Archive for August, 2010

Tristan, Teagan and the rest
August 29, 2010

I wrote this as an essay for my non-fiction creative writing class last semester, and I thought I’d post here, since it clarifies some of the things obliquely referenced in Teagan’s birth story.


I imagine God in the ceiling.  Sometimes on the roof.  I look up when I pray my helpless, hapless prayers and imagine an infinitely small, infinitely bright point of light and the smell of fresh, wet leaves and the sound of rain.  At my confirmation–the taste of boxed wine bitter in my mouth–and at my wedding, I remember looking up at the ceiling right before the priest said his final words, grasping for that final puzzle piece of divine assurance before I took the plunge.

God was not in the ceiling September 23, 2008.  I scanned the ceiling tiles in the operating room over and over again, trying to ignore the quiet bustle of the surgical nurses preparing the tools, the occasional comments from the anesthesiologist–okay, this will feel like cold water on your back…now you may feel like you can’t breathe, that’s normal.

My doctor arrived, there was a lot of pricking and poking to make sure I was numb from the chest down, and then my husband crept in.  My blood pressure dropped from the increased anesthesia and I started shaking violently, tears running out of the corners of my eyes.  I was shivering.  The lights were blinding.  My husband was almost unrecognizable from all the surgical garb.

“Time to meet your baby,” the doctor said.  A nurse gave me a smile through her mask.

More cold feeling on your back, the anesthesiologist said.

Intense pressure.  Pressure so great that I thought the table would crack underneath me and the floor under that, and I’d go plunging into the basement.  I stared up at the empty ceiling, waiting for hope, waiting for strength, waiting for any other feeling than cold and pressure.

There was a strangled cry and my son was hoisted over the curtain for me to see.
I thought my lips would go blue from cold.

The year my son was born, 32% of American women gave birth via cesarean section.

A year and a half later, I’m sitting across a desk from a wide-eyed woman with dark hair. Next to me is another wide-eyed woman. I’ve hired them to be my doulas–labor assistants–for my next birth. They have soft voices and long eyelashes, like Victorian paintings. They have soft names too: J***. E*********.

“We’ll do everything we can to help you have a natural birth,” J***says. When she’s not doula-ing, she’s a chiropractor and an acupuncturist.  She got her pre-med degree from a small Mormon university in Iowa. When she listens, she stares at me with this intense look, hands clasped together on the desk, like a priest.

“I’m just worried it won’t happen.  That something will go wrong like last time.”  This is only a partial confession.  The rest feels too stupid and embarrassing to say out loud.  That I’m worried that since my mother had a c-section with me, then I’m doomed to have all my babies the same way.  Or that I secretly believe that my body is a Murphy’s Law of all things that can go wrong with a gravid vessel.  Or that I’m also worried that the hospital and my midwife and the nurses and my insurance will all come together in some giant conspiracy to force me back onto the operating table and into another four-week Darvocet-riddled hell of recovery.
E********, who could have been a Maxfield Parrish painting, picks up on this last worry.  “We won’t let the hospital or the doctors force you into anything.  We’ll stand up for you.”
They list the things they can do for me–acupressure, aromatherapy, massage, visualization, position changes.  They’ll stall for me when nurses want me to do something I don’t want to do, feed me a secret supply of Powerade and granola, they’ll make sure that every procedure is explained in careful detail so I can accept or decline in a position of informed consent.
The things that a husband or a sister or a mother might do for a woman, except my sister lives in Virginia, my mother is bipolar and dying of cancer, and my husband–a police officer who routinely photographs corpses and attends autopsies–grows faint at the sight of needles and blood and at the idea of his child being extruded into our world.
“Remember that sixty to eighty percent of women trying for a vaginal birth after a cesarean get one,” J*** says.  “And since only sixty seven percent of women overall achieve a normal birth, I’d say those are good, good odds.”
I leave the meeting quietly positive.

In the 1970’s, boosted by improved surgical techniques and effective, available antibiotics, the cesarean rate began to rise.  More doctors chose cesareans over using a forceps when birth got tricky.  The new continuous fetal monitoring systems–monitors which gave a constant, live read out of the baby’s heartbeat–led to more surgeries since the data was, and still is, vastly open to interpretation.  And when something’s open to interpretation in obstetrics, that means liability, which means a cesarean.

