A rogue wave

As a midwife, my colleagues and I usually meet once a month to discuss protocols, clinical issues and patient care.  I enjoy these meetings because it’s rare that we actually see each other in person.  I’m in an office with maybe one or two other midwives or docs on any given day, but even then we are all busy seeing patients, often working through our lunch hour.  It’s a pleasure to spend some time face to face with my coworkers- even if it’s entirely work focused.

Recently our monthly meeting has been cancelled or rescheduled for all sorts of logistical reasons, so when we had our first one in several months earlier this week, I was looking forward to it…even though it’s at 7am.  The hour long meeting flew by and I was leaving the hospital, where our meeting is held, in a good mood.

Until I walked out the main entrance.

Sitting there as I was leaving was a woman with a newborn carrier waiting for her ride home.  My heart clenched and I was thrown backward in time. Here I was, leaving the hospital, empty handed once again.

So much has happened since that first time I left the hospital without my baby.  I returned many times- for meetings, to visit staff and friends. I even finally had the chance to leave the hospital with an actual living breathing newborn. But it had been a while since I’d been back at the hospital and it’s amazing how even though it’s been two and a half years since I said goodbye to my Mabel, like a rogue wave in a quiet sea, the grief can still hit hard out of nowhere.

I don’t spend much time actively grieving these days. I often feel that my other job- working for Hope After Loss, the non profit that supports the pregnancy and infant loss community, is my way of grieving. I get to speak of my daughter often and empathize deeply when I’m speaking new a new loss mom or dad.  What I realized earlier this week at the hospital is that though I may be honoring Mabel in my role at Hope, I still compartmentalize my feelings.  It’s protective.  Grief is hard work.

Seeing this mom and her newborn, I was reminded I still have work to do.

I miss her, my baby Mabel.

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?

 

at the dog park

At the dog park, we watch our dogs run around and play together.  We refer to each other in relation to our pets.  “I’m Muppet’s mom.” and “Oliver’s mom brought dog toys.”  We swap names of groomers, complain about those who don’t clean up after their dogs and laugh our dogs romp around.  Occasionally, the conversation turns to life outside of our dogs.  Bringing Felix to the park often invites this kind of conversation.  Today, I had the same question, but different conversations.

_____

“He’s been cranky all day, which is not easy when I work from home!” I shared when someone asked about the little guyI was wearing in the baby bjorn.

“What do you do for work?”

I explained about my two jobs- I work part time as a midwife and part time for a non profit. Usually people, especially other women, pounce on the midwifery as an area of interest.  But this time it was different.

“What non profit?”

“Hope After Loss- we support the pregnancy and infant loss community. We run support groups, do outreach and give financial support for burial and cremation.”

“Oh….” the light hearted tone of the conversation had changed.  A beat later, the lightness returned as she changed the subject. “How was your labor with him?” she asked, nodding toward Felix.

“Hah! That’s a story!”

“Oh, was it long?”

“Oh no, it was super quick,” I said as I gave her the breakdown of how after a fifteen minute labor he was born into my hands over the toilet.

“Wow! And he’s you’re first!?” she said questioningly.

“My second, that’s why he came so fast.”

“How old’s your first?”

“She would have been 20 months…” I could see the confusion in her face as she tried to understand the past tense.  “But she died.”

Her face fell as she struggled to comprehend. “Oh I”m so sorry… She lived for 20 months?”

“No, she lived for six hours.”

“I’m so sorry,” she repeated, looking distressed.

“Thank you.  I like talking about her,” I reassured her.  Then followed a short conversation about my daughter.  It felt good to be open and honest.

As we wrapped up the details of Mabel’s birth and death, she looked at Felix in the baby carrier and said “at least you have him now.”  Looking for the silver lining in the death of a baby.

I kissed my son on his head and said “Yes, I am so grateful to have him.  But I miss his sister still.”

________

“Is he your first?”

“My second.”

“Oh, well then you know what you’re in for!” she said with a smile.

“Nope.  No I don’t.” Except I didn’t say that.  I thought it.  I thought about saying it, especially after the previous conversation I had. But I didn’t.  There’s just a split second I have to make the decision, whether I tell her.  I spent that split second thinking and not speaking and the moment was over.  Sometimes I wonder what the conversation would have been like had I spoke.  It’s just so much easier to answer direct questions rather than volunteering the information.

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.

That same day

“has not had a period since birth of her son on February 15, 2014”

I read the last note I had written on the patient before I went in to see her.  I rarely am so specific in the dating- usually I’d say something along the lines of  “has not had a period since childbirth 5 months ago.”  Clearly the date had struck me.  I wrote it down mindfully, deliberately in the note.  I remember that visit.  I was seeing the patient in the same room actually and thought of how that was also Mabel’s birthday.  At the time all I could think of was how she had a baby to go home to and I did not.

