Wednesday, January 10, 2007

Chapter One: We are born.



OK, this may be the longest post in the history of blogging, and if it were going to be workshopped, I'd most certainly be accused of the cardinal sin of abject naturalism. Truman Capote might say of it what he said of Jack Kerouac: "That's not writing; that's typing." It's short on wit, long on detail, and probably rife with errors, but I really wanted to get it all down, in large part for my own future reference. If I had time, I'd have created an abbreviated version for the blog, but -- well, time is about as scarce as dry diapers 'round these parts. So, feel free to skim, ignore, etc.

I promise that the next post won't be so prolix!

* * *


By Wednesday the 27th I was just so damned ready to not be pregnant anymore. Not purely because of the discomfort, but because the waiting was getting to be awfully tedious. I was too big and uncomfortable to leave the house much and too distracted (and also uncomfortable) to get any productive writing done. It was beginning to feel to both A. and me like the girls had resolved to stay inside for as long as fetally possible.

And then, whaddya know. Just as I was getting into bed, at about 11:45 pm, my water broke. We'd just finished watching The Innocents with Deborah Kerr, (an adaptation of James's The Turn of the Screw). Nothing like a movie about creepy, possessed demon children and a possibly mad governess to induce labor, I guess. I'd had some mild contractions throughout the evening, but they were no different from what I'd been experiencing most evenings for a while, so I didn't let myself get too excited about them.

The sensation of the water breaking was unmistakable – a warm spreading gush. Rather nice, actually. I leapt (as best a woman with a belly the size of a prizewinning hog can leap) out of bed and ran to the bathroom, heroically sparing the sheets. We'd changed them a couple of days earlier, which seemed a good Murphy's Law kind of way to encourage my water to break.

After a bit of running around, packing things up, and—yes—a quick blog post, we were on our way to the hospital. I'm so glad it happened late at night, incidentally. For the same reason I love driving to the airport when it's still dark out: this feeling that you're in a slightly altered version of the world, where only a small, strange population is awake and exciting things are about to happen.

My contractions started coming on soon after the water breakage, growing stronger and more regular. Very manageable, though. (Hooray for ujayyi breathing!) When we got up to the labor/delivery floor, they johnnied me up and checked to make sure my water had really broken—a sophisticated diagnostic test consisting of seeing just how fully one soaks the paper on the exam table—then hooked me up to two fetal heart monitors and a contraction monitor. These would soon become the bane of my labor. I was also readied for an IV, but asked them not to actually hook me in until it was necessary; the fewer encumbrances the better. I guess I'm a fairly assertive person in general, but I was impressed with my own ability to draw lines and make my preferences clear. A. was also a great support in this respect.

And it's a good thing, because the on-call doctor was a freakin' idiot, with a skittish, nervously smiling bedside manner. He told me that it's "standard procedure" for twin mothers to get an epidural. I informed him that no, it wasn't; it was my choice. He smiled skittishly and nervously. Then we asked him if he was prepared to do a breech extraction for the second baby if necessary. He said he didn't do breech extractions. Needless to say, we didn't exactly feel like we were in expert hands here. My next question to the nurse, when the doc left, was what time his shift ended and someone new would be in. 7 am. Excellent. I wouldn't even be close to delivering then. I thought.

We were brought into a labor room with a gorgeous view of the Charles River (not that we had much time to enjoy it). A labor nurse came named Chrissie and helped us get settled, then I had to lie on the labor bed (grrrr) while she tried to get a good trace on both heartbeats. They'd been having trouble getting a good line on Elsa. Meanwhile my contractions were getting stronger and closer together, moving more prominently and painfully into my lower back, and I was itching to move around, sit on a birthing ball, assume wolf-woman primitive squatting poses and channel lunar energy and whatnot. But there I was, stuck on the bed as the heartbeats fluttered in and out of view. I had to do this a couple more times during the course of the labor – lie down and have them attempt to find the heartbeats and it was just terrible to be stuck in that bed.

