so I’m not perfect…

I was out for a run with Muppet and came across a lemonade stand- some neighborhood kids raising money for cancer. I was running by at just the right time, with several families approaching the stand. When the kids asked if I wanted lemonade, I regretfully said I didn’t have any money, but I’ll try to come back when I was done with my run.  Just as I was about to take off, I saw you there. My smile brightened with recognition- a fellow professional in my field and a someone who chose my practice for care.  You have a son a few years older than Felix and I was reminded seeing you there that you live in my town! Since I”m not attending births and you work in a different practice, I haven’t seen you in a while- in the past I crossed paths with other OB professionals on the labor floor, a place I don’t often visit these days. Seeing you with your son, gave me pause. We should be friends, I thought.

I stopped and chatted with you, saying hi to your husband and letting your son pet Muppet.  I learned your son had some developmental delays, something I hadn’t known before.  I straight up blurted out- “I need local mommy friends,” a truth so prevalent lately. I find it a little hard to make mommy friends easily… something I’ll elaborate in another post…but since you’re in my professional community, I’m pretty sure you know my story. You know I’ve lost a baby.

You given me your number and tell me how you have a good group of local moms who get together every now and then. You warn me that the moment you say you’re in the OB field, everyone likes to tell you their birth story.  I laugh in total understanding. You roll your eyes and we talk briefly about yours- how you tried so very very hard for a vaginal birth but it just wasn’t in the cards despite everyone’s best efforts. I could see how frustrated you could get hearing other’s stories especially when you felt frustrated with your own. It’s like hearing how someone has a beautiful birth when yours was traumatic. It hurts a little.

And then I blurted out something I wish I hadn’t.  “Well did you hear about Felix’s birth story? How I didn’t make it to the hospital?” You smiled and laughed a little, telling me how you read it in the paper.

I realized shortly after I said it, that I did exactly what you had just said was hard. I told you my birth story. I’m sorry.

I wanted to tell you, that I often blurt out Felix’s story because I can’t so very easily with Mabel’s because no one likes a story that ends with a baby dying. Blurting out his story makes me feel a bit like a normal person. I wanted to tell you that Felix’s birth story is a tribute to Mabel, because there is no way he would have come so fast had he not been my second child. I wanted to tell you that when I learned your son had some delays, I felt a small kinship with you because Mabel would have had delays too and I imagine parenting a child with special needs is especially hard, but it’s just what you do, isn’t it? I wanted to tell you I shared Felix’s story with you because I assumed you knew about Mabel.

In that brief exchange we had, I am reminded that I am not perfect and sometimes says things I wish I hadn’t. It was a good reminder that others do the same and to give them a little leeway.

Have you ever said something you regretted? Do you hold yourself to a high standard of always saying the right thing?

Damned if I do….

October 2013- that was the last I had seen her.  I knew because that was the date on the last note I had written.

You had a baby! Congratulations!

Thank you, I smiled warmly.

So much has happened since I was here last!

Yes- a lot has happened. The emphasis in my words hinted at a hidden story…

Well now you really know what it’s like, huh? she jested, referencing my my former life as a midwife who hadn’t given birth, who didn’t have kids yet.

My heart beat a little faster and my head spun a little- it was the shadow of a feeling I used to know very well, in the early days.  I used to tense up- heart racing, palms sweating, chest tightening- when someone would ask “How’s the baby?” or “Do you have kids?” It’s a feeling of fear, grief, sadness, anger all mixed up, when asked a question I wasn’t quite sure how to answer.  It was a feeling of anticipation- wondering how the other person would react, how to tell of my daughter without making the situation overly awkward.

Now the situation has changed. The tense feeling has softened.  She didn’t ask if he was my first.  There was no question to respond to.  It was all assumption.  The only way she could know the whole story was if I volunteered the information, something I have yet to master in a way that feels good. I wanted to say. I sure do! Two kids since I’ve seen you last! But doing so would only lead to follow up questions- how old is your first... I’d share that she had died and the requisite polite words or unhelpful platitudes would come. And it would feel like I’m fishing for sympathy.

I chose the path of least resistance-maybe not an outright lie but a lie of omission almost. It didn’t feel great.

Not telling the whole story felt wrong, telling the whole story felt wrong.  Damned if I do, damned if I don’t.

what do you do?

 

June 22, 2015

A few warnings… 

  • *potential trigger* This is Felix’s birth story
  • It’ll probably take you longer to read my birth story than it took for the actual birth story to happen. I didn’t want to forget a thing.  
  • I don’t skimp on details, gross or not.  Take heed if you’re squeamish.

I first started feeling contractions in the late afternoon/early evening. They didn’t faze me because I had very similar contractions the previous weekend and they went away. Plus I was early- 36 weeks and 6 days. This baby had no issues, s/he would likely come closer to the due date. I had already discussed a plan with my midwives. I really preferred not to be induced, plus I had no medical indication for induction, but I knew my anxiety would start skyrocketing as we approached my due date. I also knew that birth doesn’t always go as planned (a lesson learned by my patients and with Mabel) and so I didn’t have many specific wishes on my list when it came to labor and birth this time. I knew these things:

  1. I didn’t want to go past 41 weeks (and there’s medical reason to be induced then)
  2. I wanted my midwives to sweep my membranes starting at 39 weeks, and they agreed. I had two appointments scheduled back to back to do so (and I was going to have my midwife friends I work with give it a go too! I knew I’d be wiling to have practically anyone get their fingers up and in there if it got things started naturally)
  3. I wanted the gas! I wanted to try to avoid the epidural this time. I had one with Mabel, which I still have mixed feelings about. As a midwife, I had some expectations of myself- believing I could have had a drug free childbirth. And under different circumstances I probably could have. I console myself, reminding me that birthing a child that would likely die changes everything. Expectations go out the window. BUT this time, expecting a child that would live, I hoped to avoid it- to prove to myself that I could do it. I’d accept nitrous oxide because to me it felt like a minor intervention- and it was NEW at our hospital. I frankly wanted to know what it felt like so I could tell people. I made it clear to anyone who would listen- I wanted the gas! I even had the consent form in my purse so there would be no delays!