On this day, many months later, a new thought crossed my mind when I re-read my note.  As I stared at her, all I could think of was how she had been on the labor floor at the same time as me.  She was there, down the hall, when I was wheeled from the NICU back to my labor room so that we could call our family in private and tell them our daughter was going to die soon.  As I said “it’s a girl!” in the same breath as “her time with us is short,” picturing the five pound wonder child I had just left on a warmer, tubes criss crossing her slowly bluing face and body, this woman was holding her baby on her chest, shushing those first newborn cries and excitedly cooing over her own little wonder.  Not long later I held my dead daughter as I struggled to keep my eyes open, having been up all night in labor, but not wanting admit I needed sleep for it meant saying good bye to my baby forever.  She probably struggled with fatigue as well, wondering how on earth she would be able to take care of her needy little one when she was just so tired.  I returned to a postpartum room, crawled into the hospital bed with my husband and slept, undisturbed in a quiet room.  She went down the hall, her attempted sleep punctuated by cries telling of a needed diaper change or feeding.  I walked out of the hospital with a box and she was wheeled out with a baby.

I write these words not out of bitterness and jealousy, as I would have many months ago, but out of fascination… that here we both were, face to face, our lives forever changed by the birth of our first children on that same fateful February day, in the same place, but how very very different our lives are now.

 

 

Play Date

I was at the dog park with Muppet and she was having her usual blissful time running around with the other dogs. The snow has begun to melt creating a large muddy patch at the park, which of course tends to draw all the dogs. Muppets fur soaks its all up and she gets crazy dirty, loving every minute. This day she found a couple of puppies that she played so well with. Coco was a brown and white dog (I am terrible at remembering breeds) just a few months older than Muppet and about the same size. They romped happily giving chase and play biting.

Dog parks are friendly places. Conversation seems to flow easily between puppy parents.

“Which one is yours?”

“What’s his name?”

“How old?”

“Where do you get her groomed?”

We exchange advice on boots for the snow, where to get a cheap light up collar, where there is a do-it-yourself dog bathing station near by.

On this day, Coco’s mom and I struck up conversation. She seemed about 15 years older than me and very friendly. She spoke with an accent and I soon learned she was from Columbia. She told me how she met her husband, an American, while she was vacationing here and ended up moving here for him.

“Our puppies get along so well!” she said. “If you ever want, we have a fenced in yard and live down the street. You can come over with Muppet and they can play!”

She told me how she works, but her mother is at home with Coco during the day.

“but she doesn’t speak English,” she warned.

“Esta bien. Hablo espanol!”

Her eyes widened and she smiled! “That’s great! She would love you! Even if you speak just a little Spanish.” She wanted to know what I did and I explained I was a midwife (“una partera o comodroma” I said when she wasn’t familiar with the English word. “pero en la hospital,” explaining that here midwives practice a little differently). I joked about how my obstetrical and gyn spanish was much better than general conversational Spanish, so hopefully her mother wouldn’t mind if I talked about vaginas! She laughed.

I left the dog park with her name and number to later arrange a puppy playdate. I thought, is this what parents with living children do? Would I be making similar playdates for Mabel, had she lived? Or not because she would have been sick?

Grief exposed

It was the end of my day and I walked my last patient up to the front desk. “She needs an appointment in 4 weeks,” I told my secretary.   As she searched the schedule, the patient tapped me gently on the arm.

“And how’s your little one?” she asked, continuing some of the friendly banter we had started in the exam room. She remembered that I had been pregnant the last time I saw her.

I am so prepared for this question. I’ve answered it time and time again. I’ve come to terms with the fact that people will ask- a lot of people, because I have a lot of patients who saw me pregnant. Probably hundreds of them. Some know what happened and some don’t. I no longer get emotional or shut down when asked. I have my go-to words that fill the once awkward space the question leaves.

But this time was different. I had an audience. I am usually asked about my baby when it’s just me and the patient in the exam room. I don’t think I’ve ever been asked in front of others who know and here I was, with the patient, sweetly asking in about my daughter with my front desk staff there to witness. I felt self-conscious.

“I have sad news about the baby. She died last year,” I told the patient. She was kind- gave me a quick hug and expressed genuine condolences. And then I quickly moved on and brought the conversation back to the future appointment for the patient.

It was a little different than what I usually do in privacy with the patient. If it’s someone like this patient I usually give a little more space for them to react and leave room for conversation if it happens. I think it helps me and it helps the patient. But this time I felt almost embarrassed that my staff had to watch this awkward interaction, perhaps thinking about how awful it must be to get this question over and over. Part of me is glad they witnessed- people getting a little window into the ongoing grief I have, but another part of me is so very shy about it. I can open up about the raw grief I have more easily in the privacy of an exam room, but not while being watched.

