Breast-feeding in NICUland
September 15, 2010

NICUland is staffed by some of the warmest, smartest people I’ve ever met. Those NICU nurses fight constantly against death and sickness, and still manage to find various ways for parents to be involved and vital in their child’s care. But, in any hospital department, policies and realities can make individual experiences difficult.
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Teagan was born at 9:14 a.m. At 1:52 p.m., I finally got to hold her and nurse her. She was listless about breast-feeding; she nibbled and licked for a while before she latched on. She stayed on for a few minutes, then fell asleep. The nurse assured me that she was getting everything she needed through her IV line, so there was no need to fuss about my milk coming in.

Down in my room, they brought in The Pump. There were several of these Pumps floating around the NICU for lactating mothers, so that they could pump and spend time with their baby. They even gave you free accessory kits, with the tubes and shields and whatnot, in addition to unlimited sterile bottles to express into. Despite the helpfulness and the fact that I had pumped for ten months with Noah, I found the whole array foreign and intimidating. I had dreamed for months (years?) of this blissful skin-to-skin breast-feeding heaven after her birth, where she’d latch on right after my awesome unmedicated VBAC, room in with me, and snuggle in my arms for days. Instead, I had The Pump, which, on its stainless steel rig, looked like it belonged aboard the Nebuchadnezzar in The Matrix. The top of it looked like the sleep-medicine machine from Inception. It had WHEELS, for crying out loud. Instead of my soft baby in my arms whenever I wanted, I got to hook up to the thing with wheels that the nurse wiped down with sterile wipes beforehand. Yay. (side note: I’m grateful for the breast pump as a tool–and it is a fantastic tool, especially in the NICU, but also for working and studying mothers.)

The second time we went up to see Teagan, the nurse laid down the law. We were allowed to sit with her as much as we liked, as long as we liked, but she was only supposed to nurse every three hours, and only for thirty minutes at a time. I’ve never had a baby not room in with me and I’ve certainly never breast-fed on a schedule (mostly because I’m too disorganized to put *myself* on a schedule) so I was a little taken aback. What if she got hungry in between feeding times? If I was holding her and she started rooting, was I supposed to ignore it? And with such an iffy latch, was I really supposed to pull her off if she was having a great nursing session? Everything about it was antithetical to my mothering instincts. But the nurse was firm: sick babies can’t nurse too much. It wastes their energy. Plus, they’re getting everything they need from the IV. Nursing is really more of a recreational sport at this point.

On the way down to our room, Josh shook his head. “You’d think sick babies would need their mommies more, not less.”

Why didn’t I fight this? After fighting off a c-section for 17 hours, you’d think this would be cake. But I don’t know. I was exhausted from the long labor and no sleep, emotionally numb from my failed VBAC and Teagan’s NICU admission, not to mention fogged out on drugs for pain. My gumption was gone. My energy to advocate was sapped. I just wanted everything to be easy and conflict-free.

Nursing was further derailed by the night nurse. Josh rolled me up to breast-feed, and Teagan was alone in her little booth (this was normal–since she wasn’t all that sick, her nurse usually had one or two other low-priority babies.) Josh, wanting to hold his less-than-a-day-old daughter, scooped her up from the warmer. One of the leads pulled loose. The night nurse, hearing the alarm, came in and literally TOOK TEAGAN OUT OF JOSH’S ARMS, snapping, “You can’t pick her up unless I am here!” With all the noise and jostling, Teagan started crying. The nurse gave Josh a disgusted look. “See? She’s crying now.” That nurse watched us like a hawk. If thirty minutes had passed, even if twenty-seven of those minutes was trying to coax a latch and only three were actual breast-feeding, she took Teagan away and put her back in the warmer.

It was true that it helped to have a nurse around when I tried to breast-feed. All the other nurses were much more lenient and compassionate about us handling Teagan (as in, we were allowed to.) But only the nurses seemed comfortable maneuvering her with the IVs and PIC lines and endless leads. Breast-feeding a newborn is hard enough, trying to find all the right places to support their heads and bodies and your own breasts. Juggling all this while trying not to strain or pull the lines was frustrating. It was easiest when I could sit with my Boppy and have someone hand her to me. One day, I went to hand her back to the nurse and saw blood all over her legs. The PIC line itself snapped, leaving blood to trickle out the ruptured tube.

By the second day, her latch wasn’t improving (although a wandering LC managed to get her on. Murphy’s Law of breast-feeding help: whenever an Lactation Consultant is there, they can get the baby to latch on fine. As soon as they leave, it all goes to pot again.) People started pestering me about my milk coming in. It was a good four or five days with Noah, so I knew it would be a while with Teagan. I also knew that colostrum was plenty for tiny babies. But it became a subject of concern and pity when people would ask and find out that I still didn’t have mature milk in. Still! And it’s day three already! Gasp!

It didn’t help that I wasn’t pumping anything. Even the NASA grade Inception-Matrix-Medela contraption couldn’t coax any colostrum out, which started getting discouraging. I might get one viscous little dribble, which by the time it worked its way down the shield, through the flange and down the side of the bottle, wasn’t even enough to suck up in a syringe. I hated the obligation of pumping, the necessity of stimulating my supply because my baby wasn’t nursing enough because of their stupid schedule. By the time I went up to nurse Teags, got back down, double-pumped for twenty minutes, I had about an hour to sleep before I did it all over again.

