeeze out enough into a pediatric vial for them to do one of three tests they wanted to do. My white blood cell count came back elevated.
They turned down the pitocin -- my contractions slowed down accordingly -- started me on broad spectrum antibiotics, and put ice packs in my armpits, on my chest, under my lower back, and between my legs.
Wednesday 8:52 p.m. 3.6 mmol/L
Wednesday 9:12 p.m. 4.8 mmol/L
I spoke to Dr. AK on the phone (again) and she urged me (again) to use IV insulin and dextrose. I asked her why she wanted so badly for me to use IV rather than subcutaneous insulin, and she responded, "It's faster." I didn't think that was a sufficient reason when my sugars were doing just fine, and still don't. She also talked about testing my blood gases for signs of acidosis, explaining that because of the infection, I could have ketoacidosis even without high blood sugar. The anesthesiologist explained that testing for gases requires arterial blood, so I could have it taken from my wrist or ankle, I was feeling really protective of my wrists and ankles, so I asked if there were other locations. He told me that the femoral artery was also an accessible option -- I thought that sounded best, since that area was anesthetized anyway. He got the blood, warning me first that I might see some spurting, and not to worry about it. The tests came back normal. They turned the pitocin back up.
25.5 hours -- Wednesday 9:30 p.m.
The baby started to have some fetal tachycardia. His/her base heart rate went up to 170 bpm and wasn't moving around as much as it is supposed to. The OB staff weren't sure whether the concerns over his heart rate were due to measurement error, so they suggested placing an internal monitor, which involves attaching wires to the baby's scalp to get a more direct reading of his/her heart rate. Since the risk factors for this (infection) were moot for me at this point, I agreed. They couldn't get a good signal, though, so eventually they just gave up. They had me lie on my left side and gave me an oxygen mask.
Wednesday 9:37 p.m. 7.0 mmol/L
Wednesday 9:55 p.m. 8.9 mmol/L
I was really upset about the tachycardia and thought that asking for the epidural had been a huge mistake. Carolynn reassured me that it was almost certainly something else. She said, "These are not the types of problems you would see because of an epidural."
26 hours -- Wednesday 10 p.m.
When we took the hospital tour, the doula running it showed us the "best" room -- the one I was in. I was not planning to have an epidural, but I listened anyway when she told us that since the epidurals are patient-controlled, we should be careful to use it properly. We wouldn't be able to overdose, because you are only allowed to press the "give me drugs" button once every twenty minutes, but if we failed to press the button when we felt pain, we could end up being too far behind. She explained that in absence of anesthesia, the body makes endorphins, but if you get an epidural, the endorphins won't happen, so you need to stay on top of the dosing.
For some reason -- perhaps the fever-induced delirium -- when I got the epidural, I mapped that speech to a need to press the button every time the machine beeped that my twenty minutes had passed. I have a vague memory of getting angry with DH for not pressing it for me, then, after Carolynn explained that he was not legally allowed to do that, entreating him to stay on top of it for me, and help me notice the beeps.
So, two hours later, I could barely feel my legs. Since I was lying on my left side, the epidural stopped working on my right side and I started feeling the contractions hard on the right side of my back. That was the most painful part of the whole experience. I so desperately wanted to move, and I couldn't. I turned over for a little while to allow the medication to reach both sides.
Wednesday 10:16 p.m. 7.2 mmol/L
Wednesday 10:55 p.m. 5.8 mmol/L
27.5 hours -- Wednesday 11:30 p.m.
I was at 5-6 cm at this point. The baby was starting to have more nonreassuring fetal heart tones. There had been a few eyebrow-raising heart rate decelerations along the way, but the OB said that while they were concerned, they know that monitoring is not as accurate as they would like it to be.
It was starting to look a little more concerning -- the base heart rate was up at 180 bpm now and not varying very much at all -- so the OB suggested getting drop of blood from the baby’s scalp, because the pH of that is a much more objective measure of fetal distress. It involved inserting a wide tube with an extremely bright light, and nicking the baby's scalp. I remember Carolynn telling me excitedly when they had the light in, "Your baby has hair!" They told me that the baby's heart rate did not change much when they did it, which was slightly concerning. The baby's head was being forced out of my cervix, though the 5-6 cm opening. It was starting to develop caput (swelling of the soft tissues of the scalp.)
While waiting for the result, Carolynn asked me what my gut feeling was. I told her that it was that I wasn’t going to have a vaginal birth. I was pretty upset about it. I think it was at this point that she made a comment about how impressed she was with the way the staff was respecting my preferences. She said the hospitals in Scarborough (at which she has clinical privileges) are much worse.
They put me on the phone again with Dr. AK. She told me, "I really think you ought to consider IV insulin in case of surgery." I was so incredibly tired of fighting her on this, and I wasn't sure how well I would be able to manage my sugars during surgery -- an entirely unfamiliar scenario for me -- so I gave in.
The pH test came back just within normal range, and a seed of hope was planted. The OB suggested testing every half hour for a while.
Wednesday 11:30 p.m. 4.1 mmol/L
Wednesday 11:51 p.m. 3.9 mmol/L
28 hours -- Thursday midnight
The baby's heart rate didn’t change with the second nick, but the test came back within normal range again. I started to get my hopes up, and waited patiently. I had stopped pressing the epidural, having decided a while back to see if I could let it ease off so that I might be ready for pushing.
Thursday 0:16 a.m. 3.3 mmol/L
I don't know why I wasn't treated for this low. I was clearly dropping. I don't remember exactly what was happening.
29.5 hours -- Thursday 12:30 a.m.
The third test came back just within normal range (still no response from the baby, though.) I was told that the baby was having late decels, but that the normal pH readings were a good sign. I was really getting my hopes up.
A few minutes after we got the test result, though, the baby had a deep deceleration following a contraction. I couldn't see the monitor, but I could see the faces of everyone in the room, including DH and Carolynn. That was the first time I had ever seen Carolynn look alarmed. She jumped out of her chair and came to the side of the bed to stand with DH. The heart rate paused for what seemed like forever at 40-50 bpm, and very slowly came back up.
They turned off the pitocin (my contractions stopped again) and did another vaginal exam. They told me I was still at 5-6 cm. The OB told me that we needed to make a decision. He said, "We can't keep doing these tests every half hour all night." This is the one thing about this OB with which I took issue afterwards -- in my chart they wrote that I was given the option of continuing tests every half hour.
I asked everyone to leave the room so I could talk with DH. As everyone filed out, I called out to Carolynn to come back for a minute. I asked her what she thought, and she responded, "I don't think this is a baby that can tolerate much more pitocin." I realize now that she may have meant that continuing on without pitocin was an option (although it may have taken 18-24 hours for my body to even start making its own oxytocin) but at the time, because no pitocin meant no contractions, I didn't even think of that. I looked and DH and asked him what he thought. He said, "I think we should do the c-section." I was worried, and I felt like the baby was tired and scared. Maybe I was just projecting, but if someone had asked me to articulate the baby's thoughts at that moment, I would have said, "Help me, mama. I'm scared and I don't feel good."
I agreed to the cesarean.
29.75 hours -- Thursday 12:45 a.m.
They took DH to scrub and change for the OR. Carolynn and Charmaine weren't allowed in the room for the surgery. They stayed and waited for me in recovery.
As I was wheeled into the freezing cold room, I felt scared and queasy. I felt myself crashing low. I told my nurse, and she brought me my test meter. I was at 2.4.
Thursday 0:49 a.m. 2.4 mmol/L
The team didn't appear to have any instructions about how to correct for lows. I was going to pass out any moment. I told them that if I were correcting with food, I would take about 20-25 g of carbohydrates for a reading of 2.4. I was sliding in and out of consciousness as they started a dextrose drip.
