Friday, February 09, 2007

From Sunrise to Sunset

(This post is very long and medically graphic. Fair warning.)

My client went into labour, thus ending my “on-call” status which was weighing heavy on my mind. It has been nearly two years since I last attended a birth and I was struck by how being on call felt like moving through mud rather than contributing to a sense of excitement in my world. The honeymoon, it appears, is over, long over. The first baby’s who birth I assisted at turned ten years old in early December, I’m not clear, not at all where all the time went. I was hoping for some sense of redemption, to gain my devotion, or perhaps something more base like make me feel good about this work again. I wish I could say it worked.

Tuesday I thought about my client Elaine* a lot, leaving her a voicemail to touch base. It was my official fourth day of not doing school work on purpose, and trying very hard not to think about it. I spent a lot of time trying to wind a ball of yarn. Again. It’s still not done by the way. The yarn is beautiful though I have no idea of the material (I’m guessing rayon maybe with some silk) or the yardage (I’m guessing at least 350 yard but perhaps as much as 600). But I digress.

At 11p.m. I thought perhaps I ought to head to bed but in typical fashion sleep did not occur until about 12:15a.m. A noise pierced my densely dream-packed sleep jarring me awake but far from coherent at 1:35 a.m. when it came to trying to figure out how to turn off the answering machine. I never did figure it out- we hung up and I called back. Elaine’s water had broken but nothing was really happening however the hospital told her to come in very soon. She was hesitant about that advice and I certainly had never heard that without certain concerns that someone needed to come in right away. I encouraged her to do what was most comfortable to her, to listen to her instincts. Of course the right thing to do would be right back to sleep, right? Instead of slumbering my brain wove like a car driven by a drunk teenager through the streets of anxiety. Eventually by coaching myself through breathing exercises and mentally chanting I fell back to sleep only to be awaken by the ring again at about 3:20a.m. Contractions were quite regular, every four minutes or so and Elaine felt like she wanted to go in and they would call me when they wanted my presence. Once again I tried to sleep just a bit until 4:01a.m. when Dan* called requesting my presence. A quick shower, an internet search for direction because I realized I hadn’t been to the hospital since their nephew’s birth two and half years prior and getting lost would not be a good thing, I was on my way. It was still quite dark out as it was about 4:40a.m. and there was a light rain.

The couple were in a good rhythm, contraction were happily regular and taking some attention but there was an angry looking IV sticking into her hand with the fluid being pumped in viciously fast causing a bloated look to her hand and forearm. It was already done, but I couldn’t see any reason for her to even have an IV yet but I could easily imagine the conversation that transpired before I got there.

Nurse: So we are just going to place an IV to give you fluids

E: Really? Do I need that? I really don’t like needles.

Nurse: Well it’s protocol, and if you decide later that you want an epidural we won’t have to do it later. It’s really better if we just do it now when things are easier and your labor isn’t as hard as it will get later, ad nauseam. Thus an IV that hurts the entire time is placed.

Elaine was not tied to “going natural”, and despite medical phobias including needles, she was open to an epidural. New policy means that only one support person can be in the room and she chose Dan, quite reasonably. I hate not being in the room like that. Why? Because docs can lie, because some nurses do not comfort well. Because damn it, it’s my job to be there! The reason for the policy change is due to a freak accident. I kid you not. Since I’m usually in the room I have no idea how long it takes to do the procedure. I know that sounds odd, but I am so focused on the clients I don’t watch a clock. It took three tried until I could reenter the room. Poor Elaine, it took three tries to get the dang thing placed and then the baby didn’t like the meds or the position or something so some minor and short lasting frenzy ensued. All was well but it rankled me that I was not there during the hubbub.

Things moved along, though I can’t say quickly as the epidural slowed labour- one of the potential side affects so pitocin was added. Everyone was excited when Elaine was close to complete, and which point to just let her body work to “labour the baby down” before starting to actively push. (Some day I may rant about the pushing circus that often ensues at hospital births.) The laboring down worked in that the baby really moved down and again much happiness filled the room. Pushing in earnest began at about 5:20 p.m. This stage is exciting but can feel exceedingly slow since the distance being measured is so short but often takes some time. Once pushing begins at a hospital there is often a “clock” that starts because protocol says X act (dilation, pushing) should take Y time and if there is a variation it is a pathological situation that needs intervention. As we approached the ends of the time table the midwife brought in an obstetrician for consult. An assisted delivery was recommended which means vacuum extraction. This was upsetting news for Elaine and Dan, and yes even me. I wasn’t surprised as I could tell how limited the progress was after 2.5 hours of pushing. There were questions and answers about potential outcomes, adverse effects, and all the rest.

