Birth Story, Part 1: Delivery

I had a caesarean birth plan, a list of preferences. But that’s mostly all they were – preferences. Loss and infertility have taught me that sometimes the best laid plans go to waste and you have to adjust your expectations. Whatever would happen on October 24, there were four things that transcended any mere preferences:

1. That Baby V be delivered safely;

2. That she be healthy enough not to need extra care;

3. That I not need an emergency hysterectomy;

4. That I be able to breastfeed her.

♥ ♥ ♥

The story begins the eve of V’s birth. I’d seen my OB, Dr. D, that day for my final prenatal appointment, at which I was given a small bottle of Hibiclens, an industrial strength antibacterial soap. At 11pm it was Nil by Mouth, so I finished packing my hospital bag and showered. As instructed, I used half the bottle to scrub my body, used a clean towel, reluctantly skipped the moisturiser, put on clean pyjamas, and tucked myself into clean sheets. Unsurprisingly, I didn’t sleep well that night and woke up shortly before my alarm went off at 4:15am. I jumped in the shower and scrubbed myself with Hibiclens for the second time.

As instructed, I called Labor & Delivery at 5am to confirm they still wanted us to arrive at 5:30. They said to come in at 6am, so I sat on the sofa quietly sipping on water and crunching ice cubes. I texted my family:

At 5:45, DH and I left for the hospital. It was dark outside, and the streets were clear of traffic. He asked what music I wanted to listen to and for the first time in my life I said I didn’t want to listen to anything. I just wanted silence, light conversation. I wanted to take in the enormity of what was about to happen.

A little before 6:00, DH dropped me off at the main entrance and went to park the car, and I took a selfie. I couldn’t fit in my bump and I felt a bit self-conscious in front of the few people dotted around, but I made a point of inhaling the cool, damp early morning air, noting these would be my last outside breaths before meeting our baby. As I headed inside, I smiled to think the next time I saw daylight I’d have her in my arms.

It was a long walk from the second floor elevators to the L&D check-in station, but I knew where to go from my visit at 25 weeks. Up to the second floor, turn right and right again, past the second set of elevators, down the corridor, past the janitors, through the double doors, past the NICU (please don’t let her need it), and finally at the nurses’ check-in window. Good morning! I announced. I’m Lauren ____ and I have a caesarean scheduled for 7am with Dr. D. Some paperwork was printed, a couple of wristbands produced, and I was led to a curtained cubicle where I changed into a gown.

Maybe it’s because I grew up on the NHS, but I was expecting a short wait before being attended to, but no. A nurse immediately strapped two monitors to my belly: there was some uterine activity, but no contractions; and the baby’s heart rate was right on track. I listened to the little galloping hooves noise and put my hands over my belly. Soon there’ll be a bright light, baby girl – remember to scream your head off when you see it, okay? I willed her. The nurse then set about clipping my pubic hair with an electric shaver and was halfway done when DH appeared, wide-eyed and breathless. He set down my little suitcase and his backpack and hovered next to me.

Our assigned OR nurse, Gena, introduced herself and started prepping the IV to give me pre-op fluids, but another – I’m guessing less experienced, because it hurt a lot and there was quite a bit of blood – nurse placed it in my right arm. That’s the first item struck off my birth plan – IV not to be placed in my dominant arm, I thought, but I didn’t really care. Surgery was scheduled for 8am, and it was already 7.40am. I was more focused on the fact that this long-awaited baby would soon be born. I reckoned within the hour – and I would be right – and I got quite emotional. I pictured myself crying tears of joy and relief at the first sound of our baby’s cry.

My doctors stopped by for the pre-op checks. First, Dr. D, who reminded DH that the 20-30 minutes we’d be separated as the spinal block was placed would feel like a long time. Next was the anaesthesiology team, Dr. A, a tall, bearded man in his 50s, and Dr. J, a resident. They looked in my mouth, got my consent for the spinal block (and, despite my fear of a needle going in my spine, my refusal to “go cold turkey” on any sedatives), and showed me how they’d like me to curve my back in preparation for the spinal: Hunch over exactly the way your mother told you never to!