Thursday 0:59 a.m. 9.1 mmol/L
Thursday 1:00 a.m. 9.7 mmol/L
Within minutes I was rebounding up way too high way too fast. I was really upset about this, since the whole point of having such a stringent plan for glycemic control was to maintain my sugar below 7.0 in the two to three hours prior to the baby's birth. I had freaked the team out with my extreme low, and they corrected much more conservatively to bring me down, despite my pleas to normalize my sugar as quickly as possible. I'm still furious that Dr. AK botched this so badly by not even bothering to tailor the insulin and dextrose ratios to me and my body. After all that bullying, when I finally gave in, she completely messed it up.
Thursday 1:09 a.m. 7.4 mmol/L
In preparation for surgery, they were testing my sensation. I could feel things on my abdomen for a long time. I don't remember how many times they added more anesthesia, but I remember again and again, they tapped my belly with something sharp, I said ouch, and they added more anesthesia. DH came into the room as I could feel things around my navel, but no lower.
I had requested in my birth plan that in the event of a cesarean, I would like to see as much of the procedure as possible, but when they put the screen up, I didn’t bother asking them to lower it. I was so tired at this point.
DH got to see the whole thing, and has described it all to me. He said that the resident who was doing the incision looked nervous, and her right hand was trembling, but her left hand held the scalpel completely steady as she sliced me open.
The surgery was painless; I didn't even really feel the pressure that people talk about with respect to cesareans. I don't remember how long it took to get DS out, but it wasn't long. Maybe 5 minutes from the time of the incision.
nearly 29.5 hours -- Thursday 1:25 a.m.
DS was born. Someone held him up so DH could see and announce, “It’s a boy!” The liquor was thick with meconium. I felt completely disconnected from this, and in fact, have no memory of seeing him for the first time. I didn't really feel any joy. I didn't feel anything at all.
They whisked him over to a warming table with a neonatology team. DH went with him. I could hear DS crying but couldn’t see him, and was straining my neck trying to look behind me. (According to the director of perinatal services, they have plans for a camera system in the future.)
He was 4218 g (9 lbs 4 oz) and 51 cm (20 inches) long. His Apgars were 8 and 9.
They finally brought him to me, wrapped in a blanket. I got to hold him for a few seconds, and then he was whisked away to the NICU.
a few seconds to hold him
DH went with him and I was alone with the surgical team.
DH and DS in NICU assessment
They finished suturing and stapling my incision, and then the nurses wheeled me to recovery. They took me over to the NICU first (for which I am very grateful) and I had three beautiful minutes with DS. Sometimes I wish now that I had just refused to give him back.
a few minutes in the NICU 1
a few minutes in the NICU 2
While I was in recovery, DS was having his blood sugar tested. It was very low: 1.4 mmol/L (that's 25 mg/dL for American readers) -- due almost certainly to the mismanagement of my sugars just before and during the surgery, and the fact that it had been nearly an hour and half since he was born, he was cold and hadn't been able to start breastfeeding.
They fed him the colostrum I had been pumping for weeks before his birth. DH told me later that the NICU nurses were very pleased to see it, and it was the first thing he got.
I cried hard when he told me that. I was heartbroken that I didn't get to be with him, but it meant a lot to me that he at least got something from me to help him adjust from the inside to the outside.
professor & maman de DS1 (6) & DS2 (1)
They took me up to postpartum around 4 a.m. I could feel that my blood sugar was starting to come back up, so I started my insulin pump again. The endocrinology protocol was to give no insulin until I hit 10.0, but I had already experienced the poor results of their outdated protocols, so I was more than ready to take back control of my sugars.
I think DH came to see me in recovery, just to let me know what was happening with DS. They had put an IV line in for antibiotics and dextrose. Apparently it wasn't a lot of fun for DS and took a four attempts (two by a junior and then two by a senior staff member) before they finally got it in. DH said it was tough to watch, and I could see that DH had been crying. He told me months later that he kept telling DS that I was OK, and to hang on, I would be with him as soon as I could.
They were also having DH feed DS formula by cup. We were participating in a study about type 1 diabetes, breastfeeding and formula, so in the event that he had formula, he was only to have Nutramigen, a special formula. DH was spending most of his time in the NICU holding him. DS was having trouble maintaining his body temperature. He was in an open bassinet and the room was freezing. The whole NICU experience was frustrating in that sometimes it felt like the staff didn't seem to understand that even though he was big -- gigantic compared to all the other babies there -- he was still a newborn, just a few hours old.
I was moved up to the postpartum unit. The nurse told me that I could go down to the NICU once I had my catheter out and could get into a wheelchair. I asked for a breast pump; she brought one to me right away and got me pumping. DH kept running upstairs to update me. (Later, he posted on the blog about his great new weight loss method: The Labour and Postpartum Support diet. He lost 10 lbs while we were in the hospital, and he was in pretty decent shape to start with.)
Finally, a little after noon, the nurse removed my catheter. DH came up shortly afterwards and took me down in a wheelchair. I got to hold DS for a while, which was really wonderful. It was slightly tricky because we both had IVs. Every time I held him over the next day and a half, we had a tangle of IV lines.
I wanted to start nursing him right away, so the NICU nurse brought me a pillow. He latched on beautifully, but didn't seem too interested. I was disappointed to hear that he had just had a huge cup feeding of formula about 30 minutes prior. It was nice to know that he had a good latch, though, and I overheard one of the NICU nurses tell another, in conversation about getting him nursing, "It'll be OK. Mom's a natural."
photos from a later visit to the NICU, courtesy of my Mom: nursing, DS
He was being fed formula by cup every three hours on the dot. I wanted to sit and hold him and nurse him on cue all day, but it was really painful for me to sit upright so I spent as much time as possible with him and the rest of the time resting and pumping. I asked the NICU nurses to please call me if I was was upstairs and he was rooting or crying, which they did. If I didn't hear from them and wasn't there already, I went down just before feeding time so that I could nurse him first. Once I was late because it took me longer than I expected to pee (I was surprised by how difficult and painful it was to pee post-catheter) so the nurse just postponed the feeding and waited for me. I really appreciated that.
It was extremely frustrating, though, that even though he was maintaining his blood sugar and had had no lows since that initial 1.4, he was on a steadily increasing regimen of formula. By the end of day 1, they were giving him 42 cc (1.4 oz) per feeding after he had been nursed. DH noticed that they took the equation for preemies, and simply scaled it up linearly for a baby DS's weight, even though he was less than a day old and should only have been receiving small amounts of colostrum.
Lisa W. (my backup midwife) came on day 1, and helped me with nursing in the NICU. I was telling her that I was wondering if I should have just had the induction at 38 weeks like most other type 1 diabetic women. She pointed out that I could have had all the same problems plus a baby with immature lungs. I appreciated that thought, and felt better about sticking to my guns despite all the pressure to go earlier.
I was in quite a bit of pain when I sat, moved, coughed, laughed, etc., but the silver lining on the NICU cloud was that it was a powerful incentive to get me up and moving around. The wheelchair was a colossal hassle, so after the first wheeled-in visit, I walked down to the NICU myself. I think that forcing myself to walk is part of what helped my physical recovery go well.
The morning of day 2 of DS's life, Dr. AK attempted to visit him in the NICU. Thank goodness it was during rounds and she was not allowed in. I don't know if I could have dealt with her seeing him while I was not with him, since she was the physician who bore the most responsibility for his NICU stay.
I was still on IV antibiotics four times a day, and the order was that they could stop after I had been afebrile (no fever) for 24 hours. My fever finally subsided about 8-12 hours after DS was born. On my last dose of antibiotics, the nurse informed me that Dr. AK had ordered a change to one of them, citing risks of kidney damage with the one I had been on for the entire previous time, and that this meant that I would have to continue to be on IV until I left the hospital.