Also on the second day, the nurse practitioner raised the possibility that Teagan might be able to go home the following day or, at least, move into the step-down nursery. But in order to do that, she had to keep her temperature without her warmer and produce so many grams of wet diaper without being hooked up to the IV fluids. We had a choice at that point: supplement with formula on the chance that she might be able to leave the NICU and come home with us sooner, thus freeing us from the restraints on nursing and cuddling OR we could leave her hooked up to the line and delay homecoming. We chose formula supplementation. This is something I go back and forth on in retrospect. I wish I would have talked with the neonatologist and maybe a lactation consultant before we agreed, just to make sure that those really were our only two options. At the time, the prospect of bringing her home put stars in our eyes. It was all we saw.

Cups and syringes weren’t allowed feeding methods in the NICU, and I didn’t think to ask about finger feeding, so it was going to have to be the bottle. Teagan’s first bottle experience wasn’t pretty. She turned her head away from the rubber nipple over and over again, making this disgusted face. The nurse grasped her by the neck in one hand and used the other to force the nipple into her mouth. Teagan gagged and sputtered, formula running down her cheeks and chin, fussing and squirming to get away. The nurse just adjusted her grip on Teagan’s neck. “Sometimes they just need to get a taste of it to learn it’s yummy food,” she told us cheerfully.

Unkind words ran through my mind.

After that, I tried to be the one to give her the bottle as much as possible (although, if I liked the nurse on duty, I’d let them do it so I could pump while I watched and potentially get more time to sleep.) There’s no reason that bottle-feeding can’t be a gentle and loving activity, and how much longer would it really take to allow a baby to “latch” onto the bottle themselves and drink at their own pace? Even when Teagan would turn her head away and cry when the bottle was put in her mouth–clearly done eating for the time–some nurses would force her to finish the full two ounces of formula. Why couldn’t they just let her eat to hunger? More things I wish I would have challenged… And, after a full day of bottle-feeding, nipple preference set in.

Hard.

Teagan only had to feel my nipple touch her lips to start shying away. This dead look of existential despair would appear on her face and she’d press her lips shut, as if waiting to die. Death would be better than have that awful fleshy thing that was so much *work* in her mouth. Even the LCs couldn’t work their magic. But as soon as she got that bottle, she’d chug the whole thing in no time. (Also, by this time, it was clear that she was staying the full week, so I didn’t think I had the option of banning the bottle altogether.)

At least my milk came in (four and a half days postpartum), so we could supplement with MamaJuice, but I didn’t want to be doomed to be an exclusive pumper. I wanted to breast-feed her normally! Early on, with her iffy latch, I’d been thinking about a nipple shield to help get her on the breat more. The LC who’d been working with me had been holding back on the shield, treating it like it was a freaking missile code or something. But the other LC gave me one straight away. And guess what? After shooting a little syringe of expressed milk on the silicone, Teagan was able to latch on long enough to get a let-down. With my newly minted supply, the let-down was a like a beer bong. Her eyes widened in surprise, but then she hunkered her body closer to mine, furrowed her brows and got to work.

The syringe of milk onto the nipple shield was Nurse Awesome’s idea. Just like Molly the LC was the reason I kept breast-feeding Noah, L the Awesome Nurse was the reason Teagan and I could shed so much NICU baggage. She was the first nurse to actually read the doctor’s orders regarding Teagan’s feeding. I was putting Teagan back in her warmer and telling L that I’d be back in three hours, when she bit her lip and started rifling through papers. “Dr. S wrote on here that you could breast-feed ad lib,” she said. I stared at her. She explained, “That means you can feed her whenever you want, as often as you want.”

Oh.

“And,” she continued, looking through the nurses’ notes, “I can see that you’ve been able to pump several ounces after each feeding? There’s no need to keep supplementing. Even if you weren’t pumping a lot, I’d still say let’s stop supplementing and see how her wet diapers are now that your milk is in.”

She peeked in the trash and shook her head at all the used bottles of expressed milk and formula. In the NICU, they had two kinds of nipples that were both technically newborn nipples, but were from different manufacturers. L always gives her breast babies the one with a single small hole, so that they have to work at the nipple like they do at the breast. The other nurses had been giving Teagan the other nipple–one with two larger holes. “The milk just pours out of those nipples,” L said. “No wonder she got nipple confusion.”

L was only Teagan’s nurse for twelve hours. In those twelve hours I got Teagan back on the breast, stopped supplementing and discovered the cause of her intense nipple confusion. Another bonus? After five days of scheduled feedings and aggressive formula supplementation, Teagan weighed one ounce under birth weight. After twelve hours of unrestricted, on-demand breast-feeding with no supplementation? She had gained four ounces. The nurse on the shift after L’s couldn’t believe it. He weighed Teagan three times to make sure the scale wasn’t malfunctioning.