And that’s about it. Seemed reasonable. I also thought this labor would be longer than Mabel’s. My midwives warned me it would likely be fast, because Mabel was fast for a first baby. But I thought otherwise- this was going to be a bigger baby, likely 8-10lbs if I went to my due date and I thought the size would make the labor longer (ignoring the general obstetric knowledge that second babies usually come FAST).

So when I started contracting, I thought little of it. They weren’t painful- I called them pressure contractions. I felt them in my butt as pressure that was somewhat uncomfortable but not debilitating. I was still able to function- walk and talk. I went grocery shopping, cooked and ate dinner, watched tv. Chris said occasionally I’d shift and make a small groan for a second but he wasn’t concerned either. At one point while watching tv, I downloaded an app to time them. They seemed regular and I was just curious how frequently they were coming. After hitting the button a bunch of times I looked at the app and saw they were basically 2 minutes apart. And then I stopped timing. When I relayed this story to a friend, she asked “why did you stop???” Because the timing of the contractions wasn’t going to make me call my midwives- I needed to be in pain as well. When they became painful- unbearable- that’s when I’d call. I also knew if I called them at that point (regular but just pressure), we would all agree that I was either dehydrated from the earlier road race (likely) or at most was in early labor and I should drink water and call when I was in pain. So I was my own midwife and drank water- and a glass of wine (a well known obstetric trick to stop contractions). After a second episode on Netflix, I decided I was ready for bed.

I fell asleep with the help of unisom (what I would usually take after a day of intense exercise- because the bone pain would be so uncomfortable I needed some help to sleep somewhat through the night.) I dropped into sleep pretty easily, woke an hour later to pee and fell back asleep again. It is also well know that you don’t sleep through labor- so I knew I wasn’t in real labor yet.

I remember waking up at one point with an intense pressure contraction in my butt- intense enough to put my on my hands and knees and breathe through it. Though when it was over, I fell right back asleep. It happened a second time (how many minutes later? I have no idea- I didn’t even open my eyes to look at the clock to time them) and this time Chris heard me and asked if I was ok.

“Yup. I’m fine. Go back to sleep”

And so he rolled over was snoozing pretty quickly. After it was done, I did the same.

The third time it happened I felt a little pop and small gush of fluid.

I was instantly brought back to when I first noticed bloody show with Mabel. At the time I cried “I’m not ready!” I had such similar feelings this time, though this time for some different reasons- I had a bunch of work deadlines July 1, which was over a week away and so I truly wasn’t ready. We hadn’t installed the carseat or packed a hospital bag. And in truth, though sometimes I would admit to wanting to hang up my pregnant belly for a few hours, I wasn’t done being pregnant. I loved having a big belly and being publically pregnant. I was so busy with my two jobs that I hadn’t mindfully spent time bonding with the baby or nesting.

I stood up out of bed and said to Chris, “I think my water just broke.” Not having had the experience with Mabel since she had no fluid, I still was hoping the little pop and little gush was just discharge or something. But then I felt a huge gush while standing up. “Yup. It did, “ I affirmed.

Chris jumped out of bed. “Ok! What do we do?”

“Nothing,” I said blandly, “we wait for labor,” knowing that since I was GBS negative, the water seemed clear and I wasn’t in pain, my midwives would say call in the morning or when I’m contracting up a storm. (That’s essentially what is stated in their written directions- so I wasn’t taking too many liberties with myself, just simply following the instructions). “wait- what time is it? That’s important.”

“1:45” Chris said, looking at the clock.

Before I waddled into the bathroom to clean myself up, I looked at Chris and said somewhat sadly, “I’m not ready.”

“It’ll be ok,” he reassured me.

While in the bathroom, I shouted to Chris “Remind me to change my top! I don’t want to go to the hospital in this bra.” I was wearing a old sports bra and wanted a newer one, frankly, to look nicer in those laboring and immediate post birth photos I imagined. I always thing of the green striped sports bra as Mabel’s because it’s in all the photos I have with us together. I even thought that might be the one I wanted to wear.

But a moment later I was forgetting all about what I was wearing. As I stood over the toilet, the first real contraction hit like a brick.

It. Was. Blinding.

With Mabel, I had early labor that quickly morphed into active labor within two hours. There was a rev-up period, where each contraction got a bit stronger and stronger. This time was different. This contraction was off the charts.

I’m going to need an epidural. I thought. I knew I had SO MANY more contractions to go and if they were that bad, I would need real pain relief. As it began to subside, I started sweating profusely- so much so that the floor was getting wet and slippery. Chris grabbed me a fan and plugged it in and then retrieved some ice packs for my neck and forehead.

After it left, I sat back down on the toilet, emptying myself- figuring my active bowel was part of the start of labor. I felt nauseous so Chris found me a trash can to vomit in, remembering how I threw up all the sushi and ice cream we ate before I went into labor with Mabel.

After what felt like seconds later, another contractions hit. I stood to withstand the pain, letting moans rise up from somewhere deep inside me. Chris says I’m noisy in labor and he’s right. At the peak of the contraction, I literally thought I’d pass out from the pain. As it began to leave I thought:

I want to call my midwives! This pain is so bad! But I can’t call my midwives. I’ve only had two contractions. No one calls after two contractions. Especially not a midwife.

The third contraction hit and the room was a blur.