At this point I wanted to hurt the woman. When I spoke to her on the phone, she cited concerns with antibiotic resistance as the reason I needed to continue the course of treatment. I couldn't understand why it would be so necessary to change the drug on my last dose. If there was to be any kidney damage -- and I looked up the risks later, they were very small -- then chances were that it would already have happened. The IV line was painful, it was cumbersome to have to take the pole with me everywhere, I was puffing up full of fluid and ringers and it was interfering with my milk coming in and with holding my baby. I was beginning to suspect that she was actively trying to be horrible to me as "punishment" for not just going along with everything she suggested during the labour.
I was going to refuse the continued IV anyway, but fortunately, I got a little extra ammunition because the OB disagreed with Dr. AK. He said that while yes, they probably should have used the alternative antibiotic from the beginning, there was no reason to suspect antibiotic resistance, since the source of the infection (almost certainly the placenta and amniotic fluid) had been removed. I had the IV removed after the last dose.
36 hours after he had entered the NICU, we finally were able to get DS out, and brought him up to our room.
I was still pumping about every two hours to help stimulate milk production. He had gotten used to the large volumes of formula and refused to latch for the piddly little amounts of colostrum. He screamed and screamed, and I cried and cried. Carolynn reassured me that his behaviour was not atypical for a two day old infant, and said, "Think of him as a little angry cheerleader, telling your body, 'Make More Milk!'" That, "little angry cheerleader," image got us through a lot of difficult nursing sessions over the next week or two. She also told me that she had a 100% success rate with women who wanted to nurse. That made me feel hopeful.
I still had some really tough moments over the next few days, though. He just didn't want to nurse, and I was so worried that we wouldn't be able to work through it. Every time we nursed, he would open his mouth wide and shake his head frantically back and forth, looking for volume. He screamed and thrashed, and we finally started letting him have one or two sucks on a bottle of glucose water before nursing. It would usually calm him down enough that he would latch. Every time I managed to get him to latch, it was cause for celebration.
I was also having some trouble of my own. I was completely puffed up (when I left the hospital, I was 10 pounds heavier than when I came in) which was uncomfortable almost to the point of being painful, and was also extremely anemic. My hemoglobin was 86. (Normal is 120 – 160. DH theorized that perhaps when DS was having trouble tolerating labour, my body sent a lot of blood to the placenta that I never got back. Certainly when we picked up the placenta to take it home, it looked a lot more red and had a lot more bloody liquid around it than all the photos of placentas I had seen.) When I look at photos of myself from that time, I'm shocked at how bloated and pale I was.
The day I was to leave the hospital, I attended the nursing group they have each morning, led by a lactation consultant. Everyone else was having issues with latch. We were the opposite -- we were having issues with everything *but* latch. The LC was concerned about our situation and managed to arrange an appointment at the breastfeeding clinic for us that afternoon. There, they set me up with an SNS (supplemental nursing system) and a rental hospital grade pump. The SNS was basically just a little tube with one end taped to my nipple and the other connected to a bottle of Nutramigen at first, and then expressed breastmilk. It meant that DS could get the volume he was used to, while still stimulating my system to make milk. I was crying about the formula, but ultimately decided that since he had already had so much in the NICU, he didn't have a virgin gut anyway.
We left that evening. It felt so unbelievably good to put DS in the pouch DH had made and walk out of the hospital into the warm summer night. We took the streetcar home, and stepped (gingerly!) off at our street in Little India, which was in the midst of a festival, so the sidewalks were packed with people.
A woman was very excited when she noticed us and we had the following conversation:
|Woman: “LOOK at that baby!! He is so cute! How old is he?”
Us: “Three days.”
Woman: “THREE DAYS?!!”
Woman (gesturing to friends to come over): “This baby is only THREE DAYS OLD!”
We walked slowly up our street to our house, where Carolyn and Jim (DH's mom and stepdad, who drove 12 hours just to spend a couple of hours with us) had dinner waiting for us, and a huge bowl of wild blueberries for me.
Once at home, I continued to nurse with the SNS and I pumped for 15 minutes on both sides after every nursing session with the rental hospital pump. After a few days (day 7 or 8 of DS's life) my milk finally came in. I still remember the joy and amazement I felt that day. At each pumping session, I got more and more liquid and it turned from yellow to white. We had finally weaned off the formula a day or two earlier, having used about 12 oz. in total. Now we ditched the SNS. It was so relaxing to be able to just nurse him without all the paraphernalia.
I'm still a little frustrated that we went through that. It was almost certainly due to all the IV fluids I received, the lack of early initiation of breastfeeding, and mostly the NICU formula-pushing. But I really, really wanted to nurse and I'm so happy that we managed to make it work.
As I wrote that paragraph, I wondered for the first time if the SNS was really necessary. At the time, I got the feeling that Lisa W. (my backup midwife) and Charmaine (midwifery student) thought it was a bad idea. (Carolynn is often pretty inscrutable, so I have no idea what she thought.) Maybe it's just a coincidence that things improved as soon as I started using it. But really, whether it was necessary or not, I don't think it was a bad idea to trust the IBCLCs, and of all the decisions that I made and now wonder about, that one I am not going to bother questioning. However it happened, nursing worked out for us, thank goodness.
Nursing DS was very healing for me in the early days, because it meant my body was doing something right. I felt like such a failure over the birth -- I failed to make good decisions, failed to protect my baby -- so it was really important to me to succeed at nursing him. I am so very grateful that I was lucky enough to have all sorts of community and family support, especially from DH, who supported me emotionally and practically. For the first week we were home, all I did was nurse, pump, sleep, and eat the food DH brought me. I will never forget that, and it is one more reason I will love this man forever.
He wrote this on the blog a little while after we were finally nursing successfully:
|The hardest thing I’ve ever done is nothing. During the birth I had a role, so even when Maria was having a hard time, I had things to do to make her feel supported and loved. After we finally got DS out of the NICU, stinky and gorged on formula (the formula made him stinky) we got the chance to do demand breast-feeding. Except, Maria’s milk hadn’t had a chance to come in yet, both DS and Maria had to learn how to nurse, and the little man was hungry.
He’d fret, and cry piteously, and pull off the breast because he wasn’t finding the huge quantities of fluid that he had been accustomed to in the NICU. Maria, exhausted from the surgery and sleepless nights in labour, would wrestle with his strong, sweaty little body and try to get him to suck, to stimulate the milk he wanted so much… and I’d sit there, heart bursting with love for these two precious people, unable to do anything, no role to play, trying not to cry, which would only be distracting and upsetting to Maria. It is the hardest thing I’ve ever had to do.
Because of that experience, the happiest sound in the whole world is the contented little gulps DS makes when he nurses now.
professor & maman de DS1 (6) & DS2 (1)
For a while, I had elaborate fantasies of hurting the people who hurt me. I wanted them to know -- to really deeply understand -- that their decisions were not benign. That even though DS and I are both alive and more or less healthy, it was not OK. It was not OK to lie to me, to bait and switch at the end of my pregnancy or to strong-arm and bully me. I thought about ways to hurt their careers.
Now, I no longer want to hurt them, but it may happen incidentally, and I am OK with that. I have a lot of letters and other, more ambitious plans in the works, so that hopefully no other mother and baby will have to go through such unnecessary and/or preventable trauma at their hands.
I find myself feeling happy for -- but also extremely jealous of -- women I know who had relatively uncomplicated births. I congratulate them and then later, in private, I cry. For women who have births coming up, in the near or not-so-near future, I want them to have great experiences, but sometimes I wish that someone would have an experience like mine, so I wouldn’t feel so alone. And then I hate myself for feeling like that.