Not that being off the bed was that much better. With three contraptions strapped to my belly, their tubing draped over my neck, and a Johnny that kept falling off (the person who designed that garment ought to be drawn and quartered) it was tough to maneuver. I began to understand why the people in natural childbirth books are always naked. I would have killed to be naked and unencumbered. My most oft repeated phrase for the next hour or two, I think, was (in reference to the tubing) "get these fucking things out of my way!" A. was a saint, patiently rubbing my back, helping me disentangle myself from the tubing, giving me ice chips, and even managing to make me laugh. What was strange to me then, and even moreso now in retrospect, is the fact that the nurse didn't stay with us and help me through the contractions or coach in any way. Which was OK, I guess; A. was on the job. But I sort of thought that was a big part of a labor and delivery nurse's job....

At some point in all this, the other on-call doc came by for a visit—the chief resident, a woman my age or younger—who told us she did do breech extractions, and explained the risks, etc. Explanation! Respect for my wishes! Thank you!!

But then, a visit from another dickhead doctor, the on-call anesthesiologist. I'll cut him a little bit of slack, noting that a language barrier might have been part of the problem. Maybe he didn't really mean to sound like such an ass when I asked him about having the epidural catheter inserted but waiting on meds and he kept saying, "Why would you do that? It doesn't make any sense. Why suffer if you don't have to?" Apparently he and the on-call OB read the same book on how to perpetuate stereotypes about doctors and modern, medicalized birthing. I actually snapped at him at one point. "No, you're not listening to me. This is why I want what I want…." That felt great. I was really enjoying being difficult. Don't fuck with a woman in labor.

I took a walk around the floor, stopping to grasp the handrail and have A. rub my back during contractions (now less than a minute apart, if that, and evilly focused in my lower back). Stupid-ass on-call doc smiled skittishly at me as I passed and said, "we do offer the epidural, you know." I all but flipped him the bird.

It took a bit of pride swallowing for me, therefore, for me to finally ask for the epidural at around 4:30 am, at 5 cm dilated. The pain was so intense in my back, and the contractions were coming so hard and fast (I was under the mistaken impression that the time between them would be longer than 20-30 seconds.) Oh yeah, and because no story of mine would be complete without vomit in it, I'm pleased to report that I also puked.

Thinking that I still had hours to go, I told A.: "I don't think I'm going to be able to do this without the epidural." I might have been able to go a little bit longer without, but worried I wouldn't be able to stay still for them to insert the line. As some of you may know, I had a very bad, extremely painful experience after a spinal tap a couple of years ago, when the doctor nicked a vein on the way in. I wasn't about to risk going through that again.

Listen to me rationalizing. Yes, I would have loved to do the whole thing without pain meds. But at the time, and in retrospect, it felt like the right decision. When the anesthesiologist came in (a resident, not the dickhead from earlier) I was so glad to see him I held out my hand for a shake and said, "It's great to meet you," which seemed to take him slightly by surprise. Staying still for the insertion was tough, but the meds acted blessedly fast. I could barely feel the contractions once the epidural took effect, and yet I could still move my legs fairly well (though I wasn't allowed to get out of bed). Really, I was quite comfortable. "We should have brought Scrabble," I said to A.

I even managed to get a bit of sleep. Then, all of a sudden the doctor and a couple of nurses were in the room, and I could tell they meant business. Elsa's heart rate was dropping, as was my blood pressure. They put a shot of something into my epidural or IV (Ephedrine?) and slapped an oxygen mask on me, and that seemed to help. (Pro: the oxygen mask smelled like a Pecan Sandie. Con: it ironically felt harder to breathe with the mask than without it.)

They also put an internal fetal monitor on Elsa's head so they could get a better and more consistent read on her heartbeat. Everything seemed to be OK, but for next hour I couldn't take my eyes off the monitor. Every once in a while, Elsa's heartbeat would go down down down, into the 70s or 80s, and I'd be seriously tempted to reach up and hit the Code Blue button. Then it would climb back up.