Meanwhile, DH was in the next cubicle with a hospital representative to prepare the birth certificate and social security paperwork. We’d picked out the name V when I was just seven weeks’ pregnant, but hadn’t confirmed with each other that her middle name would be – partly because, I think, we kept coming back to the same name. It’s not like we were scouring baby books or debating another name. In that moment, things got a little more real. Baby V was on her way!

At 8am, Gena took me to the OR in a wheelchair. I looked around me, expecting the room to be a similar size to the OR where I had my D&C, but it was a lot smaller. Opposite the door, all the way at the back right corner of the room was the isolette for the baby. My heart exploded, but there wasn’t much time to take it in. I was instructed to sit on the edge of the operating table, and Gena stood opposite me with her hands on my knees. She introduced me to Peyton, the “awesome” OR nurse, whose only visible features were her pale blue eyes. Dr. A reminded me to Hunch! as he and Dr. J performed an ultrasound on my spine. I sat slumped over my giant belly, feeling the baby move for absolutely the last time. Remember, scream your head off, baby girl… With the ultrasound performed, a local anaesthetic was administered. It stung a little, and Gena talked to me in a soothing voice. She’d had two spinals and understood I found it disconcerting. Right then I noticed that beautiful song, Somewhere Over the Rainbow / What a Wonderful World was playing. Tears sprang to my eyes, as they did again just writing this. Listen to the lyrics – there can be no better song of gratitude for a rainbow baby than this. It was like Nanny (my darling great-grandmother for whom V was named) and Bean were winking at us. In went the spinal block, like a bee sting, and I must have gasped because Gena squeezed my knees and stroked my legs.

No sooner had Dr. A begun to tell me that my legs would start to feel warm and tingly than they did so. Swing ’em up on the table while you still can. Less than 20 seconds after the spinal it was already more difficult to move them. I reminded myself that if I felt I couldn’t breathe then to try talking – because even if you can’t feel your chest moving, if you can talk you can breathe. Suddenly, I felt terrible. I was overcome with nausea and felt lightheaded. Dr. A explained that a spinal block can cause a rapid drop in blood pressure (and mine is pretty low to begin with). He lowered the gurney so my head was lower than my ankles and instructed Dr. J to give me something intravenously. Soon I was feeling better, albeit a little woozy. He asked someone to “get the ice.” To my right, Gena and Peyton checked off the list of instruments. I could see them – there were no knives or other scary hold-the-belly-open instruments, just a bunch of tongs that looked fairly alike but had completely different names from each other.

Dr. A held up a purple glove filled with ice and explained that he was going to touch it against various parts of my body and I was to tell him if it felt Cold or Touch. My shoulder was Cold and my thigh was Touch. Somewhere around my lower ribs Touch became Cold. Satisfied that I was completely numb from the waist down on both sides, I was catheterized. A blue curtain was draped high above my head. With that, Dr. D, the obstetric and paediatric / NICU teams entered the OR. And finally, a bit before 8.30am, DH was summoned to the OR.

He appeared wearing a white zip-up bunny suit, cap, and mask, and was shown where to sit at the left side of my head. We clasped left hands and he cradled my head and stroked my hair with his right hand. We had eyes only for each other, and talked quietly about how we couldn’t believe we were about to meet our daughter. Our daughter! I didn’t notice the caesarean had begun until I heard suctioning. I was more focused on my husband’s beautiful round blue eyes and the enormity of what was happening. I felt him turn my head more towards him – I’d later learn because blood spattered on the curtain. Neither of us is particularly squeamish, but DH decided Lauren doesn’t need to see that!, and Dr. A praised him for keeping his cool, saying most partners would have freaked out.

I felt movement in my belly, this time from adult hands. There was some tugging and pulling. I pictured Dr. D’s hands cradling the baby’s head to manoeuvre her out of my pelvis. I grinned and said to DH, It really does feel like someone doing the washing up in your belly! There was more tugging, this time it felt like a pushing down above my belly button, and someone said the baby would be born soon. Was it a minute that went by, or five? The next thing I heard was a collective gasp from the obstetric team, Dr. D saying Here she is!, and the most beautiful and reassuring wail. At 8:37am, Baby V made good on her mama’s request and was screaming her head off!