For a long time after the birth, I thought that the cesarean was an inevitable end to the train of events that I set in motion by agreeing to the induction. I went over and over "what if" scenarios for refusing the induction or doing the induction differently. I wonder what might have happened if I had had Cervidil (cervical ripening gel) overnight, or if I hadn't been so idiotically nervous about bothering Lisa D. and called her in to do some acupuncture in the middle of the night, or if I had refused ARM and started with pitocin, or even if I had done the ARM but agreed to the pitocin earlier -- when I would have been less tired. Perhaps we would have been done in time to avoid the infection. Sometimes I wish I had abandoned all attempts at keeping the birth low intervention after the ARM, and just gone straight for the pitocin and epidural.
Now, after reading more and seeing my medical charts, I'm even wondering if the cesarean was necessary. I don't know if DS was truly having as hard a time as we thought. There were certainly things that were cause for concern -- his high heart rate with low variability, the fact that I had had an infection, and the fact that he was born covered in meconium. But the pH tests kept coming back in normal range and his Apgars were fine, so maybe he was OK after all. Maybe if we had just turned off the pitocin and let my body do its thing, I would have eventually finished dilating and could have had him vaginally.
Maybe I could have done something differently so that I would have been able to hold him afterwards. It kills me that I didn't get to do that. Even though he was stable at birth, they took him away rather than helping me to be able to hold him for a little while and nurse him.
Months later, the whole separation experience just wasn't sitting right with me. I started to do some poking around. Because of my infection and diabetes, I knew that DS needed an assessment, but he was stable and needed no resuscitation, so I didn't understand why they took him so quickly. I learned that the NICU representative at the birth was a visiting fellow from Shanghai -- part of a hospital exchange program. She didn't know that protocol here is that if the baby is stable, they let mom have a good cuddle before taking the baby away. It was just bad luck and lack of hospital safeguards against that sort of mistake.
I wish I had known what to expect in case of an emergency cesarean. I just assumed that whoever was attending would try to make sure I got to hold the baby if at all possible. It was in my birth plan, and I had received assurance from various people that they always try to make sure mom gets to hold her new baby for a while. There is a lot of research that shows that holding the baby right away is important for mother-baby bonding. (For example, mothers who are separated from their babies at birth show a higher incidence of being abusive later.) Bonding can happen without that initial cuddle, but it's harder.
Having that separation was a big blow, and it took me a long time to really bond with DS. I loved him and protected him and cared for him, but I didn't feel bonded. I'm angry that we had problems over something so stupid and unnecessary.
I also found out that even though I had been denied the chance to cuddle him right after birth, I could have gone down to the NICU sooner. The nurse who told me that I needed my catheter out first was not telling me the whole truth -- I could have gone, but she would have had to get me out of bed and into a wheelchair. I just accepted her statement that I had to wait and didn't ask again.
It didn't have to be 12 hours until I saw him again. I'm really anguished about that. I always really want to be liked by everyone, especially authority figures. Due to previous life experiences, I have serious problems with authority figures yelling at me. It is very important to me never to make them angry.
I think if I had worked harder on overcoming that, too, I would have been able to question things better, especially not being able to hold DS after birth, and not being able to see him for so long. I feel so naïve that I just accepted him being whisked away despite no evidence that he was in immediate trouble, and that I needed to wait to go see him, even though I felt OK and was really anxious to get down there.
I wish I had had a doula. I didn't arrange for one, because you're only allowed one extra person besides your partner, and I was having Carolynn there in a support role. I thought it would be more or less the same thing, but it wasn't. I think it was kind of boring for her anyway -- she had a two hour drive just to sit and watch me make decisions, offering info and help when asked. She never even got to meet DS until he was out of the NICU. Both times I called her, I left it until too late. It was great to have her there when she was there, but I think if she had been there for more crucial parts of the experience, it might have gone differently.
I thought I was going into this well-informed, but there were so many things that I just didn't know, everything from what type of cesarean I was having (they called it an emergency cesarean, but no one was running, so I wonder if some might consider it simply unplanned), to the fact that some physicians consider falling insulin needs to be simply a "normal variant," rather than a major cause for concern, to the risks of various induction and augmentation methods. I didn't fully understand the risks of infection with ARM, and didn't even consider that it might be an option to refuse all vaginal exams after the ARM -- I thought we were doing the best we could by restricting them to important decision-making points. I think because I really didn't want an induction, I avoided learning too much about them, even though I was obsessive about learning about all sorts of other issues to do with pregnancy and birth.
In dealing with health care providers, I need to be perceived as extremely well-informed and able to make my own decisions. I've had so much medical management in my life, and I think over the years, the way I learned to cope with it was to take over that management myself as much as possible. Whenever I see a new HCP, I go armed with knowledge of all the latest studies, statistics, and systematic reviews. I want them to think that I know everything that needs to be known, so that they will respect me and listen to me. I still wonder if I had worked on overcoming that, if I might have been able to overcome my own biases in my decision-making. I think that some of my HCPs -- especially my midwives -- could probably have helped me in my decision-making more than they did -- if only I had let them.
All I wrote in my birth plan about induction and augmentation was that I didn't want ARM under any circumstances, and I didn't want pitocin for augmentation. I felt so confident that my body would go into labour a week before my due date. I wrote it on the calendar. My mom did that with me and that was the day I was born. Then, that day passed with no indications of labour, and I started to get nervous.
My estimated due date had originally been July 8 based on last menstrual period (LMP). The peri didn't want to change it based on one u/s, or even two, but by the time I had three all suggesting the same date, he decided that was too much to ignore. Then he forgot that he changed it, and I told him so. If I hadn't corrected him, I might have gone through the pregnancy with the July 8 date, and would have had so much less pressure to induce for dates. Sometimes I wish I had done that, though I probably would have had much more pressure to induce for macrosomia (big baby for gestational age.) DS was on the big side, anyway -- he would have been huge if they thought he was 11 days younger.
I do have some regret about consenting to the induction, though, and giving up my idea of a "surprise" homebirth. Refusing the induction and having the baby at home would have been objectively risky decisions given my diabetes, but I see now that objectivity isn’t all I cracked it up to be. I thought it was the hallmark of the right decision, but it isn't, especially in a situation that has so many unknowns.
I worked so incredibly hard to make evidence-based decisions, and I discounted a huge source of evidence: me. I knew I was fine. I knew DS was fine. I didn't know how long that fine-ness would last, and that was part of what scared me out of considering not going in for the induction, but I wish I had trusted myself and my body.
I could have listened to my feelings that we were both fine, or to my instincts at the moment of the ARM telling me that it was a bad idea, or I could have done more to avoid starting an induction at 8 p.m. For a while after the birth, I felt like my body betrayed me, and now I feel more like it was the other way around. I was so strong for so long in the face of so much medical intensity, but I caved at the end when it was most important.
I feel horrible because I had everything in place that I needed in order to refuse the culmination of all the medical intensity: midwives who would support me in unorthodox choices at some risk to their own careers, a supportive partner, time to devote to trying different things, no older child to worry about, a naturopath/acupuncturist who was making home visits and was willing to be on call in the middle of the night, and I still didn’t do it. I let myself get sucked in by the, “Something horrible could happen at any moment,” ethic, and I hate that I gave into that. I hate that it was so important to me to be rational that I ignored my own gut feelings.
I feel so unbelievably stupid. I thought I was smart enough, informed enough, prepared enough, and strong enough, but I wasn't. I let myself get railroaded. I never thought it would happen to me.
I felt totally blindsided by some of the things that happened. I was assured before the birth that only intermittent monitoring would be necessary. It was written in my birth plan, signed by my peri and Dr. AK, and I confirmed it on the phone with the OB who would be on call the day of my induction. Then when I went in, they told me I needed continuous monitoring. I questioned that, but I wasn't strong enough. I didn't flat out refuse it. I thought there must be some good reason for the change. I am appalled at and confused by my naiveté. I didn't think I was like that.