At the same time, with each contraction, I was starting to feel a stronger and stronger urge to push. I think I expected this to feel more…er…vaginal in nature. But really, it just felt like an urgent need to take a crap. The next time the nurse came in (new nurse, now; a feisty gal from Georgia named Penelope), I asked – thinking I must still have a few hours to go – if she had any tips for trying to stave off the pushing urge. Her answer: let's have the doctor take a look at you. (And by "look" she meant a couple of fingers in the cooter). The doctor—a new one, a young woman, very smart, friendly and direct—introduced herself, then promptly shook hands with my cervix. Lo and behold, I was fully dilated. It believe it was just before 8 am.

It would be grossly inaccurate to say that the pushing was fun. But there was something rather satisfying about it – this feeling that I was actively doing something, rather than letting my uterus do the work for me as it had been for the previous seven hours. For each push, I'd wait for a contraction, then hold my legs up, bent at the knees, curl forward, take a big breath and bear down like I never had before, making all kinds of strange noises and ridiculous faces, while the doctor and nurse urged me on and said things like "push right into your bum," and "all your strength, all into your rectum." I swear that at one point somebody's finger was in my butt. Who knew giving birth was such an ass-centric activity?

Despite my hard work, the pushing was not going well. Elsa wasn't making much downward progress, and each time I pushed, her heart rate would drop. Her cord was evidently wrapped around her neck or was otherwise getting compressed with each push, so I had to wait out every other contraction to give her some recovery time. We tried some different positions—me on one side, then the other. Still, she wasn't descending the way they wanted. The doctor finally said that if we didn't make any more progress in the next few minutes, we'd need to go into the OR and try some vacuum extraction. Or….menacing music…we may have to go to C-section.

Well, that did it. I don't know if was me or Elsa or both of us, but on the very next push we made us some serious progress, oh yessiree. I said to myself, I know I can do this. If I can hold a challenging yoga pose just a few seconds longer than I did the last time, if I can climb the highest mountain in Central America fighting altitude sickness and nearly blacking out every step of the way, if I can spend three years writing a novel only to have it rejected and then go ahead and write another one, if I can deal with depression and a major disease scare, if I can deal with my crazy family, if I can carry two babies around inside me for nine months while keeping all three of us healthy, then I can push these babies out of me myself.

(Ahem. That was the inspirational paragraph, if you didn't notice. The one where the John Williams soundtrack swells to a rousing, moving climax.)

So, the pushing progressed, while a steady stream of people in surgical scrubs started coming in and out of the room, introducing themselves: pediatric nurses, physicians, anesthesiologists, chefs, jugglers, God knows who, all of whom would be in the OR while I delivered. (It's hospital policy for twin and other high risk births to happen in the operating room.) There must have been at least a dozen people who came in and out, all very cheerfully introducing themselves between pushes. As if I would remember who any of them were, or recognize them once they were in their surgical gear. At one point I looked over at A. and gave him a "what the hell?" look. (He'd put on his scrubs now, and I must say, he looked pretty damned cute in 'em.)

Finally, I was wheeled into the OR by a wisecracking anesthesiologist who made fun of the nurse pushing the bed for nearly crashing me into the wall several times. I was moved onto the table in the operating room—again, I was pretty mobile, so I wasn't flopped around like a rolled up carpet, but was able to do the moving myself.

More pushing ensued, and things seemed to be progressing well, with the doctor and a resident cheering me on as I pushed through one contraction, then rested through one to give Elsa some time to recover, and so on. Again, I really think that at one point someone had their finger in my butt.

Then, A. said, "look who's here." My obstetrician, the fab Dr. Huang, had happened to be in the hospital to perform a GYN surgery that was cancelled, heard I was here, and quickly suited up to come deliver the babies. The on-call doc stepped out, and he took over. "Fairy tale ending" sounds rather silly where mass amounts of blood, amniotic fluid and grunting are involved, but it felt quite auspicious that he showed up.

