singsong baby voice

She sat across from me in my office.  Clearly excited about another pregnancy, but also distracted by her one year old.  She used that baby voice- the kind that is singsong, the rises and falls of her tone easily grabbing the attention of her toddler. My questions interrupted her playful talk.

“Any family history of thalassemia? sickle cell? congenital heart defects? Down Syndrome?”

She answered easily without taking her eyes of her son who was exploring the bookshelf, then the chair, then the picture frame.  I was very attentive to their interactions, ones that would solicit coos and oohs from most people, but from her perspective I likely seemed immune.
All I could think was- my baby died.  I will never develop that singsong voice with my baby. She’ll never explore a doctors office like he was.  This child was three months older than what Mabel would have been and he was developmentally age appropriate.  He did not wear leg braces to correct clubbed feet or have any marks from heart surgery or kidney dialysis.  I realize that the pairing of this mother and her healthy child would never have been like that of me and my sick one, had she lived. I grieve not only the child she would have been, but also the child I  know she wouldn’t have been.  I was jealous of this mother and her seemingly easy parenting.  It was hard not to think it was being flaunted in my face, though I do recognize she had no idea the pain it was causing me- and I didn’t expect her to.  She was just doing what she should be doing, mothering.
Where have you seen pain in day to day interactions?

Sometimes knowledge is power and sometimes knowledge is pain

I have a friend who is a doctor and she shares snippets of her daily life- the trials and tribulations of a resident physician, her patients and the lessons about life she learns. Some stories are beautiful and uplifting. Some make me cry. Some make me cringe. All are insightful.

Recently she wrote of a meeting of providers- discussing their patients’ cases and one of them, an oncologist was distracted because he had recently learned of his mother’s breast cancer. He had trouble focusing on the meeting because he knew better than anyone what the diagnosis meant for his mother and his family.

“Because sometimes knowledge is power and sometimes knowledge is pain.”

This was me, my entire pregnancy with Mabel. I had a week before my first ultrasound where I assumed everything would be okay. Until there was no heartbeat and we thought I had a blighted ovum. Seeing a heartbeat a week later, confirmed a viable pregnancy but I spent the rest of the first trimester knowing what it felt like to miscarry and worried I’d be feeling that way again. Though I told my family I was pregnant before my genetic testing, I asked them not to share the news until we got the results, because even though I had no risk factors, I knew it could still happen to me. When I learned Mabel had Down Syndrome, I decided to accept the diagnosis, but it wasn’t simply recognizing I’d be raising a child with special needs. It was also recognizing that I might not be- I was all too familiar with the risk of miscarriage and stillbirth with the diagnosis (ironically, I wasn’t thinking about neonatal loss). When we were told her kidneys weren’t working, she had no fluid and if she were even to be born alive, her lungs would likely be too small to sustain her life, I had some hope, because what mother doesn’t? But I also knew. I’ve told people myself when there is no fluid at early gestation that their baby will die. I knew.

Yes, sometimes knowledge is power. I was able to research and make my own educated and informed decisions about my body and my baby. But knowledge was also pain for me. I never enjoyed my pregnancy like I should have, like I wished I did; it was too tainted with worry.

I’m sure those of you out there who have had a pregnancy after loss also know that knowledge is pain. There are some of you who may have learned that lesson with your first pregnancy, like me.

Is knowledge power? Is knowledge pain? What is your experience?

A dream about Mabel

I had a dream last night that I was about to birth Mabel.   My midwife was there with one of the labor nurses.  After she came out, they had me leave the room.  We knew she was going to die.  When I returned she was gone and they replaced her with another baby- a boy.  I cried tears of pure happiness that I would be taking a baby home.

This dream has unsettled me.  I have had only one other dream about Mabel not long after she died.  In the dream she was alive and I held her in that white blanket we had wrapped her in and nursed her.  That one was about what I missed about her.  But this last one felt like it was about something else.  I don’t want her to think that she can be replaced and I’m saddened to think my mind is working that idea out in my sleep.  On the other hand, the joy I felt at the idea of being able to bring a baby home, was unreal.  It’s almost too painful to think about.  I think that joy is what has shaken me the most.  What is it like to bring a baby home?  To hold a baby in your arms as you leave the hospital?

As we visited her grave today, I was reclining back on the blanket we spread out.  I read to her from one of my favorite childhood books and pictured her curled up asleep on my chest.  What a painful joy it was.