Elaine and Dan agreed to the procedure and suddenly the room went into overdrive, overhead lights were flicked on, ending the soft lighting and more relaxed state. People were holding about 4 different conversations; a cart filled with instruments was wheeled in and uncovered with a flourish usually reserved for beautiful artwork. I checked in with Dan who looked a bit shaken and then went to Elaine where I leaned in close, whispering to her to close her eyes for a bit, take deep breaths to center herself. I spoke about how the vacuum was an assist to her heroic efforts rather than the vacuum saving the day or doing the birthing. I told her how strong she was, how amazingly hard she was working, focused on meeting her baby.

Once everything was in place however I had a hard time doing all that I was asking of her because there was such an urgency in the ob’s voice, as if the baby was at risk which was not the case! The baby had been tolerating labour and pushing beautifully and yet everyone in a cacophony of chaos started to chant “PUSH PUSH PUSH” with intense urgency. With the first attempt I began to see just a bit of head, internally relaxing just a bit because this was a good sign that the vacuum would work and this birth would not end in the operating room. The next contraction really brought the head out but then there was a stall, leading the ob to call out “supra pubic pressure”. I knew it meant there was some dystocia freaked me out a bit even as I told Elaine the head was out, you’re doing great, your baby’s is almost here. (Even typing this out I can feel my body tighten and my breathing getting shorter.)

Suddenly the baby was out, looking limp which again scared me, she started making small little crying sounds that let me exhale. Elaine starting crying, I think Dan might have as well, I know it took everything in my power not to bawl. It is days later and I still feel that heavy cry sitting inside me. The baby pinked up beautifully. The placenta followed pretty quickly though I wasn’t near Elaine for that as I was photographing the baby. It certainly looked healthy when held up and I assured Elaine, who had asked, that yes, some people do eat it but more people plant it under a tree. Most people have the hospital discard it.

It turns out that the baby had her left hand up by her face which technically is called a compound presentation. This is probably what held up her progress down the birth canal (Another potential rant- canal? A manmade construct for amazing path the baby travels to be born. Sheesh.) The use of vacuum also made for a fast delivery with no crowning which resulted in extensive damage to Elaine’s body. There are different degrees assigned to tears which happen in childbirth and I have never before had a client with a fourth degree. The ob spent at least an hour and a half repairing the damage, which included a long internal tear as well. This was incredibly stressful for Elaine who just wanted to be with her child.

At some point I had the baby placed on her chest so they could nuzzle together as the separation was so hard to watch. Finally it was over, some breastfeeding was attempted, Elaine was cleaned up, able to sit up for the first time since having her epidural placed nearly 12 hours previous. Family came in but I encouraged them not to stay too long and they graciously got the hint. I left shortly after that, driving home exhausted and so sad. I know Elaine is happy to not have had a cesarean but I am left here with Monday morning quarterback syndrome wondering if she would have been better off in terms of her healing and potential long term outcomes. Driving home I processed over and over again so many details. Like the midwife saying after the baby was born that she was starting to not tolerate the long pushing phase, this was not said before the decision was made – not even close. Could she have birthed a compound presentation? Possibly but there is no way to know that. Again the sky was dark and rain was falling.

I wanted my faith restored, I wanted to drink in the beauty of birth but I did not get refreshed the way I having been aching for in the past two years. This couple was not required to provide that, but they were my opportunity, my chance to recapture something. Dan’s sister is pregnant, due in about six months and she will be my first repeat client in California. I will pin the same hopes but my expectations will be even less as there are no guarantees. This is a hard path to walk- the sense of god, as in spirit not a entity in the room is so addicting, so compelling and I wanted to feel it again. At this birth I received just a whiff of it, just enough to leave me feeling like a little kid with her nose pressed against the bakery window, belly growling and the imaginary taste of sweetness dancing on my tongue.

* No real names are used and I do not identify the city or hospital for confidentiality purposes.


louisiana swamp rat said...

While I can't imagine a more incredible and heart-stopping experience, I'm sad for you that it didn't bring back the magic you were longing for.

Take care, sweetie.

Wyatt's Mom said...

The last paragraph reminded me of the song by the Indigo Girls, Love will come to you this section especially, "Guess i wasn't the best one to ask me myself with my face pressed up against love's glass to see the shiny toy i've been hoping for the one i never can afford"

Such a powerful post. I hope that you can find that shiny new toy.