Back to Miss Elsa: I could feel that head a comin' down the chute, and at one point got to reach down and feel it – it was soft and wet, like a baby chick. A., brave man, was down there helping to hold my left leg back while I pushed, and got a front row view of the head emerging. Everyone was saying "she's almost out! She's right there!" It was thrilling, especially to hear the excitement in A's voice.

But Elsa wouldn't quite get her little coconut out the door. My doctor asked me if I would be OK with a small (2nd degree) episiotomy. Hell, at that point, I would have let them amputate my left hand if that's what it would take to get the baby out. A quick snip—I didn't feel it at all—and Elsa's noggin emerged, face up.

The cord was wrapped around her neck, so they cut it immediately, and then the rest of her slipped out. (Amazing how small the rest of a baby seems once you've passed its big ole head through your vagina.) I only got a quick glimpse of her; she was quiet and quite pale, her eyes wide open. She was whisked away immediately for oxygen and Apgar-ing (she got a 5 to start, then an 8), then taken to the Transitional Care Unit for some extra TLC. I remember being slightly concerned, but not scared. I must have delivered the afterbirth at this point, though I have no memory of it.

Meanwhile, Clio was ready to roll, having cooperatively stayed head down. They broke my water with something resembling a crochet hook, which resulted in an impressive splash onto the OR floor. It didn't take long at all to push Miss Clio out, and I felt like an old pro at that point. She came out screaming and looking quite pissed. (Apgars: 8 and 9) While she was weighed and swaddled, the doc pushed on my belly to help deliver the afterbirth. When that was over, I took a look at my belly—it was so odd to see it so much smaller. There was an odd football-ish shaped mound in the middle that emerged when I tried to sit up a little. The resident said, "that's your little alien," – the result of the abdominal muscles having separated. Or something.

Clio was brought to me then, wrapped in a blanket, her face still wet with vernix. She looked surprisingly like her U/S pictures – a little turned up nose and round baby face (both courtesy of her Dad, methinks). I was awfully glad to see her, but I didn't cry. I didn’t really expect to. I'm weird like that – I cry in anticipation of and after momentous events, but rarely tear up in the actual moment. During my pregnancy I got blubbery every time I watched a video of a baby being born and put into its mother's arms, but I somehow knew that I probably wouldn't cry when it happened to me. It was all just so intense, so real – I was too close to it all to have any sense of emotional perspective or context of the sort that would cause me to cry. Or, maybe it was just the fact that I was so damned dehydrated. I'd never felt so thirsty in my life.

Clio and A. and I all went back to the labor room to chill for a little while, enjoy the view of the Charles River in the morning light. They took my vitals, we were brought some breakfast, and I took a first shot at breastfeeding Clio. It was amazing to see her instincts at work – opening her mouth wide, looking for the breast, sucking. (She didn't actually get a very good mouthful of boob, so it was more like she was giving me hickeys, but hey, it was a start.)

We were then moved down to our room on the post-partum floor. I won't go into detail about the next 48 hours, except to say this: it is absolutely EVIL that the hospital / insurance companies / the Man / whoever only let you stay 48 hours after a vaginal birth, even if it's twins. I had thought that the hospital stay would be a chance to rest and recover a little bit, but instead it was like a three ring circus – a nonstop succession of people in and out of the room: to check the girls' vital signs (their temps were tending to run low), to check my vital signs (my blood pressure was running high; I had elephant feet and a moon face), to have us fill out paperwork for birth certificates, to empty the trash, to bring food (which wasn't bad, but which was inevitably cold by the time I got around to eating it), to help us with breastfeeding/supplementing, to go over mandatory lists of "things I should know" about my recovery and the girls' first days at home, to show us how to bathe the girls. There was also a baby care class to take, and stress tests to run on the girls in their car seats because they were so small. Plus feedings every three hours, with a complicated catheter/syringe formula supplementation system, and even some milk pumping, so we'd be able to take the babies home with us. (The pediatrician said they might have to stay an extra day if they lost too much weight, but I'd be discharged, which meant we'd have to camp out in a room in the NICU and fend for ourselves re. food, etc.) Then there was the fact that every time I had to go to the bathroom, it was a 5-10 minute operation, involving a squirt bottle, gigantic mesh underwear, ice packs, and diaper-sized maxi pads. Ladies who've given birth will know what I'm talking about.