I've always been heavily influenced by the attitudes of the people around me. In the past, I noticed it especially in sports. When I'm playing with teammates who have confidence in me, I perform at a much higher level than when I'm playing with people from whom I feel no warmth. So I think being in the hospital with so much medical intensity was an especially bad thing for me.
In principle, I agree with the philosophy, "Trust your body, trust your baby," but in practice, it was really hard for me to do that. I was working against 23 years of having a defective body where everything that ever went wrong with my body was somehow attributed to my diabetes -- infections, flu, pneumonia, eating disorders, depression, slow healing, foot problems, and even the ankle that I broke in an accident. (I once had a CDE -- certified diabetes educator -- tell me that type 1 diabetics were statistically more likely to break their ankles.)
I also felt like I was working against a void where a history of birthing would be. When I was diagnosed at age 7, I overheard a conversation about how I might never be able to have children. Steel Magnolias (in which Julia Roberts' character is type 1, has a baby despite medical advice, and leaves him motherless) didn't help my confidence. It's only in recent history that more and more type 1 diabetic women have been having uncomplicated pregnancies, and I don't think the birth stories have caught up yet. Almost every birth story I have heard from other type 1 diabetic women has been a very high-intervention birth. But maybe it's just a numbers game. There aren't very many of us, and in this day and age, the vast majority of births are overly medically managed. So it makes sense that I wouldn't find more than a handful of low intervention births in this small group.
I also don't think the research on the elevated risks for type 1 diabetics and our babies has caught up with the rapid strides in treatment options. With insulin pumps, continuous blood glucose monitors, newer, faster, more stable insulins and other technologies made more available and more popular in the past few years, we can keep our blood sugars much closer to a nondiabetic than ever before. So for a motivated type 1 diabetic who has no end organ damage and uses all the latest technology, do research findings from the 1990s -- or even just five years ago -- really apply? After DS's birth, I saw the protocol sheet that the labour and delivery staff have about type 1 diabetics. It is dated 2001 and has all sorts of outdated statements about "modern" management of diabetes.
I am so angry that I have this disease. I've never felt so before, but throughout my pregnancy and birth, I felt truly defective. I calculated it at one point -- I was spending an average of two full days a week in appointments or waiting rooms. I've always been high risk for everything, and right now, I'm so jealous of women who had low risk pregnancies and thus had science on their side for having a homebirth and for staying out of specialists' offices. Women who could relate to the glowing stories of perfectly healthy pregnancies and births. Women who heard the phrase, "Women have been doing this for thousands of years," and didn't think to themselves, "But even a hundred years ago, I wouldn't have made it past age eight. I am only alive because of technology -- how can I trust my body?" The only type 1 diabetic homebirth I ever heard about was a second hand account of a woman who was having her fourth vaginal birth.
But maybe the scientific proof and stories are just crutches. Maybe I should have been brave -- or foolish -- enough to disregard all the supposed risks to me and DS and refuse the interventions. I don't know.
I remember when I was diagnosed at age 7 and I was given a few books about diabetes. One of them had a page about how diabetics can do almost everything that normal (yes, the book used that word) people can do, except for a very short list: be a pilot, be a firefighter, skydive and scuba. There was nothing on the list about how I couldn't have a normal birth.
I met with Carolynn recently to talk about this, and she said she thinks the cesarean was inevitable given how DS was responding to labour. She said it might have come later if we had decided to wait things out after the alarming decels, but it probably would have come. She also brought up good points about placental health, and suggested that if I had refused the induction, DS might have had just as much trouble tolerating labour -- maybe more. I am inclined to believe her because she isn't the type to sugarcoat things, but I can't decide if that makes me feel better or worse. I do think that the cesarean was necessary at the time, but I really do wonder whether it might have been preventable.
DH and I have not decided whether or not we’re going to have more children. The decision will be made based on whether or not we want to add another person to our family, but right now, I can’t help thinking about it in the context of whether or not I want to have another birth.
Even though it’s the best, most rational choice given my “high-risk” status, I don’t know if I could have another birth in a hospital. It was such a bad place for me. I don’t ever want to feel that powerless again. But I also don’t know that I would have many other realistic options. I would be facing even more obstacles if we did this again. I would still have all the same risk factors, plus I would be older and would be looking for a VBAC (vaginal birth after cesarean).
VBACs are on the decline -- not because they are unsafe, but because of insurance, medical, and social politics. It enrages me that of women who want a VBAC in the US, only about 17% of them are able to find a physician and hospital who will "allow" it. I cannot wrap my head around the idea that so many women are unable to obtain "permission" to use their own vaginas.
If I could manage it, I would strongly consider a HBAC (home birth after cesarean.) And then I would send a thank you card to Dr. AK. I wanted to have a home birth, and decided not to, partly because I didn't think the hospital would be so bad. But it was horrible, and she was a major part of that, so if there is a next time and I have an HBAC, I will thank her for scaring me so far away from hospitals that I got to do it the way I wanted to do it in the first place.
If an HBAC is not possible (it could certainly be very difficult to find someone who would attend me at home), I would have to do some hard thinking. I would actually consider a repeat c-section. I really never thought that I would be a person who would consider an elective c-section. I never said so, but I felt a lot of disdain for the other type 1 women I know who chose elective c/s for the second -- or sometimes first -- birth. But now I think I would at least consider it. Having a scheduled birth, with no reason to have anything but perfectly stable sugars in the hours immediately prior to birth would make it much more likely that I would be able to keep my baby with me afterwards. That would be a very powerful incentive.
I really, really mourn not being able to hold DS, nurse him, bond with him, and help ease his transition from inside to outside. I can't even begin to describe what a loss that was for me. And maybe for him.
For about his first month of life, DS had what looked like nightmares, and it bothered me to think that he might be processing the birth and its aftermath. I don’t like to think about the fact that after nine months of knowing nothing but me, he was taken away from me to a cold, bright room where they threaded tubes into his body and poked him over and over again.
It made me sad and angry to learn that the reason he was whisked away at birth was simply lack of communication and orientation to a visiting practitioner, and that had I had a different postpartum nurse, I might have been wheeled to the NICU as soon as I wanted to go, catheter or no.
My priorities for the birth were, in order:
1.Healthy baby, healthy me
2.No separation between me and baby
5. Ability to move around
5. No continuous monitoring
8.No pain meds
9.Control my own sugars
10.Labour at home as long as possible
11.Go into labour on my own clock
One by one, they kept being taken away, until all I was left with was the top one. It is not a trivial one, and I am grateful that we are both OK, but I feel like I gave up so much.
I wanted so badly for there to be no separation between me and my baby, and I feel strangely empty at the thought that we didn’t even get that. I think I could have dealt better with the events of the labour and birth if I could have just cuddled him for an hour or two afterwards. And then I feel stupid because there are women who never get to hold their babies, whose babies die or have major health problems, and who am I to complain about my gorgeous, healthy babe?
I had a really hard time trying to understand everything that happened in his birth. I desperately wanted to talk to Carolynn about it, but she is a very busy midwife as it is, and during the time when I was going through all this, she had some health and personal issues of her own. On a rational level, I totally understood. Goodness knows she had several extra helpings of busy over those months. Still, after a while, my emotions started to take over and I started taking it personally. I was having such a hard time, having intrusive thoughts, nightmares, crying all day and all night, and I felt really rejected and abandoned. I thought she must be disappointed in me (I was going a little crazy) and so didn't want to talk about it with me. At one of my postpartum appointments, I had planned to ask her some questions about the birth, but she came into the room glowing about two, "beautiful births," she had just attended with first time moms who had uncomplicated homebirths. I just put my questions and feelings away. It took me months to work up the courage to ask her to meet and talk with me about the birth.