Things were much better after that. It took about a week after we got home to wean off the nipple shield, but we took it slowly, and I let Teagan dictate the pace. I did get some plugged ducts and mastitis, probably because of the shield use in addition to my tendency toward oversupply, but we got over that too. She wisely rejected a pacifier, and decided that first week home would be all about building my supply. I sat in my glider for hours at a time. We had bottles and bottles of milk pumped in the NICU–Josh would have to cup feed her expressed milk just so I could take a shower. She ate constantly.

And here we are, two months later, no worse for the wear. Even though everything is fine now, looking back, there are a few things that I wish I would have done differently.

1) Most importantly, I wish I would have asked more questions about the mandated schedule. I knew Teagan wasn’t very sick, and I also knew that it was my right as a parent to question anything that felt wrong to me. It turns out that I could have breast-fed on demand her entire NICU stay, and those five days of scheduled feedings and headaches are days I’ll never get back. That she’ll never get back.

2) I wish I would have made sure there was no other options than formula or more NICU time (she ended up having to stay longer anyway…bad gamble on our part.) I also wish I would have remembered to ask about finger-feeding. I would have been willing to take the time to do it, and it might have prevented the nipple confusion and thus the shield and thus the mastitis later on.

3) I wish I would have spoken up about some of the more aggressive bottle-feedings. One nurse tried to get Teagan to eat four ounces in a setting so that she’d go FOUR hours in between feedings instead of three. I was so unhappy about it–why didn’t I speak up?

Teagan was only in the NICU for a week. I can’t imagine all those brave mamas who struggle through all the necessary and unnecessary concessions to NICUland for weeks or even months to continue nursing. Of course, we all know it’s more than worth it; breastmilk is even more vital to vulnerable preemies. But sometimes that fact is cold comfort when you’re pumping alone at three in the morning, staring blearily at your baby in her web of leads and tubes. All nursing mothers should be celebrated, but NICU mothers deserve something more. Praise. Limitless admiration. A nap, perhaps.

Life in NICUland, Part 1
September 3, 2010

Imagine you woke up one morning unable to breathe. And you looked over across the room, and there were your lungs, sitting in a plastic box. You’d panic, of course, because how are you supposed to breathe without your lungs? And how are your lungs going to function without your body and blood? Now imagine that when you went over to the box, someone stepped in between you and the box and told you that you couldn’t have them right now, that your lungs were sick. But they’re my lungs, they belong with me, you’d want to say.

“Well,” the person would reply. “You can have your lungs back. But only for thirty minutes every three hours.”

Can I preface this by saying that the NICU is an incredible place staffed by incredible people? That the compassion and wisdom of the staff, from the neonatologists to the nursing assistants, still astounds me, even in my memory? And can I also say that I think NICU parents are allowed to have more than one emotion about their experience? Teagan’s stay was short and pretty uneventful, but the bundles of joy, hurt, loneliness, regret and longing are heaped in piles higher than I can see.

They wheeled me up to see Teagan over three hours after she was born. Nothing had hurt more than seeing her rolled away in the isolette after only one caress of her cheek. Nothing hurt more, except maybe having to give her back after we were finally reunited. I missed her first few hours, her first meeting with her grandparents, her daddy and her brother. That still makes my eyes sting–I missed the moment when Josh held Noah up to see her and he said her name. And now, when I finally got to hold her and try to nurse, after a few minutes of her apathetically nibbling and licking (Josh said in the hour right after birth, she was like a little bird, mouth open and searching for mama), now I had to give her back. The nurse tucked her back in her plastic box, and I went downstairs again.

The second visit was the hardest. Because this time, she latched on and nursed like a pro. This time, I was less groggy from drugs. This time, I unwrapped her from her never ending swaddle and explored all of her silky, tiny body. She was so little in my arms, with these sad wrinkles on her legs and arms. She had perfect lips, like a rosebud, and eyes a dark, dark blue.

Only the parents were allowed to hold her, and I was glad. I wanted to be selfish with her and hold her forever.

Friends and family started piling in to see us and her. I already had my parents and a friend in the booth with me, then several more people arrived at my postpartum room down stairs. The nurse came in and murmured noises about checking Teagan. I knew I had to leave, but as soon as I eased her into the nurse’s arms, I started sobbing. Not crying, where tears sort of leak out, but the sobbing where you can’t breathe (and yes, you make those awful sounds) and there’s snot and did I mention the sounds?

I felt like I was being cut open again, like my baby was being stolen from me, and that her being packed away in the box was the most unnatural and depraved thing that the universe could inflict.

Then my mom said to the nurse, “She’s just emotional, you know, being hormonal.”

I could have spit, I was so mad. Here I was, completely undone (and I don’t get emotional very often…the last time I cried in front of an audience was in 2006 at Krista’s funeral), and my own mother was dismissing my very real pain. I kept crying as Josh wheeled me back down to our room, where the visitors were waiting, and it was all I could do to keep those sounds at bay while everyone talked. I just wanted to hold her again, press my lips to her chest in thanks, thanks, thanks that she was alive and breathing through those little rosebud lips.

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.

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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.”

2007
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.
Tristan.
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.

2010

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.