I’d been imagining this moment since I was a little kid, and from then up until a few minutes before I’d been so sure I would be in floods of tears… but those first moments of our daughter’s cries were so profound, they reverberated to my bones and have made an indelible audio etch on my brain. I was too shocked to cry. I listened, wide-eyed and clutching DH’s hand. I longed to see her, but the curtain wasn’t lowered. Where is she? I wondered impatiently. Finally, I caught a glimpse as she was carried past us and I craned my neck and swiveled my eyes left to watch as a small group of people huddled around her, rubbing her vigorously. A chubby pink thigh. The smooth grey rubber of the umbilical cord. A blue hand. Overall, she was a swirl of light purple. A much bigger baby than I expected, her features were swollen from the fluids administered to me via the IV. Go look! I said to DH. Take a picture, because I can’t see what’s going on. DH, who before had reluctantly agreed to take photos, preferring instead to live in the moment of our daughter’s birth, caught some terrific moments with my iPhone:

Finally, she was brought over to me. It was a magical and weird moment to meet the creature who I’d only known from the inside of me. DH held her and we lay cheek-to-cheek. I reached my arm around and cradled her and kissed her cheek. She seemed calmed by my presence and my voice. It wasn’t so much a rush of blind, unconditional love that I felt, but a surge of fascination and tenderness. I took in her tiny swollen features, and quickly recognised her full lips, pointed chin, chubby cheeks, and DH’s brow from our many ultrasounds. Someone took our first family photos together. (And that’s how I knew there was a spatter of blood, so if you are squeamish, don’t study the blue curtain in the second photo closely!)

Not long after this photo was taken, the shit hit the fan. From here on, my sense of the sequence of events is a bit jumbled because, unbeknownst to us at the time, my uterus wasn’t contracting. Dr. D would describe it as “boggy,” meaning it was soft and kept filling with blood. I was haemmorrhaging.

I heard “Miso rectally” and enquired as to what that was. I’d been given a rectal dose of Misoprostol, a drug that causes uterine contractions, and the same one that induced my miscarriage last year. The irony was not lost on me, but I grinned and told DH, Man, you know you’re numb from the waist down when someone puts something up your arse and you don’t even notice!

Meanwhile, V was back in the isolette – either for her 5-minute Apgar check or because her breathing was still a little fast. I remember smelling cauterization and murmuring, Mmm, burning flesh… to DH. Someone announced, “Here’s the placenta,” and, per my birth plan, I asked if I could see it but no one responded. I didn’t have time to argue. My placenta would be described as “macerated” and “like hamburger meat.” I began feeling lightheaded, sort of like when the spinal block was administered. Someone, probably Dr. D, asked “How much have we lost?” Came the reply, “800,” and I figured out that they must be talking about blood loss and milliliters. A few minutes later, I heard “1,483,” as my eyes began to involuntarily roll in the back of my head. I had the thought, Keep your eyes open. Don’t fall asleep, that would be bad. I forced my eyes open and wanted to tell DH that I didn’t feel so good, but keeping my eyes open was all I could do. And I knew DH would notice. I heard him say, “Dr. A? Lauren’s having a hard time keeping her eyes open.” Dr. A evenly responded with, “We’ve already given her something for that.” Whatever it was that he gave me, I swam back into consciousness.

As the Misoprostol didn’t work (déjà vu), Drs. A and J began quickly and repeatedly injecting my shoulders with two different kinds of drugs (one was called Hemabate) to get my uterus to contract. Each injection would work a little but didn’t have the desired lasting effect. Dr. A said we needed to start a second IV line, and then he turned to me and informed me that I needed a blood transfusion. I was quite shocked by that. Someone was on the OR phone to the blood bank to request extra units of A-negative blood. Dr. A tried to start an IV in my left hand. It hurt, but I didn’t flinch. It didn’t work. He tried another spot and, even though the OR was brightly lit, asked someone for a flashlight. DH pulled out my iPhone and turned on its flashlight, but it didn’t help. Dr. A was still having trouble placing a second IV because my blood pressure was so low that my veins had collapsed.