How am I going to get into the car? I can’t even move. How will I survive the thirty minute drive to the hospital? I was thinking how I still had hours to go before birth. It seemed impossible.

As the fourth contraction peaked and released, I looked at Chris and grunted “Call! Midwives!” I was done. This was just too much! I put embarrassment aside and called my midwives after ten minutes of labor.

When Chris got the answering service, the operator asked what was happening. I heard him say calmly, “My wife broker her water,” and I quickly interrupted him, yelling.

“no- I’m in LABOR!”

I knew that getting the message about water breaking might not seem urgent, but labor would get a quicker call back. Luckily, the operator just transferred him directly to my midwife- the same one who delivered Mabel, in fact. Chris put her on speaker.

“What’s happening?” she asked.

“Well, Meghan’s broke her water, “ Chris started to tell the midwife the details about the timing and how my contractions started just after.

I interrupted again with the next contraction.

“I’m puuuushing and I feel the head!” I had reached between my legs and felt the hard tip of a baby’s head and found myself involuntarily grunting and bearing down.

“Chris, you need to call 911,” my midwife instructed him. Apparently this was only the second time ever in her career she instructed a patient to do so. She had him keep her on speak and he went to the bedroom to grab his phone and dial emergency services. While he was walking back to the bathroom, I called out.

“Chris!!!”

I felt the head coming. I had two thoughts as the pressure of the head pushed against my skin. First I wondered if I should get in the bathtub- would it be easier/cleaner to deliver the baby there? I didn’t take into account the fact that I had been physically unable to move an inch due to the pain. The second thought I had was which way I should flex the head. As midwives, when we deliver babies, we often put a little pressure on the head in one direction to flex it- making the diameter of the head a tiny bit smaller and hopefully reducing tearing. I put my hand on the head as it crowned- trying to flex it (in retrospect- I was flexing it the wrong way! Hah!)

Chris heard my call and rushed in juggling the two phones trying to get 911 on speaker.

“What can I do?” he asked me.

In a voice I didn’t recognize as my own I said to him “CATCH! BABY!”

And with that final word, I felt a slippery wet little being slip from me as my skin tore. As I stood over the toilet, unmoved from when I first entered the bathroom, I instinctively put one hand between my legs from the front and one from the back, like I was dribbling a basketball between them, and caught my baby as he slipped from me.

“Eh! Eh!!” my baby squeaked, announcing his safe arrival.

“Oh my gosh! Oh my gosh!” I laughed, unbelieving that the pain was over and I actually had a live, squirming baby in my arms- one that breathed!

Chris handed me a towel and I wrapped the baby in it as I sat back on the toilet, still in shock. I suddenly had a realization and I held my baby away from me, looking down.

“It’s a boy!” I said, laughing again. My instincts were right the whole time.

“What’s his name?” my midwife chimed in.

“Felix. Felix Odom,” we told her.

Chris asked what else we should be doing.

“Nothing! He’s crying which is a good sign. And I’m sure Meghan is holding him skin to skin.”

I looked at Chris, eyes wide, and quickly brought my baby to my chest. I had been holding him away, mesmerized at his little body and boyhood, that I forgot abut the first thing we do after birth. I held him skin to skin after hearing my midwife’s words and Chris brought me a dry towel to keep him warm.

Moments later we heard a female voice calling, “Hello?” from downstairs. At some point Chris had run down and unlocked the front door, as instructed by the 911 operator.

“We’re up here,” Chris shouted and we were shortly joined by Gretchen, one of our local town cops. At first I thought she was an EMT- her uniform looked more like that of an EMT than a police officer. It wasn’t until later that I learned she was an officer.

The EMTs soon followed and began telling me what would happen next.

“Well, first we’ll cut the cord and then you have this thing called your placenta…”

My midwife was still on speaker phone on the counter right by my ear. “Meghan,” she instructed softly, “tell them you’re a midwife.”

I hesitated, worried what everyone there would think- this midwife trying to have a homebirth on her own.

I looked up at the EMTs and officer and said sheepishly, “I’m a midwife. But I didn’t mean for this to happen!” I explained how I wanted the gas- our hospital recently instituted nitrous oxide (or laughing gas) as a method of pain relief (those who watch Call the Midwife might be familiar with “gas and air”). I reaaaallly wanted to know what it felt like and be able to tell my patients and colleagues. I had even procured the consent form ahead of time and was carrying it around in my purse so I could have it as soon as possible in the birthing room.

I then took the lead in my bathroom-birthing room. The EMTs handed the cord clamps to the cop who was closest to me and I showed her where to place them as I milked the cord. “I’d like my husband to cut the cord,” I instructed. The EMTs handed a scalpel to chris, letting him know which was the sharp end, much to his chagrin. And with a little swipe of the scalpel, my son became his own entity. I was able to lift him up (his cord was short and so I couldn’t lift him too high until then) and really see him.

As I held him, the EMTs were bustling in the hall- doing I don’t know what- and I made small talk with the cop.

“Is he your first?” she asked

“My second.”

And then she asked a question that made me respect her even more. “Oh, where is your first?” A good police officer, ensuring the safety of everyone!

“She died last year.”

She relayed the appropriate “I’m sorry” and I said the first of many “And so we are so lucky to have him”s

Soon enough I realized my placenta was ready to come- I felt the telltale signs: gushes of blood, cord lengthening, pressure. I looked at the cop and said,

“I’m ready to deliver my placenta now. Can you help?”