Mabel’s Birth: Part II “No No No”

The good thing about labor is that the pain takes you to a different world.  It distracted me a little (a lot?) from my fear of what was going to happen with my baby.  I mentally and physically transitioned in to active labor as they wheeled me down to the labor floor.  I remember being worried that they would make me walk down- the walking I wouldn’t mind, it was just that I was beginning to get really vocal with my contractions and it would take some time to walk and I felt it would be too public.  Luckily an aide showed up with a wheelchair and whisked me away.  I had only two contractions en route and then had the freedom of my labor room to move and make noise as I needed.  I’m told I got rid of my clothes as soon as possible (though I have a memory of sports bra for some of it).  As I got settled, the Newborn Special Care attending physician came in to introduce himself and let us know he was familiar with our case (he read the note from our meeting with another of the Newborn doctors).  As he saw me on hands and knees, moaning loudly and vomiting between contractions (there was a fair amount of vomiting), he asked my midwife if he should come back at a better time.  She laughed at him and said, “I think this is a good as it’s going to get.”  Apparently she had gone over to the Newborn unit shortly beforehand and was telling the team there that I was 4cm and on the labor floor and to be ready because she thought I’d go fast.  A resident said indignantly, “but it’s her first baby and she’s only 4cm, why would you think that???”  The high risk doctor who had accompanied her, piped up “oh, D’s patients always go fast!”

 

Once on the labor floor, I was feeling out of control.  I felt like I couldn’t get a rhythm to help me through contractions- I’d try one thing, then another.  I had a worry stone the chaplain had given me in the beginning of my hospital stay and I was using that to look at or hold onto.  But nothing was working.  I knew nothing would take the pain away, but I felt like I just needed a rhythm.  When I felt like I was losing it, I got in the shower, which helped a little.  I thought it would have helped more, but surprisingly it wasn’t what I needed.  So after about 20 minutes I got out and back into trusty hands and knees.  The vomiting returned.  Chris had his jobs- provide me with barf bags, put pressure on my back (until I said stop) and cover or uncover me with the sheet, depending on my moment to moment mood.  He did such a good job, such a trooper.

 

At this point I felt like I couldn’t do it anymore.  As a midwife, I know everyone hits that point- and they are usually in transition.  My midwife checked me and I was 6cm.  Through my contractions I was saying a lot of “no, no, no“ and “make it stop.”  I was saying it to the pain- I didn’t want any more.  But I was also saying no to my labor.  I still didn’t want to be in labor.  I wasn’t ready!  I asked for an epidural.  I was afraid my midwife was going to tell me I was 8cm and going too fast.  So it was a relief, in a way, to be only 6cm.  It took three attempts to get an IV (I have lovely delicate veins and was dehydrated from all the vomiting).   During that time I discovered there might be nothing worse than vomiting while having a contraction.

 

I entered labor feeling ambivalent about an epidural.  I had written earlier that I would try not to beat myself up for getting one, but it is hard, because as a midwife, there is some sort of expectation to have natural childbirth.  I never blame anyone for getting one (previously I said, that labor sure looks like it hurts and now I can say it really really does), but I also believe with the right preparation and right kind of labor, women can certainly do it without one.  Labor is not predictable and there are many circumstances that might change peoples plans.  I thought I’d need more special monitoring that would limit my movement and ability to shower.  But I didn’t.  I had the right kind of labor (fast) but not the right preparation or mindset.  How do you endure the pain that brings you your baby when you’d rather keep her inside?  When each contraction takes you closer to the moment when you know whether your baby is going to live or die?  I also thought I might want to be as calm as possible during birth, so that I can enjoy it and be as rested as possible for my baby and whatever time I had with her.

 

I got an epidural.  The attending placed it for me and told me I had great spaces in my spine and held my position well.  I thought he was fabulous- very quick to place and it worked within 1-2 contractions.  My first words were, “I don’t regret it.”  And once I was very comfortable, I turned to my midwife and said “we can wait til 39 weeks now, right?”  I said it in jest, but there was still truth behind that.  After the epidural, the baby had a quick drop in her heart rate, but came back up shortly after my midwife got up to check me.  So she sat back down and a minute later the heart rate did it again.  This baby made her get up out of her chair twice, so she decided it was time to check.  I was fully dilated and +2 station (the head was low in the pelvis).  Many people would start to push at this point.  We all decided that we should rest and labor down a bit (let the head come down on it’s own without actively pushing).  I was thrilled when she spoke of laboring down- I could rest and try to prepare for what was about to happen.