Have you had this question asked in a group setting? How have you reacted?

World Down Syndrome Day 2015

World Down Syndrome Day.

March 21- 3/21-  a day picked to represent trisomy 21 or three of the 21st chromosomes (most of us have only 2- the third is what is responsible for what we know as Down Syndrome).  It’s a day of celebration for the Down Syndrome community- a group I tentatively belong to.  For me it’s a day of celebration, a day of sadness and anger, a day of reflection.

Last year I wrote a letter to those who were expecting a child with Down Syndrome.  I’ve written a lot throughout the year about Down Syndrome- what I see in the news, how it crosses my path on a daily basis, my memories… I recently reblogged this post by Sadie at Invincible Spring, which I wanted to share again today, of all days.

1) Prenatal screening can detect the risk of delivering a baby with Down syndrome.

2) Prenatal screening can detect the possibility of delivering a baby with Down syndrome.
They mean basically the same thing, but not. We welcome possibility, while we shy away from risk.

After reading her words, I have totally changed my practice.  In the babyloss community we are admittedly very sensitive to words and phrases, even if they are well intentioned.  “God needed another angel” is well meant, hoping to give us comfort- but those words sting us, even those in religious communities.  Those in the Down Syndrome community, can experience the same hurt.  And it starts early- before a diagnosis is even made.  We obstetrical providers are the first to address the idea of having a baby with Down Syndrome.  Sadie’s words has made me rethink how my simple words as a midwife portray Down Syndrome in our society.  I no longer use the word “risk” when discussing  genetic testing.  I now talk about the possibility of having a baby with Down Syndrome.  One little word, that connotes so much.  Especially for me.

I was open to the possibility of having a child with Down Syndrome.  I opted for testing even though based on my family history and my age, I was “low risk.”  But as I have counseled patients in the past, low risk doesn’t mean no risk.  I wanted to know my chances of having a baby with Down Syndrome, even though I didn’t think it would change my management- I thought I would continue a pregnancy with that information.  I have also learned, we don’t really know what we would do until actually faced with a certain situation.  When I was told, “it’s Down Syndrome,” I felt relief. The initial abnormal screening had me worried about all the life limiting conditions it connoted, but Down Syndrome was livable in my mind.  My baby could live!  I certainly cried my tears later over the loss of the dream child I thought I was having, but I also eventually embraced the idea- going to my state’s annual Down Syndrome conference, talking with parents of children with Down Syndrome, researching therapies and pediatricians who specialize in children with Down Syndrome.  I had a registry full of special baby wearers and toys made for children with Down Syndrome.  I accepted.  My baby began to feel extra special- yes, a wanted baby, but a wanted baby with Down Syndrome.  An estimated 92% of pregnancies diagnosed with Down Syndrome are terminated.  I was proud to be part of the minority, and also sad that I was part of the minority.  In some ways, I feel future pregnancies may never have that same specialness.  Don’t get me wrong, I hope for nothing but as healthy a baby as possible, but having a baby with the typical number of chromosomes seems almost easy.  Almost.

International Down Syndrome Day is also a little painful for me.  I see photos of smiling children on the news and flooding my facebook and blog feeds, their features of Down Syndrome evident in their faces and their stories of how happy and loved they are written underneath.  I so badly wish I could be in that club- that club I at first never wished I belonged to- the parenting a child with Down Syndrome club.  It’s a lovely community, full of support for people having both an easy and a hard time.  Raising a child with Down Syndrome is a challenge- no one can argue that.  But what child doesn’t have his/her challenges?  Learning your baby has Down Syndrome simply makes your baby’s challenges known and upfront.

At times I can be a little angry- it was the extra chromosome that stole my baby from me.  Mabel’s kidney defects are rare, but they are more common in babies with Down Syndrome.  I sometimes get angry that I was in that minority that said “yes,” that I would raise a child with Down Syndrome, while the overwhelming majority chooses not to.  But I was given a child that wouldn’t live, while others terminated a pregnancy of child that might have lived.

I still believe in a woman’s right to choose. I just simply wish that more people would choose yes, when it comes to Down Syndrome.  It is not an easy road- sometimes it can end in heartache, like with me- but I don’t regret taking the risk of loving my child with Down Syndrome.  I would carry another child with Down Syndrome, despite the risks of loss.  There are no guarantees in life, in love, in family- all we can do is hope.

***

In remembrance of our daughter Mabel, my husband is fundraising for Best Buddies, an organization that helps people with intellectual and developmental disabilities- including those with Down Syndrome.  On May 31 he is biking 100 miles across Cape Cod to raise money in her name for Best Buddies.  If you’re looking for a way to celebrate World Down Syndrome Day, consider donating by clicking here.