I saw a glimpse of panic and excitement in her eyes, but she said okay in her calm, officerly way. I explained that I was going to stand up and push and have her catch the afterbirth, but we needed something for her to catch it in. I asked for a chucks pad, but the paramedics were insistent on a bowl. I found this humorous as the traditional way to catch a placenta is in a bowl. I was even symbolically given a “placenta bowl” when I went off to integration in midwifery school. So after the paramedics became intimately acquainted with my kitchen cabinets, a bowl appeared (funnily not the midwifery school placenta bowl”, and the police officer caught my placenta in a chucks pad, as I requested and then it was put into the bowl. Everyone was happy.

The paramedics then helped me into a chair contraption to carry me down stairs and on my front step they transferred me onto a stretcher. Wrapped in a sheet, I was loaded into the ambulance to be transferred to the hospital.

As I sat on the stretcher, my baby boy skin to skin in my arms, I realized that I was still wearing that ratty sports bra. It was the only thing I didn’t want to wear to the hospital and lo and behold it turned out to be the ONLY thing I actually wore to the hospital.

In the ambulance, I reminded them to take me to my preferred hospital, since it was 20 minutes farther than the closest one and where my midwife would be waiting. The paramedic reached for IV supplies and I stopped him.

“Is that for an IV?” I asked. Once he nodded, I said, “I’m going to respectfully decline, thank you.” My midwife’s last words on the phone to me were to remind them to take me to the right hospital and that I could refuse an IV if I wanted. Her patient population often forgoes an IV in labor because there isn’t really a reason for one unless there is a medical need (like pain medication, Pitocin, high risk issues, etc). Both of us chuckled later, thinking how I probably shouldn’t have refused, being that I was known to be anemic and had a precipitous (ie extremely fast) birth, both are good reasons for an IV because of risk of hemorrhage. Luckily, I was stable, and also happy that I was IV free.

Upon arriving at the hospital, I was greeted with familiar faces, those of nurses I have worked with for years, despite not having delivered babies for a year and a half. I saw the look on the face of my nurse, a sarcastically funny woman who I had seen grow from a new nurse to one in charge.

“Meg…” she began, calling me by my shortened name that a few people use.

“I didn’t mean to!” I cut her off. “I really didn’t! I was asleep! I woke up and 15 minutes later he was here!” I knew that my story would cause much of my community to think I waited too long- tried to do most labor at home and then it got too late. “I wanted the gas!” I told her.

As my midwife examined me, I told her and the nurse the whole story. I was supposed to have an appointment with that midwife two days later. I told her I had the consent form for nitrous oxide in my purse and was going to give it to her at my next visit. As my midwife put in some stitches, she offered me gas for pain relief, but I declined. I had wanted to see what it did for labor and now that my baby was here I didn’t want to be affected. I opted for the traditional lidocaine. I had a bigger tear than with Mabel, unsurprising because of Felix’s fast entry into the world and his weight. At the hospital we learned, weighing in at 7lbs 3oz, he was almost 2 pounds bigger than Mabel.

As the repair was under way, I asked my nurse which other nurses were on the floor. She told me and when I heard one name, I lit up. “Is she busy? Can you tell her to come by and say hi?”

When I was put all back together, the second nurse popped her head into the room, beaming. We laughed together as I told her the story. And then we took a photo, me, Felix and her. I felt warmed that Felix could meet Mabel’s nurse.

Thank you nurses and midwives

This week is a big week in my healthcare world.  It is Nurses’ Appreciation Week and tuesday was International Day of the Midwife.  In honor of both celebrations, I wanted to thank my beloved nurses and midwives.

*********

Dear Nurses,

thank you for bringing some laughter into my triage room as we waited for the maternal fetal medicine doctor to come and give me terrible news.

Thank you for being the protector of my privacy- making sure I was ready for visitors in the midst of emotional turmoil.

Thank you for telling me about the “secret menu” the hospital offers where I can order quesadillas and pork bacon.

Thank you for sitting and chit chatting during my two week stay, keeping me sane and reminding me that things were happening beyond the fetal monitor I was trying not to watch.

Thank you for watching that fetal heart rate monitor so I could have the freedom just to be pregnant, knowing my baby was safe.

Thank you not commenting on how ridiculous i must have looked in in my sleeping outfit- it was just too hot to wear pants even though I knew you’d be coming in to readjust the monitor.

Thank you cheering me along in my in hospital exercise regimen.

Thank you agreeing to be my labor nurse, knowing my case would be emotionally hard and would likely sit in your memory for a long long time.

Thank you for taking photos of Mabel’s birth- not in your job description, but so meaningful to me.

Thank you for watching my baby in my stead, while she was whisked away to the NICU and I got my stitches.

Thank you for repeating everything the neonatologist said, right after he left because I could barely process it all.

Thank you for getting Mabel skin to skin with me for as long as humanely possible.

Thank you for the footprints, in ink and in clay, that turned out amazing, all done while she was on my chest.

Thank you for making sure she wasn’t in pain.

Thank you for taking out her breathing tube, gently, allowing me a first good glimpse of my daughter’s face free from medical equipment.

Thank you for taking photos, during her life and her death and in the after.

Thank you for feeding me, which I needed direly, but was unable to recognize myself.

Thank you for being present but unobtrusive.

Thank you taking her gently when I gave her up that very last time.

Thank you for giving me peace and solitude to sleep and to grieve in the hours after I gave her up.

Thank you for coming to her wake, taking me for walks, bringing me food in the aftermath.

Thank you for being part of it all and keeping her safe, in pregnancy, in labor and in the NICU.

**************

Dear midwives,

Thank you for all the extra care

Thank you each for calling and checking in when we got the news about Mabel’s Down Syndrome.

Thank you for letting me make tons of extra visits to help keep me sane.

Thank you for letting me use my appointments as mini therapy sessions

Thank you listening for a heartbeat first thing, so I knew she was still alive, before doing the rest of the visit

Thank you for having the hard conversations with me- the ones that were hard for me and hard for you.