I had been struggling under the weight of postpartum depression (PPD) and/or post traumatic stress disorder (PTSD) since DS was born. (I'm still in the middle of being diagnosed, so we aren't exactly sure which.) It isn't terribly surprising -- I have many risk factors: medically complicated pregnancy, traumatic birth, separation from baby, and family history of depression and anxiety. Every time I think about his birth, I've felt so sad, empty, and hopeless. For a while I was able to contain that sadness and only let it out when DS was sleeping, but it started forcing its way out at other times. I started understanding things I never understood before. Years ago, a woman in Toronto jumped in front of a subway train with her baby. I understand that now. I wish that she had had the support that I have from DH -- it was the thought of him being lonely or DS crying for me that made my intrusive thoughts so horrifying to me, and thus gave me some reassurance that they would remain only thoughts. I was still relieved, though, when the intake nurse at the psych clinic told me that such thoughts are common and normal.
There are a number of thing I have read that have helped me to feel more normal.
Last summer I bought a book for a dollar at a clearance sale, I Wish Someone Had Told Me: A Realistic Guide to Early Motherhood. I read it before I had DS, and it was interesting, but didn’t resonate with me. I put it back on the shelf with other pregnancy and parenting books just outside my bedroom door. About two weeks after I got home from the hospital, I grabbed it to read while nursing, and started bawling as soon as I read this section in the first chapter:
|“[I]t was a very weird experience.
For one thing, there was a vaginal birth going on in the room next to me. I could hear them all yelling “PUSH PUSH PUSH” and the woman was really screaming, and even so, I kept thinking enviously, “She’s going through that, and I’m not.”
They got the baby out very quickly, in just three or four minutes. But for some reason, my arms were shaking uncontrollably, so I couldn’t hold him immediately. My husband did, and that was nice. But I’d had this whole image of giving birth to the baby and holding him immediately.
I feel almost like a failure, because I couldn’t deliver this baby myself. I know rationally that’s silly. I know that if this had been a hundred years ago, the baby probably would have died unless he’d been lucky enough to get himself untangled. Yet, I still have a nagging sense that if I’d done something differently, I could have had this baby the regular way. And when I hear other women describe the pushing stage, I feel like I missed something because I didn’t go through that. I know it’s crazy, But I feel like I didn’t quite *do* it.”
|For many women, one of the most difficult parts of cesarean birth is the lack of bonding time with their newborn. Many women worry deeply about the newborn while separated because they usually cannot physically see and touch the baby for some time. Many also deeply grieve that while they should have been the first to hold their babies, they were actually among the last to snuggle their baby; that virtually every staff member and family member got to hold and know their baby intimately before they did. This is a deep and very primal loss, and should not be underestimated by others. Biologically and emotionally, women are strongly programmed to interact with their children right after birth, to make sure baby is all right, and to cement their prenatal bond in a new and special way. Losing this period after birth is a deep emotional wound, one which is difficult to heal. Bonding can of course take place later, but that doesn't replace the precious time right after birth that can never be restored.
Many women who have experienced a difficult birth report afterwards that hearing about other women's births is very hard for them. It's very common to feel envy, anger, sadness, or depression. All the old feelings about your own birth experience may resurface again too. Even when you have done a great deal of work processing your feelings, it's still not unusual to be broadsided by the intensity of your feelings about someone else's birth story.
Many women experience the opposite problem-------becoming upset by other women's good birth experiences. If your own birth experience was long, painful, and traumatic, it can be very hard to listen to the experience of someone who gave birth in two hours and found labor to be 'no big deal.' It's often especially difficult for women who experienced problems from interventions like epidurals or inductions to listen to the stories of women who chose these interventions without thought and sailed through without problems. It's hard to hear someone else rave about how fabulous their epidural was when complications from your own epidural is what led to your cesarean.
Finding it difficult to listen to other women's easy birth experiences is only human. It's certainly not that we want our neighbor or our sister-in-law to have a difficult birth---of course we don't wish them any ill! But it's hard when the thing we want most, some women have so easily and treat so carelessly. And to add insult to injury, these are often the very women who find it so difficult to empathize with our feelings, as they cannot seem to understand how traumatic birth can be sometimes. Although we don't actively wish ill will on anyone else, it is only natural to want for other people to truly understand our pain and what we have gone through. When they can't or won't, it's only natural to feel isolated, sad, and burdened by our feelings.
from Emotional Recovery From A Cesarean
|It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person.
For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.
Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD [Post Traumatic Stress Disorder] which include a very complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors. They include:
* Lengthy labour or short and very painful labour
* Poor pain relief
* Feelings of loss of control
* High levels of medical intervention
* Traumatic or emergency deliveries, e.g. emergency caesarean section
* Impersonal treatment or problems with the staff attitudes
* Not being listened to
* Lack of information or explanation
* Lack of privacy and dignity
* Fear for baby's safety
* Baby’s stay in SCBU/NICU
* Poor postnatal care
* Previous trauma (for example, in childhood, with a previous birth or domestic violence)
In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support. […]
It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as childbirth can be traumatising but it has been clear for many years that women can suffer extreme psychological distress as a consequence of their childbirth experience for a complex variety of reasons which are frequently related to the nature of delivery. Unfortunately, the difference between the common perception of childbirth and some women’s experience of it means that women who suffer Post Natal PTSD symptoms frequently find themselves very isolated and detached from other mothers. They also find themselves without a voice in a society which fails to understand the psychology of childbirth and which therefore expects mothers to get over their birth experience very quickly.
Consequently, women affected by Postnatal PTSD often find that there is nowhere to turn for support because even other mothers, who have not had traumatising births, can find it hard to understand how affecting a bad birth can be. This can make sufferers lonely and depressed as they often feel they are somehow ‘weaker’ than other women because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’. They may feel incredibly guilty as a result.
from Birth Trauma Association
|There is great understanding for a man who is unable to get an erection or ejaculate; most people understand that this is part of his total identity as a male. There is support for feelings of inadequacy, frustration, failure, sadness, and guilt. But there is very little understanding for cesarean women who have feelings of disappointment, sadness, failure, and frustration at not being able to complete the normal womanly physiological process of giving birth. For many women, being pregnant and giving birth are intricately linked to feelings of self-worth and identity.
from Silent Knife by Nancy Wainer Cohen & Lois J. Estner
A few well-meaning but wrong-headed people may tell him, "Well, at least you're still alive, right?" Just as many well-meaning but wrong-headed people may tell a woman who has had a cesarean section, "At least you have a healthy baby." But both the man and the woman in these scenarios have experienced major blows to their sexual identities, and this is not a trivial thing. He was not supposed to require needles, pumps or pills in order to be able to have an erection. She was not supposed to require major abdominal surgery in order to have a baby.
I had trouble with comments from people who didn't get it. I remember after the birth, everyone was just so excited, and I was excited, too, but there was so much more than that going on for me. For months, I only talked to DH about it, until finally I realized that I was going to have to share with other people. My ability to cope was decreasing rapidly. I decided to mention it on DS's blog, partly because I was having trouble maintaining its cheery, "here is the latest cute picture," theme.
For the most part, my admission of my struggles was well-received, but I also got some comments that really stung. I didn't necessarily expect everyone to get it, but I expected that I would be given the benefit of the doubt that if I was having significant trouble, perhaps it was for good reason.
This is an essay that I have found extremely helpful in the past few months. It is reprinted with permission of its author, Gretchen Humphries, and may also be found on her website here.
|You Should Be Grateful - by Gretchen Humphries
You should be grateful, after all, you have a healthy baby.
How many times have we heard those words? How many times have we said them? It seems so obvious, you wanted a child and now you have a healthy child. You are alive to enjoy that child. You should be grateful. Right?