The c-section rate rose from about 5% in 1970 to 25% by the end of the 1980’s.  Alarmed, public health officials called for a decline in the number of c-sections.  Doctors listened and allowed women with the so-called bikini cuts–incisions made from side to side, rather than up and down–to attempt a trial of labor for their next pregnancy, rather than scheduling a repeat c-section.  By and large, they found that it was safe, and the national c-section rate began to dip.

Unfortunately, the careful attitude of the first generation of VBAC (Vaginal Birth After Cesarean) doctors had grown lax.  By the mid-nineties, obstetricians treated VBACing women the same as their other clients, and started inducing them with prostaglandins (medications that ripen the cervix) and augmenting them with Pitocin (a synthetic and stronger version of the hormone oxytocin.)  Consequently, the rate of uterine ruptures, where the uterus tears along the old c-section scar causing hemorrhage and the possibility of fetal demise, began to rise.
Something like controlled medical panic ensued, and rather than stop administering prostaglandins and Pitocin to women attempting a VBAC, the doctors and hospitals began to back off VBACs altogether.  Which brings us to today, when ninety-two percent of women who’ve had a c-section have repeat c-sections and only eight percent will deliver their next child vaginally.

My midwife is a Certified Nurse-Midwife, which basically means that she’s a nurse with a Master’s in midwifery and that she has an office and delivers in a hospital, just like an obstetrician. She is blond, and she hugs me at the end of every prenatal visit.

Right now, I’m trying not to cry.

She scooches closer to me on her stool. “Your operative report says that your previous cesarean was for ‘failure to progress.’ I’ll be honest with you. Women who try for a VBAC who’ve failed to progress in past labors…they don’t have the best odds. Only about sixty percent.”

“Which means a forty percent chance of having a c-section?” I ask.

“Yes.” She leans forward. “I want you to know that if you decide to schedule a repeat c-section, I’ll still provide all your prenatal care and I’ll be right there with you in the operating room.”

I think back to the cold, the shaking, the empty ceiling.

“But…” I hate being in conflict with authority figures. This dates back to my years at Catholic school. “Isn’t a forty percent chance of a c-section better than a one hundred percent chance? And just because I have less of a chance of succeeding, the rupture rate won’t change, right? It will still be just as safe?”

“Well, yes, it’s still as safe. But I have to tell you that my supervising obstetricians want to make sure that I’m only taking the best VBAC candidates. And, realistically speaking, you’re a poor candidate.”

The 2004 Landon Study was the largest study done on contemporary VBACing women.  It included women being induced or augmented with prostaglandins and Pitocin, and it showed a 0.7% risk of uterine rupture.  Of the 0.7% women who ruptured, about ten percent of those babies died or suffered brain damage.  Put another way, a woman attempting a VBAC has a 99.93% chance of delivering a healthy baby.

My mother calls my step-father’s ex-girlfriend from the ’70’s. Yes, this is strange, but Cee is an old friend. She’s also been a midwife for decades, a midwife of the herbal tea and homebirth order, and has personally delivered countless VBAC babies in beds, bathtubs and on living room floors with no adverse outcomes.

“Is her midwife right?” Mom asks. “About this poor candidate business?”

Cee snorts. At least, my mother tells me she snorted. “All a failure to progress diagnosis means is that a doctor failed to wait.”

My last labor gives women like Cee nightmares. My water broke, I checked into the hospital, was immediately told my contractions weren’t strong enough, and was summarily hooked up to Pitocin. They had me lay in bed for fourteen hours–I got the epidural after the first eight–cranking the stuff up to try to get me to dilate. In all fairness, the doctor waited plenty. But my son’s head was cocked sideways, and while this wouldn’t be a big deal for a client of Cee’s who would be up and moving and swaying, in the hospital, trapped motionless in the bed, the kid couldn’t find his way out.

Mom asks, “Have you ever delivered a woman who had her c-section for failure to progress?”

“Absolutely,” Cee declares. “The truth is that women need to be upright and moving and left alone during labor.” She pauses. “The other truth is that they were never planning on giving your daughter a vaginal birth. The first excuse they can find, and this ‘poor candidate’ thing is just the first in a long line, they will use to force her into a c-section. I know that hospital and I know those supervising obstetricians…they’ve written her off as a c-section from the very beginning.”