Thank you for being honest, saying “I don’t know,” when I asked how I was supposed to return to midwifery if my baby died.

Thank you for giving me the few things I had hoped for- skin to skin, Chris cutting the cord and announcing gender (if he could figure it out!).

Thank you coming to meet her in the few hours she lived- so that you are part of the proof that she actually existed.

Thank you for her dress, an outfit given with love and purpose, the only outfit she worse outside her grave.

Thank you for eating wings with me, bringing me cabbage leaves for engorgement and looking at photos in the aftermath, reminding me that you are not only my midwives, but my friends.

Thank you for the donations you made in Mabel’s memory

Thank you for the lilac bush that you gave me because you know purple is my favorite.  It’s beginning to bloom right now.

Thank you for remembering dates- due dates and anniversaries.

Thank you for saying her name, easily and freely, just like she was any old living child.

Thank you for keeping her safe in my womb and alive in memory.

 

 

 

 

 

Work update!

I have a new job!

I still have my old job too.

Since I returned to work I’ve been seeing patients in the office 4 days a week, the fifth day is a day of appointments- therapist, chiropractor, acupuncture and general mental well being. I took a significant pay cut to work this schedule, one that kept me out of the hospital, and I am thankful that my practice was able and willing to accommodate me. But the “(when) will I go back to births” question always hung over my head. When I first asked to be an office-only midwife, I left the door open to return to birth, but with no time line. I still like having that option, but my practice needed something a little more definite. I honestly thought I’d be back by the holidays (Thanksgiving and Christmas) so I could repay my co-midwives for unexpected holiday time they put in for me last year. But I soon realized that goal was unrealistic. It caused me a lot of stress to even hear my co-midwives even talk about holidays and schedule, knowing they had more to do because of my absence from the hospital. When the topic came up at our winter midwife meeting, I conveniently had to use the bathroom at that moment. In addition, my practice wanted to know whether they should hire another midwife to replace me or if I’d be back soon. Well I finally was able to give them an answer.

As of April first I took on a part time position as Program Director for Hope After Loss, my local non profit helping those who have experienced pregnancy and infant loss. The organization runs peer-led pregnancy and infant loss support groups in four towns, does outreach and education to hospitals, medical providers and anyone who asks, and provides burial or cremation financial assistance to those who cannot afford it for their babies.

Taking on this new position means I plan to remain in the same capacity at my other midwife job- no call. I gave them the go-ahead. Hire another midwife! Takes a huge burden of guilt off my shoulders. I know my colleagues are sad to hear I’m not doing birth in the near future and I’m sad too- there are some things I miss about it, certainly the hospital staff I almost never see anymore! But I know I’m not ready. Some may call it avoidance, but I call it self-preservation. I need to still work on enjoying midwifery in the office and finding fulfillment there before I can return to joyful birth in a place that holds so many memories for me.

This wonderful new part time position has kept me a busy bee these past few weeks, hence my absence from the blogosphere.  But my dear friends, I have missed you!  And I”m trying to be back.  I have much to tell.

Words of Advice from Baby Loss Moms

At the end of my talk to my local midwifery students, I gave them a handout, that speaks volumes.  You may recognizes some words, because they were simply taken from the comments section in response to my question of what would you like midwifery students to know about baby loss.   Feel free to comment if you have more advice to give! Here is the handout:

Words of Advice from Baby Loss Moms

 

“Video clips of ultrasounds meant so much to me and I would have like a recording of my daughter’s heartbeat if they could have given me one. At the time I didn’t know it those would be my only memories of her. I appreciated when my doctors were honest but sensitive.” -mother of Caroline, carried to term after a Trisomy 13diagnosis, who lived for 58 days.

 

“I think they didn’t tell me anything because they had no clue what was going on themselves and wanted to wait until they had more info- but, that choice made things much worse!!!! Talk to the patient, you have to talk them through what’s going on, you have to tell them. Also: if there’s a chance a baby might not make it, you have to prioritize letting the parents see the baby while working out the logistics. I didn’t get to see my kid until after he was gone. I even asked but was told it was too complicated. That’s still absolutely devastating to me, and probably always will be….One other thing: I was given the choice to go to private room on postpartum, or to a different floor. I really appreciated having a choice.” –mother of Sacha who died day after birth from unexpected brain tumor

 

“Perinatal loss can be such an “ambiguous loss”. It was so validating to see everyone reinforce that he really was a real baby (a concept that almost all brand-new mothers struggle to comprehend at the moment of birth).” –mother of Sacha who died day after birth from unexpected brain tumor

 

“Even if the death occurs later, call or write or visit the parents. We so appreciated that one of our midwives and her intern were able to make it to the ceremony we held for Paul. But a call would have been just as meaningful…. If applicable, invite the parents to share a photo of their baby for the baby photo board or book.”mother of Paul who died unexpectedly a few weeks after birth

 

“And for subsequent pregnancy: if you need to discuss the death of the previous baby, give notice in advance so the parents can prepare (especially if you need them to tell their story, or to dig into traumatic events). Also I was offered a viability scan I didn’t “need” but that was really reassuring.” mother of Paul who died unexpectedly a few weeks after birth

 

“With miscarriage (or infant death in general I suppose), even if there is ‘something wrong’ with the baby that you can prove with genetic testing, no one should ever say ‘It’s OK- the baby had a problem anyway.’ I’ve noticed a lot of pregnancy books use this kind of logic, and it’s bad. We don’t throw out people or stop caring about them because they’re sick, so what are we supposed to feel better that our baby that died wasn’t perfect, and that caused his death?” –mother of Serphim, who died of Potter’s Syndrome five hours after birth

 

“Encourage parents to hold, kiss, love, bathe their baby… If you’re uncomfortable handling a dead baby, please ask one of your colleagues to take over. This was our only negative experience with the staff- and it felt awful to have someone reject our precious babies. Remember that these parents need your care, support, love perhaps more than anyone else on the floor.” –mother of A&C, twins who died after PPROM at 20 weeks.