All this, plus visits from A's parents, my parents, and phone calls to and from friends, all of which were delightful and much appreciated. But Lordy, the whole hospital stay felt rather like running a small corporation. So, while more time to recover would have been nice, I guess in some ways it was actually a relief to come home.

As we left the hospital, a light snow was falling. Much oohing and ahhing over the twins in the hospital lobby while I waited for A. to get and warm up the car. The drive home was, indeed, a little harrowing. Every other driver on the road was a menace, an asshole, an idiot. Which is par for the course in Boston, naturally, but we felt it more keenly that day. A. decided we should get a "Baby on Board" sign, reasoning that whenever he sees one he tends to back off a little. I wasn't wild about the idea on principle, but on our next trip to Babies-R-Us we picked one up. It makes a nice counterpart to the "Anarchy" magnet.

The strangest thing about all this, is that I'm actually already nostalgic for it: the excitement of the birth and the first precious hours. The intensity and strangeness of it all. It was so surreal to think: these are our children. We made them. It still hasn't fully sunk in, I don't think, and as much as I adore them, they still feel like strangers sometimes.

But more on that later...

9 Comments:

Anonymous heather said...

This birth story is very close to my own (sans twins.) I too was so excited about going to the hospital in the middle of the night. It really felt like I was in the middle of my own mini-drama that the rest of the world wasn't privvy too.

Do you mind me asking which Boston hospital you delivered at? You can email me if you would prefer (hlholland@gmail.com)

1:14 PM  
Blogger T-bone said...

Wow! What an excellent story; I'm so glad you wrote this. It really takes me back to the mesh underware/ice diaper days. Did they give you a donut? Mini-T, Gillymonster, and I hope you are all doing well.

4:48 PM  
Blogger greeneyes said...

Many, many congratulations and best wishes!

6:00 PM  
Blogger Churlita said...

What a wonderful birth story. My first daughter's birth was much like that, except the hospital labor lasted 36 hours. I do remember saying that I felt like the baby was coming out my butt at one point, though.

It's also good that you had them in the winter so you can hibernate and not feel obligated to take them outside because the weather is so nice.

I'm so glad everything went so well and that you are all healthy and happy. Good job, mom.

1:20 AM  
Blogger Motel Manager said...

I read it all (and cracked up over the finger in the butt comments). The story is amazing!

I hope your downstairs is recovering and that we get to hear more soon about the young ladies and your new life as parents. :)

12:17 PM  
Blogger TLB said...

Awesome post, awesome girls. Can't wait to see them grow.

12:04 AM  
Blogger OHN said...

No skimming here. I love baby stories--though after my own horrendous deliveries, I would much rather read about them than repeat them :)

BEAUTIFUL BABIES!!

4:04 PM  
Blogger BabelBabe said...

don't feel at all bad about the epi; you did great. i tried to do my first w/o, because i was terrified of a spinal headache, and i have no idea how you got as far as you did! incredible.

as for the pooping thing - yeah, it does feel really alot like pooping, who knew? Why don't they tell us?? it surprised me too.

congrats again!

9:48 PM  
Blogger Larki said...

I'm so glad you wrote this down! It takes me back, and you really capture the immediacy and intensity of it all. Kudos to you for pushing those girls out yourself, and for surviving, and even bossing around, the idiot doctors!

And yeah, that mesh underwear and the squirt bottle...whew.

7:31 PM  

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