That phrase (or the similar, "All that matters is a healthy baby") did more damage to me than anything else said to me after my cesarean section. Because on the face of it, it seems so true. My husband and I had struggled with infertility for several years. My pregnancy came after at least 2 miscarriages and drugs to make me ovulate and then to maintain the pregnancy. I had beautiful twin boys. Why was I so upset? Wasn't I grateful? They were apparently healthy and so was I, if you discount the physical devastation of major abdominal surgery on top of the exhaustion taking care of newborn twins brings with it. My recovery was, after all, uncomplicated by medical standards. Physically, I was healing well. Wasn't I grateful?
So many people said it to me, I started to wonder. People I trusted, people I respected, people I loved. Women that had cesarean sections for their children and trumped the advantages of it. Maybe I wasn't grateful for my babies? Maybe I didn't love my babies as much as I should or as much as other mothers did? Maybe I was being selfish and petty to be so upset about the birth and not blissfully happy with my babies---after all, other women seemed to "get over it" so quickly---so quickly in fact that I had to wonder if I was really crazy to think there was anything to "get over." What was the big deal?
Part of the problem was that I actually didn't feel overwhelmingly grateful, nor did I feel overwhelmed with love for my boys. I knew that if anyone threatened them in any way that I'd do anything to protect them. I'd already proven that in negotiating a less traumatic cesarean than they would have normally experienced. I could protect my children but I didn't feel a lot about them. I was depressed. So for several months I wasn't feeling much of anything. It wasn't hard to believe that I wasn't grateful enough, that I didn't love them like I should. But I still had to wonder, even as the depression lifted, why hadn't I 'gotten over it?' What was wrong with me?
Then I began to realize how evil it is to tell a woman who's experienced a physically or emotionally traumatic birth that she should be grateful because when you say that, she hears that she isn't grateful enough for the precious baby she's been given. And that cuts to the quick. She may already be wondering what was wrong with her that she couldn't have a normal birth and now you've told her that she doesn't love her child enough. It is evil to say, "All that matters is a healthy baby," because you are saying that her pain, her damage, doesn't matter. You are telling her that not only is her body broken, but so is her mind. That if she is physically healthy, that's all that matters, and to be concerned with anything else is somehow wrong. That the means to the end doesn't matter, she is expendable.
The truth is a woman can be absolutely grateful and full of passionate mother love for her child and be enraged by how that child came into the world. Hating the birth, hating what happened in that cold impersonal operating room or delivery room has nothing to do with the child. It is possible to be both full of rage and full of love. When that rage is turned inward, a woman is depressed, and likely to believe you when she hears you tell her she's ungrateful and unloving toward her child. And if that rage turns back outward, it will spill over to you, because you told her a lie and she believed it because she trusted you. If that rage stays hidden, it will fester, and eventually there will be a place in that woman's heart where she no longer goes, because it just hurts too much and makes no sense. Good mothers just don't have those feelings, and she's already afraid she isn't a good enough mother. And so she loses something precious, and so do we all.
I discovered that there are a lot of women out there who hated the birth of their child; women who had bad surgeries, women who had good surgeries, rarely women who had necessary surgeries, women who didn't have surgery at all but did have horrible things done to them in the name of birth. I'm not the only one. There is a vast hidden ocean of pain in women who've had horrible births but do love their babies and continue to wonder, "What is wrong with me? If I just loved my baby enough, I wouldn't feel this way."
I was freed by the knowledge that there is nothing wrong with me! I underwent the surgical removal of my children from my body---a procedure that has nothing to do with birth, that completely circumvents what my woman's body is made to do. If it felt like an assault, then it was an assault, a very sexual assault. And if I'm not upset about being assaulted, then there really is something wrong with me. And that nothing that was done to me has the power to keep me from loving my children with passionate mother love.
I am grateful, grateful beyond words for the blessing of my children. They are miracles. The day they were taken out of me was one of the worst days of my life. Yet I am grateful for them, though not for what was done to me. My physical body might have recovered well enough to be called 'healthy' but my spirit was deeply wounded and then neglected. I was not healthy. I know my children suffered because of that. I have a lot to be grateful for but not for their birth, never for their birth. Understanding and accepting that makes me truly healthy. Admitting the horror of their birth frames the love I have for them in a way that astonishes me----amazed at what I went through because of my love for them, I now know I really would die for them if needed.
Now, when you tell me that I should be grateful, I realize that you are showing me how frightened you are. That you are afraid to look at my pain. That you are afraid to admit that maybe I have good reason to be angry, that maybe women are truly assaulted in the name of birth. You are telling me that it's okay for women to have birth ripped from them, that it isn't acceptable to look for a better way or to mourn what was lost. I know you now. You may not know yourself, but I do. And I pity you.
professor & maman de DS1 (6) & DS2 (1)
I think part of why I struggled so hard was that I felt guilty about my emotions. I told my friend Lisa D., the first person besides DH who took the time to let me talk it out and helped me move past my stalled position of grief and anger, "There are so many people in the world, and I know I have it so good. So incredibly good." Years ago, I spent some time living in Bolivia -- the third poorest country in Latin America -- working with women in rural areas. I vividly remember meeting one young woman who was about eight months pregnant with her first child. She asked me, mostly joking and partly serious, if I would take her child back to Canada with me so that s/he could learn English, which opens all sorts of doors in Bolivia. I heard rumours later that she died in childbirth.
I know that there are women all over the world who would be thrilled to have the experience I had. I had more options available to me than many women have, I was more respected than I was railroaded, and I came out alive and mostly healthy, with a beautiful healthy boy. Yet I still felt devastated.
Reading Gretchen Humphries' essay ("You Should Be Grateful") really helped me to come to terms with the fact that even though my experience had many good aspects to it, it's normal -- not selfish -- to grieve the bad aspects. Thanks to that realization, I was able to start honestly grieving the things that went wrong, and am now slowly working through that grief.
It helps me to remember that I made decisions out of love for DS. I wanted to do the best possible things for him and me, and that led me along a path to believing people who I thought were trustworthy, and that is not a horrible thing.
On December first, two days after DS turned 5 months old, all of a sudden, I was finally able to begin to forgive some of the people by whom I felt betrayed -- most importantly, myself. I don't know how or why I finally got there, but I sat at my desk, crying, and said out loud to the empty room: "I forgive you. I forgive myself."
Later that afternoon, as I was nursing DS, I felt a rush of love for him more intense than anything I had felt before. It made me catch my breath.
I think all the intense guilt I felt about his birth experience had been keeping that love from rising to the surface. Perhaps I wasn't allowing myself to feel it fully because as long as I felt responsible for the things that happened to him, I was afraid that more intense love would only lead to greater guilt. In any case, beginning to let go of the guilt made room for some truly beautiful feelings.
December 1 is the day when, each year, I start playing Christmas and holiday music. It has always signaled the beginning of my favourite month. I sat that afternoon and held my beautiful, sweet baby as we listened to some of the loveliest songs I know. It was the most at peace I had felt since having him. In the same way that the Old 97s' Adelaide will always carry feelings of grief, Sarah McLachlan's Wintersong will always carry feelings of redemption for me. I used it as the last song on our annual holiday slideshow, even though the lyrics don't really fit.
I don't know if I will ever to entirely get over the experience of DS's birth. There will always be an emotional scar to match my physical scar, but now, I trust that eventually, it will no longer be so angry and red, and will fade to a white line on the landscape of my life.
professor & maman de DS1 (6) & DS2 (1)
Our prenatal, infant care and hypnobirthing instructor, Leslie C., had an unplanned cesarean with her first baby and then a homebirth with her second. On our first day of class, she told the class that she wouldn't change a thing about either birth. When I was really struggling, I emailed her to ask how she arrived at that point. She shared a lot of really personal things with me. I cried and cried as I read her email over and over again, and I am profoundly grateful for her honesty and wisdom.