 

I marveled at how fast I went.  I don’t recall the actual times, but at about 11:30p I was 4cm, at 1:30am I was 5-6cm, at 3:00am before my epidural I was 6cm and at 4:30 just after my epidural I was 10cm.  I basically transitioned (the hardest part of labor) while I was sitting for the epidural.  I felt rather validated by this- at least I got the epidural at the last possible moment.  Had the circumstances been different, maybe I wouldn’t have gotten an epidural.  I might have asked for one, but I think my midwife would have talked me out of it, saying I was going fast.  Under different circumstances, I would have different motivation- I’d want to deliver the baby as soon as possible to meet her and hold her and have her.  But this labor, I still didn’t want to baby to come out.  She was safe inside of me.  When she came out, maybe she’d breathe, maybe she wouldn’t.

 

After my epidural I came back to myself.  I was literally in some different world- eyes closed, hearing little with my contractions.  I was a new person once the pain was gone.  We all settled down for a quick nap- I slept for about an hour.  At 5:30am, the nurse came to the adjust the monitor and we decided to empty my bladder- I hadn’t peed since I had been on the labor floor.  When she went to straight cath me, she could see the baby’s head.  At this point most women would be feeling lots of rectal pressure.  I felt nothing.  Once she said she could see the head and thus I knew how low the bay was, I started feeling a little pressure (kind of like she was pushing out a little), but still no rectal pressure. (the classic sign its time to push).  So my nurse and I had a nice chat about whether we should call my midwife and let her know- I didn’t want to call until I really really had to push.  We also talked about change of shift and if I preferred to have the Newborn team who was well familiar with our case but potentially up all night versus the day team who wouldn’t be as familiar, but better rested?  Ultimately we decided to call my midwife and the night Newborn team would be best.  It’s funny, I had this conversation with the nurse, as if I actually had control over either of these things.  My midwife had already warned my nurse that I wouldn’t tell her when I was ready to push.  She knew how desparately I wanted to keep that baby inside of me, so the nurse was going to call her regardless of whether I felt the urge to push or not.  And the baby’s head was so low there was no way I could have kept her in until after change of shift.

 

My midwife came in and sure enough the head was right there, ready to come.  She wanted to transfer me to the delivery room right then.  Typically it can take hours for a first time mom with an epidural to push out a baby.  And so in the event someone needs to birth the baby in the special delivery room (like me), she would push in the normal labor room until the very end and then be transferred down the hall for delivery.  My baby was so close, my midwife didn’t want me pushing at all until we were in the delivery room and everyone was in place.

The special delivery room was also an operating room, so Chris had to get all dressed up to come with me.

The special delivery room was also an operating room, so Chris had to get all dressed up to come with me.

I pushed three contractions- 12 minutes.  The fist two I was concentrated, wondering if I was doing it right (epidural can take that awareness away).  On the third, I knew she was crowning and about to come- then I broke down.  I sobbed as she was born, not from pain but from fear and wonder.  Chris was supposed to announced the gender, but the moment I saw her face I knew she was a girl- and I said so.  Which was good because Chris could barely see what was what in all the birth jumble.  The Newborn team had said we could do skin to skin immediately as long as she was crying and we didn’t cut the cord (brand-new protocol on our floor for preterm babies).  So my midwife placed her wet warm body on my belly, so I could grab her.  I held against me and rubbed her feet, trying to get her to cry.  She was quiet at first and so my midwife went to clamp the cord and give Chris the scissors to cut.  Immediately upon placing the first clamp, my baby let out her first cry!  So my midwife quickly unclamped the cord and gave us a precious moment together. I looked at her and she wasn’t funny looking.  I was worried with all the complications she would look different.  But she looked like a baby- a cute, vernix covered, everyday baby.

I cried as I pulled her up onto my belly.  This was what all my waiting, worrying and hoping was for.

I cried as I pulled her up onto my belly. This was what all my waiting, worrying and hoping was for.

My first look at my daughter.  Look at those cheeks :)

My first look at my daughter. Look at those cheeks!

My daughter was shortly whisked away to the Newborn resuscitation room.  Chris followed along with another nurse who graciously took photos of my birth and of my daughter’s first moments with the Newborn team.  In the meantime, I pushed out my placenta- all on my own, because the cord popped off (rare complication of placenta delivery that of course would happen to a midwife, but crisis averted because I could push it out on my own).  I then got a few stitches and was wheeled back to my labor room to await news of how my baby was doing.