The average vaginal delivery can take anywhere from six to twenty-four hours of labor.  A c-section takes less than sixty minutes.  The physician’s fee for a vaginal delivery is about $1500.  The fee for a cesarean is about $600 more.  If something tragic happens to mom or baby during labor/delivery, a physician is much more likely to be sued for a cesarean that he didn’t do rather than than an a unnecessary one.  Fear of liability was the number one reason cited for performing a c-section in a recent anonymous survey done within the ranks of the American  Congress of Obstetricians and Gynecologists.

My midwife consents to attend my trial of labor on the condition that I meet with one of her supervising obstetricians and discuss my poor candidate status with him.

My husband offers to go with. “This sounds like it will be a cesarean high-pressure sales meeting.”

It is. The first thing Dr. M does after looking at my chart is roll his eyes.

Red flushes up my husband’s neck, turns the tips of his ears the color of blood.

“So you’re here to talk about a VBAC?”

I affirm that yes, this is the case.

“The first thing I want you to know is that there are huge benefits to having a second c-section. If you never give birth vaginally–and a vaginal birth is a traumatic, traumatic thing, I can tell you–then your pelvic floor will stay perfectly preserved.” He winks at my husband in a see, buddy, I’m looking out for you way that makes my husband’s ears practically glow radioactive orange.

“The second thing I’ll say is that the rate of your uterus rupturing is about one percent. That doesn’t sound like a lot, but if you got on a plane today with ninety-nine other people, and one of those people is a terrorist, well, you wouldn’t like those odds, would you? Plus, pretty much every baby whose mom suffers a ruptured uterus dies.” He shakes his head sadly; the light catches the bald spot below the clusters of hair gel.

My husband clears his throat. “We read a survey that showed much lower numbers, risk wise.”

Dr. M bristles at this. “You know, I sit on the board at this hospital, and I can assure you, the risks are much higher than the studies show.”

“What about the risks of a repeat c-section?” I ask. I’m thinking of higher NICU admission rates for c-section babies, higher rates of respiratory distress, correlating high risks of asthma and autoimmune disorders. The fact that last year, the CDC released a report saying that c-sections, performed for any reason, carried a three-fold increase in mortality for newborns.

He waves a hand. “Just your standard surgical complications. And those are all for the mothers–a small chance of hemorrhage, blood clots, infection, hysterectomy.” He makes a face that might be concessionary. “There is a higher chance that you will die.”

He counters himself quickly. “But then you have to ask yourself, are you the kind of woman who would rather die or rather have her baby die?”

After years of calmly taking abuse at the hands of pissed civilians, my husband is clearly having trouble not throttling this man.

I try again. “But I thought I heard that c-section babies are at more risk ultimately too, like with breathing–”

He cuts me off. “They have trouble breathing because they have a little extra fluid in their lungs. What would you rather have, a little fluid or a dead baby?”

My husband stands up. “We have to go,” he tells Dr. M. “All we need to know is if you’re going to let us try this or not.”

Dr. M is surprised. I don’t think he has many patients reject his dead baby speech. “Nothing about you is technically contraindicated for a VBAC,” he says slowly. “It’s just that, if it were me, I’d choose the c-section.”

If it were you? But that’s the point, isn’t it? That it’s never going to be you. You’re never going to have to hobble around the house, in more pain than the narcotics can kill, trying to cook dinner because your husband had to go back to work. You’re never going to have to try and breast-feed after a c-section, when any pressure on your stomach makes you cry and all the Pitocin and bodily trauma have delayed your milk coming in. And you’re never going to have to bite down guilt every time a new study comes out showing increased allergies or asthma or autism or whatever with c-section babies–knowing that because your body failed to do what mammals have done for millions of years, you put your precious baby at risk.  Of course, I say none of this. Authority issues, remember? I slide off the patient table, ready to leave.

“Let me ask you this,” Dr. M says. “Why is this so important to you?”

I glance up at the ceiling. “Lots of reasons.”