Lisa D. is the naturopathic doctor and doula who made countless visits to our home in the weeks before the birth, and is now a good friend. Her place in my heart was cemented when Carolynn was unable to meet with me to talk about the birth. I was having a debilitatingly hard time, and was desperate to talk to someone knowledgeable who knew me, so I emailed Lisa. She was right there for me, and it was a major breakthrough for me to talk to someone about it all.
The women in my DDC were always here for support and commiseration as I went through pregnancy and then afterwards as I grieved the birth. Some of them have been through much worse than I have -- much worse birth experiences, losing pregnancies, losing babies -- and they never made me feel stupid for grieving what might be considered minor by comparison. I am happy that many of us continue to keep in touch as our babies grow. I also got a lot of support and recommendations from two other like-minded type 1 diabetic women, and from other women I know from an online parenting group. One group in particular was instrumental in helping me nurse DS successfully.
The lactation consultants and many nurses at XYZ Hospital all provided me with practical help, as well as emotional support. As I move forward with coming to terms with DS's birth, I am sure that the counselors with the hospital's postpartum program will be helpful, as will the patient advocate.
Jo, the director of perinatal services at XYZ, made time to meet with me before and after the birth, her assistant, Felicia, got me full copies of my charts after the hospital sent only about a quarter of the pages for the $50 I paid them. Jo also gave me some good perspectives on why things happened the way they did. It was very healing to hear her tell me that my expectations were not unreasonable and that I had good reason to be upset.
Joan, the staff member from the NICU who took the time to look at DS's chart and figure out why I hadn't had the opportunity to hold him, was so very nice to me. I teared up when she told me that it was just an error by a visiting practitioner, then I thanked her and left. I stopped to cry in the stairwell, and when I got downstairs to the lobby, she was there looking for me because she was worried about me. She sat with me for a while and we talked about my experience. She was really honest and caring, and apologized to me on behalf of the NICU. It meant so incredibly much to me to have someone acknowledge how horribly unnecessary and traumatic my separation from DS was. I cried hard, healing tears.
Family and friends reached out to me when I finally admitted to them what a hard time I was having. I deeply appreciate their love and support. I especially appreciated the listening ears and understanding emails from mothers in my life: my mom; my friend E., who offered to talk to me even as she was waiting for her own baby to arrive and who -- on the same day I finally felt some acceptance of my experience -- had her own emergency c/s; T., who had her own, much longer NICU experience; A., who read this story first; J., who had a similar story with her first birth and went on to have a successful VBAC; D., who assured me that the first year of her son's life was the hardest of hers and that it was okay and normal to struggle; X., who dragged me out of the house when I was reclusive; and L., whose congratulatory note on DS's arrival also sensitively acknowledged the loss of the birth experience. I also appreciated the empathy from the women in my life who did not have their own experiences to draw on: my sister H., and friends E., L. and L.
Most of all I owe thanks to two men.
My DH has always been unfailingly supportive of me. Since DS's birth -- and my trainwreck of emotions that ensued -- he has held me, talked to me and reassured me over and over that it was OK to feel however I felt about the birth. When he saw I was struggling, he researched postpartum depression and post traumatic stress disorder of his own accord and sought out resources for me. Even at the height of sleep deprivation with a newborn and a stressful job, he never once complained when I woke him night after night, crying, to have the same conversation over and over again. He sacrificed sleep and his own needs to give me space and time to sit, read, think and cry. I am finding some meaning in this experience by taking action to help other women deal with similar experiences, and to prevent other women from going through this. I am drafting letters to various people at the hospital, and also have a couple of ideas for papers in the works. He has been very supportive of me as I pursue these endeavours. He was also the most influential person in helping me establish a nursing relationship with DS, and, as I said above, that is just one more reason I will love him forever.
And finally, I owe thanks to my son, who, when all is said and done, was worth it. I wish so much that I could have a do-over for his birth. I would love to do it differently. But if I had to choose between doing it again exactly the same and not doing it at all, I would choose the first option in a heartbeat. His birth was ugly, but he is beautiful and I am blessed.
professor & maman de DS1 (6) & DS2 (1)
....I'm glad you survived to tell the story! Your baby is just beautiful and so are you. Many thanks for opening your heart and sharing that with the world.
You are a wonderful, beautiful and conscious woman... Your baby is lucky to have you for a mama!
*¨`*.✫*¨*.¸¸.✶*¨`*.Jasmine Rae Ojala*¨`*.✫*¨*.¸¸.✶*¨`*
I am so impressed by your knowledge, both of yourself and the processes that you were going through. Shame on a medical establishment that did not respect that!
My first child was born via c/s that I believe to have been pretty unnecessary -- but the cutting into me was not nearly as egregious as forcing me to be apart for him for almost 48 hours after his birth. He's 7 now and healthy, but I believe, still showing scars of those early hours without an understanding of where his mama was.
I've gone on to have another son via VBAC and am looking forward to the homebirth of my first daughter any day now... These things made ever so much more important to me by my experience the first time around...
Thank you for your courage.
Maybe I was just projecting, but if someone had asked me to articulate the baby's thoughts at that moment, I would have said, "Help me, mama. I'm scared and I don't feel good."
Words cannot express how much your story has affected me. I know you were writing it for yourself, but thank you for sharing it here.
Blessings and peaceful vibes to you and your family.
Your son is beautiful (not shocking when one sees the pics of you and DH!).
What an overwhelming and powerful story.
You are a very gifted writer and your experience comes through so vividly.
I can't imagine the pain of being kept from your baby like that - especially coming during a time of physical and mental exhaustion and pain.
I hope your story can be heard by the medical people who provided your care - and I hope they won't dismiss it like the endo who said you have a high need for control, but truly listen to how decisions and procedures that are all in a day's work for someone are someone else's permanent life story once they're done.
I wish you peace and healing and every blessing of motherhood.
ps - your pictures are beautiful!
Don't be so hard on yourself mama I'm amazed at how much you know and how strong you were during your labor. When you asked that residence for the incidence of a certain complication, I would have never thought of that. Still there's only so much you can do when you're in pain, exhausted from labor and people are constantly pressuring you and scaring you into consenting to interventions.
I'm so sorry you didn't have the birth you imagined I'm glad you're able to focus on the positive though. Congrats on the birth of your son and being able to bf
Where to begin? Your story is not an uncommon one but the honesty, wisdom, and detail with which you presented the whole experience is beyond anything else I've read here.
Thank you for sharing your story with us. You've bared your soul and that's not something easy to do in RL or on the internet. Peace and love to you and your family...
I've said it before and I will say it again - I am really amazed at the amount of knowladge you have about a human body and not just that obviously.
And I know you are the type of person who will make things different for other women because of your own experience.
I hope your healing continues to go well and both you and you DS will heal from your trauma.
Very powerful stuff. I am happy you have a supportive dh. I know many who don't and some who have ultimately gotten divorced- primarily because the c/s (usually more than one) caused such a rift, an untrustness, that could not be repaired, and it bled into other aspects of their relationships. That would write a book, too. Again, thank you for sharing your heart....Oh, and I was not aware that 50% of type 1 mothers have given birth vaginally...I had a doula client years ago, who was automatically told she was going to have a section at 38 weeks. I never saw her again, after the childbirth classes. I wonder what happened to her. What resources may I look up to find info on type 1 and vaginal birth? TIA
I think it is time that the society as a whole acknowlegde that the way we birth our children has a huge impact on us. The end result, a happy baby, is just one (a major one! no doubt) goal. Our emotions and spirit cannot be neglected.
All the best for you for a peacefull recovery!!
Peace and love be with you.
Mama to 4 amazing little people, another little expected 3/6/12!
Avid Unassisted Birth supporter/Mama