 

I was that woman, sitting in the OB office following my 19 week anatomy scan when the midwife came in with a student and very coldly and matter-of-factly started to explain the slight anomaly found on ultrasound. When I started to cry the midwife offered little support and I could tell she was busy and I think she really believed the finding was nothing major and that I was over-reacting. It was the student who came back into the room alone and sat with me, let me cry, and explained what was going on as best as she could.   So my advice to your students is that there will be days in clinic when you are busy and running behind and stressed, and these are the days when you might have to break bad news to a patient (or several patients), and your pager might be going off, and your receptionist might be reminding you that you have 3 patients in the waiting room, and you will probably have a huge stack of papers on your desk that need to be reviewed… but in that moment, for that patient- your time and presence is what she needs most.” –mother of Clara, carried to term after a Trisomy 18 diagnosis and born still at 36 weeks

 

“It might be tempting to let the parents know that their loss isn’t a big deal compared to what other people go through, but that can be very disturbing to the grieving parents. Don’t tell them it was nature’s way of getting rid of damaged goods. It was their baby. They loved that baby and would have done anything to save it. To you, it was a blighted ovum, or a common Trisomy problem, or ‘barely even a positive’ – but to that family it was precious and beloved. The loss is still very real no matter how unformed the physical person may have been.” –mother to baby lost to miscarriage

 

“Our nurse hung a doorsign of a baby in an incubator on our door so that those entering my postpartum room would know that we had a NICU baby. That was great as it eliminated any too-cheerful questions. However at my six week postpartum checkup, the doctor didn’t know my baby had died.” –mother of Anderson, born at 24 weeks who lived for 26 days

 

“Cyr, take photographs- YES. And remember, you can never tell a loss mom that her baby is too beautifulm too perfect, too special and too unique. She will never hear this as her child grows. Give her a lifetime of school picture Oohing and Aahing in the short time you have with her. Use the baby’s name.” –mother of Anderson, born at 24 weeks who lived for 26 days

 

“I was pregnant with our 2nd baby and had our first u/s at 9 weeks. They couldn’t find a heartbeat. I t was hard and still is. I recall the u/s tech saying ‘oh I just know you’ll be back in 3 months pregnant again!!!” She was just so hopeful. But that’s not what I wanted to hear. I needed to honor THIS baby and THIS loss. So overall, I just wanted the midwife team to honor the present and respect what we are going through at the moment.” –mother of baby lost through miscarriage

 

“To make sure parents have all mementoes of their baby that they would like; to make sure parents know they have no been ‘cast adrift’ from the unit- you become so close to staff whil your baby is being cared for going home is like an estra wrench on tope of the loss of your baby; to make sure parents know how to access counseling. I would also add a couple points about traumatic birth- whether it’s something like PPH or an illness such as preeclampsia and HELLP syndrome- that mums know where to get information about what happened to them and why, and how to access support/forums/debrief about the birth.” –mother of Hugo, born at 24 weeks and lived for 35 days

What more do you have to add?

The hospital

The hospital. Saying the words, envisioning the building puts my stomach in knots.

 

My practice has a Monday morning meeting at the hospital. It used to be every week, but in the past few months it’s morphed into a once a month affair. We gather as a group of docs and midwives and talk about protocols and patients, ensuring we are all on the same page. Aside from the 7am start time, I have traditionally enjoyed the meetings. I like having clinical conversations with my colleagues- we sometimes debate and I almost always learn something. I also think it’s good care for our patients- getting fresh eyes on complicated cases, allows everyone to give suggestions on how best to care for our patients. And on top of it all, I enjoy the company. My practice has four offices in different towns and the hospital on top of them, and we are spread among each location- so I am lucky if I interact with one of my colleagues on a daily basis. Even when we are in the same office, our schedules are quite crammed so there is not much time for catch up or small talk. So Monday morning meeting is a chance for us to see each other and catch up for a minute.

The meeting takes place on one of the maternity floors in the hospital, in a spare conference room. It’s the floor on which I spent two weeks while pregnant with Mabel. During my hospitalization I was allowed about an hour off the monitor a day and one Monday I decided to use that hour to go to Monday morning meeting. I popped in wearing my “nicer” hospital clothes (yoga pants instead of pjs) and sat as my colleagues discussed work. It was good to see them- I had seen many of them while I was there- if they were working they would often stop by my room for a quick snack and a chat, but it was comforting to see them altogether.

The meeting holds new meaning for me. It takes place in the building where my daughter died. It’s on the floor where I spent the last good moments of pregnancy and where I returned to my room empty handed. After Mabel died.

We had a Monday morning meeting this week. I went once before- in September. I felt I needed to, as we had just hired a new doc and midwife. But I skipped October- I didn’t want to go. The thought of the place causes a painful physical response and frankly, I was not up to the task. But this week, I needed to go- there was a clinical issue I needed to discuss (how to care for pregnant patients on methadone). So I skipped my usual Monday morning exercise class and headed in. I parked on the street because my usual hospital parking is in accessible- my ID doesn’t work for the parking garage and I haven’t gotten around to fixing it. As I walked closer to the door, my heartrate sped up and I felt that familiar pain in my chest and stomach. I regulated my breathing and made sure to look at the funny rabbit and carrot decoration that sits in the revolving door to the children’s hospital. The carrot gave me some comfort. But when I hit the doors to the maternity floor, I could feel the tears coming. Before heading into the conference room for the meeting, I had to hide in the bathroom for a few minutes to have a good cry.