My husband and I were married for two years when I found out I was pregnant again.  The year before, in 2006, we’d gotten accidentally pregnant and then miscarried a few weeks later.  This time, we were (a little) older, more ready, more excited.  We knew we wanted to start a family right away, before my narcolepsy got worse.
We bought little clothes and shoes, and, after we made it past those perilous initial twelve weeks, we picked a name.  Tristan if it was a boy.  Teagan if it was a girl.
Then, at sixteen weeks, there was something wrong on the ultrasound.  I still don’t understand what.  A nurse called from my doctor’s office: they scheduled me to see a perinatologist during the next week.
I cried all weekend.
That Monday morning, I laid down on the table at the perinatologist’s office for the ultrasound.  He pressed the transducer against my stomach and swept it back and forth, sometimes digging it deeper into my skin, frowning, frowning.  I could see the outline of the baby on the screen.  What was he frowning about?
“You see this?” he asked, tapping the screen.  “That’s where the baby’s heartbeat should be.  There’s nothing.”
“What do you mean?” I whispered.
He looks genuinely remorseful, which I was grateful for, since he didn’t know me.  “There’s no heartbeat.  Do you see how tightly the baby’s body is curled in on itself?  That means your baby has died.  Probably been dead for two or three days now.”

I have never wanted to be out of my own skin, disavow myself from every physical cellular atom of myself, so badly.  How could my own baby die, and be dead (curled up, a husk) in my body for days and I didn’t know it?

When you’re in your second trimester, dead babies present complications outside the realm of normal obstetrics, so I was sent off to the abortion clinic.  My husband clutched my hand as we were walked through consent forms and processes geared for someone ending their pregnancy deliberately.
Let me say this: I have always voted pro-choice.  Because I believe that whatever my own inclinations are, everybody should have the right to decide for themselves.  But at that moment, when the confused nurse congratulated me on choosing the right thing, that the abortion stigma was a thing of the past, assuming I was there to stop Teagan or Tristan’s heart from beating–at that moment, I wished with every ounce of my heart that that building would burn to the ground.
They made my husband leave, then had me lay back on the table.  Faded posters were tacked to the ceiling, all of the inspirational classroom kind.  Kittens hung from clotheslines, a mountain climber was perched on some remote crag, a cluster of hot air balloons rose among the clouds.
The doctor pulled a faded sheet off a machine in the corner.  I asked what it was, but she had already turned it on.  It was so loud that no one could be heard over it.  She motioned for me to place my feet in the stirrups.

The machine connected to something she inserted inside of me.  There was pain and a sudden lightness in my head and pain and I threw up.  The nurse patted my hair.

The doctor turned off the machine.  “I just broke your water,” she said, then showed me several white tubes.  “This is something called laminaria.  It’s sterile seaweed.  It will dilate your cervix completely overnight, then tomorrow morning we’ll get this thing out of you.”
This thing.  My baby.  After the laminaria was inserted, they had me sit up.  I fainted for the first and last time so far in my life.

No one told me it would hurt, having your cervix forcibly dilated by seaweed, but it did.  All night long, I paced and moaned and rocked on my heels like a woman in labor, forbidden from even ibuprofen because they wanted me to have an empty stomach for the anesthesia.  At six the next morning, we checked into the hospital.

And for the first time in my life, I laid down on an operating table and a stranger pulled my baby out of my body.  I can’t remember if the ceiling was empty or not, since they knocked me out as soon as I laid down, but I do remember the cold.  And a feeling of blank detachment when the doctor told us in recovery that it had been a little boy.
One year later, I laid down on another table.  Noah was pulled out, alive, full-term, healthy.  But once again, I was a passive carrier.  An inert host with a body too broken to birth.


The windows are open and it’s raining.  I just got off the phone with my mother, diagnosed last month with Stage IV breast cancer.  She wanted to know how the meeting with Dr. M went.  Somehow, talking about how I don’t want a medicalized birth and then having her compare it to how she doesn’t want a medicalized death is too much.  I tell her I love her, then hang up.

There is a story about the prophet Elijah, that when told to wait for the coming of God, he was faced with a great wind and an earthquake and a roaring fire.  But none of those incredible things were the presence of God.  Instead, it was a still, small voice in the aftermath.

I think about the fights fought and the fights left to fight.  That God hovers outside of the c-sections and stillbirths and cancers, and instead whispers to us in summer rain and tall thick trees and breezes so warm you want to sleep outside.

Thunder threatens miles away, and the restless girl in my womb, Teagan, kicks and thumps.  No matter how she is born, no matter if her grandmother is alive to see it, no matter how many babies I’ve lost…at this moment, God is on my roof, painting the sky with wet leaves and the smell of far away wind and hope.