I wouldn’t call it a panic attack- I know enough about them to know that’s not it. I simply identified my response as grief, simple grief. This place is so sad for me now. It also represents mountain I need to climb. The hospital represents birth- normal birth for most people, a usual happy occasion, and if I ever want to be a full scope midwife I will eventually nee to climb that mountain and welcome normal birth again. I am far far from that place.

My doctor called my response- a reaction to trauma. The term didn’t quite sit well with me at first. People have trauma when they go through sudden, unexpected events- emergency c-sections, stillbirth, prematurity. My daughter’s death was in some way expected. I should have been prepared. I often feel I don’t have the same right to claim trauma like those who were totally caught off guard do. My doctor encouraged me to accept her definition of trauma- that it doesn’t have to be sudden; it can be long and drawn out. Death, a life-changing event, whether expected or not can be traumatic. So I’m working on accepting that- apparently it’s necessary to do in order to move forward in my grief.

 

How do you view the hospital/doctor’s office? Are they traumatic for you at all?

A Birth and A Baby

I didn’t change into scrubs. I wanted my role to be clear- I was there for support, a visitor. My hospital badge was the only tell of my other identity. I stood there in my skirt and ankle boots, making soothing sounds, giving suggestions and just simply being there for her.

This was her rainbow. I had been there to welcome her first born into the world six years ago. A few years later I welcomed her second, born sleeping, into the same hands that caught her brother. She knew her baby was going to die; an extra chromosome diagnosed midway through pregnancy foretold the outcome, but her the hurt and pain was no less than had her loss been a surprise. Now years later she was laboring hard for the rainbow child she nervously awaited. She had asked me to be with her at the birth, knowing my story and thus knowing what she was asking. I said yes, because that’s what you do for another babyloss mom.

Originally, when I figured I’d be ready for call by September, the plan was to induce her on my call day, but that plan had to revised when I came to terms with my inability to attend birth at this time. I gave her my cell phone and would come if I could. All day I saw patients and all day her induction poked along, her uterus waiting for my arrival before really kicking in. On my way to the hospital, I was on the phone with my fellow midwife.

“How are you feeling about this?” she asked, probing.

“Honestly? I’m trying not to think about it until I get there.”

Live in the now. The only way to survive. I knew this would be a test of sorts, to see how ready I was for birth. It was also a good faith show of effort. “See? I’m trying!” my actions shouted.

While she labored, I felt detached. I tried not to think about how just a few rooms away I had done the same for my baby; I tried not to think about what would come next. I was mostly successful- my feelings disconnected from my words and motions. I felt empty, like a robot, doing what I knew I was supposed to be doing. It didn’t feel good. I have spent many long nights, with laboring patients, feeling somewhat aloof- I hadn’t bonded despite my efforts- but I now felt disconnected on a whole new level.

After the telltale “I can’t do it anymore!” she started bearing down and I knew birth was imminent. I helped hold her leg, watching the glistening dark hair of a baby make its way down the birth canal. Baby tumbled out and the midwife brought him right up to her belly. After a tense moment of silence, the cry of a newborn pierced the quiet room. I slowly put down her leg and backed away into the corner, where I found a chair to support me. Tears rolled down my face and snot clogged my nose. I tried to sniffle quietly, embarrassed by my tears. I didn’t want to take any of the attention away from this mom and her rainbow but I sat there sniveling, thinking of my poor baby, who took her last breaths down the hall. Thinking how unfair it was that I have to live life without her, that her absence weighs so heavy on everything I do. Thinking how sad and angry this birth made me, when it should have been nothing but beautiful. Thinking how this scenario of a rainbow baby, of finding joy again in the delivery room, seems so unattainable. Feeling selfish and ruined.

Birth lost its magic.

Reading my thoughts, she said through tears of her own, “Meghan, it’ll happen to you. I promise. You’ll get one too.”

The baby went to the warmer to be weighed and as the nurse helped mom get into a dry gown in preparation for some skin to skin. I walked to the warmer and picked up the little warm, squirmy being. I held him in my two hands a few inches away from my body, walking to her and presenting him like a freshly baked apple pie. No cuddling, no warm body against my chest- those were things I did with Mabel and I want no other baby to taint those memories. I quickly delivered him to his mother, proud that I could say at least I held a baby. I tried.

I didn’t stay long. My work was done- her baby arrived safe and alive. I said my goodbyes, not wanting to talk about the experience with anyone. In a way I was glad some of my colleagues witnessed my raw reaction. I can usually hold it together in the office quite well, wearing the mask of normalcy that babyloss moms are all too familiar with, which is good for functioning but bad for letting people know how I really am. There is something more telling in watching my tender breakdown than hearing me say “I’m struggling.”

I went home to Chris, too spent to even debrief with him. All I wanted to do was hold my puppy. She’s not as docile as a baby, but she’s warm and fuzzy, and she loves me back.

Have you do something hard since your loss? What did the experience tell you?

photo (26)

Disappointment

When I graduated college in California, I moved to the Washington DC area to live with several college friends. I imagined myself finding a job in a non-profit or a government agency involving healthcare. After a couple months of searching and interviewing in my brand new cranberry colored pinstripe skirt-suit (yup, I was hip) I found the job industry harder to break into than I thought it would, even with my shiny new Stanford degree. While my roommates started their more prestigious jobs at local papers, on the hill and in think tanks, I finally found work as a medical assistant in an OBGYN office. It wasn’t the glamorous job I had pictured, but I knew it would give me the experience I needed before applying to midwifery school.

I didn’t meet many people through work- those that I did had different lifestyles than me; they were older or had families. My job was also in the suburbs, not far from the house we lived in. While my roommates commuted into the city and stayed for happy hours with their new friends, I went to work early and often got out at 3:30p only to find myself home alone. So I started looking for ways to meet new people and make friends. I answered an ad on craigslist looking for women to join their indoor soccer league. I wrote tentatively, ensuring that the league was casual and disclosing that I hadn’t played soccer in eight years. Didn’t matter, he wrote, they needed women.

So I showed up, thinking I came prepared in my athletic shorts and sneakers, only to find out that the league was a bit more competitive than I had hoped. In my naivete, I didn’t even think to bring shin guards. Luckily a teammate had an extra pair and I was able to buy some socks there, allowing me to play with the regulation necessities. I was the warm body in female form that permitted them the gender balance for play.

I took a defensive position and found myself trying to makeup for my lack of skill with effort. I ran hard and fast, trying to beat other players to the ball, though I was rarely successful. The first time a ball actually rolled towards me, out in the open, I ran to it, pulled my leg back and swung hard, happy to have my chance to contribute.

I missed.

I also proceeded to basically score a goal for the other team, when the ball ricocheted awkwardly off my thigh, angling itself past my goalie and into the net. I was mortified. Yet, at the end of the game, I was asked to come back again- despite my ineptitude they needed me to be eligible for play. I left the game feeling embarrassed about my performance and walking tentatively because in all the hard effort I had put forth, I think I pulled muscles in both my thighs. I could barely maneuver the clutch to get myself home. I called my parents, as most young adults do when they don’t know how to fix something, and asked how to make my legs feel better. They suggested calling a family friend I grew up with who was a physical therapist. I told her what I had done and how I was worried I wouldn’t be able to work the next day because I could barely walk. She instructed me on the schedule of icing and rest that helped heal my sore muscles and put my in my job the next morning.

When I was recently relaying this story to some friends, I told them how I went back the next week to play again. They were both surprised after such an embarrassing show I had made of myself and the near injury I had caused to my legs. “I couldn’t disappoint them. They needed me,” I explained.

I don’t like to disappoint.

I recently did some soul searching and came to the realization that I’m not ready to do call- to deliver babies. I’ve had the conversation with work, asking to be taken off the call schedule…indefinitely. I do plan on going back to birth, I just need more time to figure out how much time I need. I am extremely fortunate that they are willing to accommodate me in this request.

Admitting that I’m not ready for birth six months after my baby died feels like a disappointment. I’m disappointing my practice partners- they’ll have to work more because of me. I’m disappointing my patients- the ones who were hoping I’d be there for their births will have someone else. I’m disappointing my nursing and midwifery colleagues who have tried so hard to bolster me up with comments like “You’re such a good midwife, you have to do birth,” and “It’ll be hard, but you’re so strong, I know you can do it.” I appreciate their efforts to build my confidence, but what they don’t realize is that I don’t need my confidence boosted. I just need time. These remarks meant to help me actually make me feel worse, because now I feel like I’m disappointing them- I’m not a good enough midwife or strong enough to get past the death of my daughter. I’m disappointing my friends who say they can’t picture me as anyone but a midwife, it’s such an integral part of my identity.

I’m not leaving midwifery and I hope to be back at birth- sooner rather than later- but I have to take care of me first. I will write more about the “why” behind my inability to face call right now, but that’s for another day. I know you all will tell me to not worry about it, to be gentle with myself, to know that I have to be good to myself before I can be a good midwife (and thank you in advance for such kind and supportive comments), but regardless of all the things I can tell myself, of the things you can tell me, I still feel like I’m disappointing everyone.

Do you ever feel disappointed in yourself?  Why?

Birth Scene from my audiobook

I drove into work this morning listening to my audiobook.  I’m not a big fan of driving and so one of the things that makes my thirty minute commute more tolerable is listening to books on cds.  On the day we moved to the house in the suburbs where I live now, the first thing I did once the movers left was head to the library and get a library card.  I was pleased to see they had a huge collection of audiobooks.  When Chris and I went on that trip to the Outerbanks, I was nervous about the long car ride.  I picked up an audiobook that I hoped we would both like- a reporters story about a New Orleans hospital’s struggles without power or transport in the days after Hurricane Katrina.  I was riveted.  Chris slept through the first part but got snagged later on.

This morning I was listening to a memoir (my latest obsession) about a man’s life growing  up on a farm.  He bounces between childhood memories and his current life on the farm he lives on as an adult.  Lo and behold, his wife is pregnant and they have a home birth.  Earlier in the book when he was describing the pregnancy, I fastforwarded.  But today as his wife is in labor, I forced myself to listen.  I am a midwife after all.  I have to do this in real life soon, I needed to start exposing myself.

I sat there in traffic as he described his wife’s contractions, her perseverance, the homebirth midwife attending. When the midwife asked if he wanted to see his baby’s head, moments before birth, I let out a choked sob.

A beautiful moment, ruined by my memories too convoluted with difficult emotions. I can’t help but relive my moments when confronted with these images of childbirth. Simply hearing of this beautiful birth made me grieve my loss of normal birth. The moment- my baby’s head crowning, about to enter this world- was supposed to me my happiest moment. It was and it wasn’t. I was terrified of what would happen next, to finally know after months of uncertainty if any of the hope I held would be realized. It was the moment my baby began to live and the moment she began to die. I could no longer protect her. As I listen to the narrator describe the moment of happiness as his baby is born, I felt taunted. This is what you wanted but did not have.

All this from listening to a birth scene described. What will happen when I am faced with it in real life?

I arrived at work just as the birth scene finished. I wiped away the tears that had fallen, but they continued to drop despite my efforts. I walked up to my building feeling the streaks of saltiness on my cheeks where they dried. By the time I walked through the door, it was over, but the tears stayed close all day, ready to peek out with the slightest provocation.