It was around this time that DH was asked to leave the OR, and that’s when we became frightened.

At a prenatal appointment back in September, DH and I asked Dr. D what would happen if something went wrong during the delivery. I, in particular, was concerned about having an emergency hysterectomy, and said to Dr. D, I know the ultrasounds have ruled out placenta accreta, but with my uncanny ability to fall headlong into tiny statistics, if anyone is going to have a surprise on the day, it’ll be me. Dr. D took the time to discuss the obstetrical measures taken before an emergency hysterectomy – there are medications, and if they don’t work, there are other measures, the last one being a balloon that is inflated in the uterus to apply pressure from within. She reassured us that DH would be allowed to remain in the OR with me unless things got very serious…

So when DH was asked to leave the OR, we were under no disillusion that things must be pretty bad. It seemed like one minute he was sitting at my head and the next he was gone. I wondered if he had stepped aside briefly before saying goodbye. He reappeared moments later, to my relief. Having left the OR in a blind rush, he returned to ask if he could kiss me goodbye, and Dr. A let him back in. All I could see were his blue eyes, pink-rimmed and damp with worry. He told me he loved me again and again. I told him I loved him too, and, because I didn’t feel as scared as he looked, I told him I was going to be okay. Then, in my brightest voice, I told him to find his parents, who had been in the waiting room since 7.30am. V was still in the isolette and I thought that if I were in DH’s shoes, I’d appreciate being directed what to do. And then he left.

V was taken to the NICU shortly after DH left. Her breathing was a little rapid, but had I not been in such dire straits, the neonatal team would have monitored her in the OR. DH told me he had changed out of the bunny suit, seen his parents, and was headed back in the direction of the OR when he came across two nurses wheeling V to the NICU. There, he sat holding her in his arms for a long hour, wondering if he would be leaving the hospital with a baby but no wife…

With my husband and daughter gone, I turned my attention towards what was happening. The very real question, Am I going to die? entered my head. I calmly considered this and decided that although things were probably serious, no, I wasn’t going to die today. I had absolute confidence in the team working on me. Gena told me that evening that I had “everyone’s favourite doctors” working on me in the OR, a sentiment echoed by a resident who had been passing by and scrubbed in to help.

Meanwhile, Dr. J placed an oxygen mask over my face and Dr. A was still trying to place a second IV. Each subsequent attempt hurt less than the previous one. Judging from the tiny scabs sitting on the large black bruises that lasted over a week, it took him 14 attempts (six on the back of my left hand, six on my inside wrist, two on the back of my right hand) before succeeding on the 15th attempt a few inches below my left wrist. I watched as each doctor hooked up one bag of blood and one of plasma to each arm — the first two of the eight bags I’d receive. I looked up and saw A-NEGATIVE printed on the bag, and my eyes followed the trail of someone else’s blood as it worked its way down the hose and into my arm.

I reflected on the half a dozen times I’d donated blood in the UK. It was something I didn’t enjoy but found rewarding in its own way. (I tried to donate blood here in the US, but was turned away because I’ve spent more than three months in the UK and might transmit Mad Cow Disease. I wasn’t able to donate V’s cord blood for the same reason.) Giving blood hadn’t seemed like a big deal at the time, but lying there as a recipient, not a donor, I understood just how important it is to donate. I offered my most profuse silent thanks to the eight individuals whose donations played a crucial part in saving my life.

I began feeling better. Calmer. I asked Dr. J if I could straighten my right arm, which was hurting from having been in the same position for so long – and it was then that I saw that my blood pressure was back up to 83/51. It was so low I asked Dr. J if that number was definitely my blood pressure. He gave me a cheerful Yes! It was he who kept me company after DH left, but I don’t remember much of our intermittent conversation other than him explaining that he was half-Korean, half-Norwegian, which had something to do with why people call him Benj, not Bjorn. I told him he looked pretty Scandinavian to me. I was glad for his company, reassured by unstressed he seemed. As it turns out, he wasn’t too worried because I was clotting okay and my urine output was good, meaning my kidneys weren’t failing.

Meanwhile, Dr. D said she was starting a “B-lynch.” She later explained that this is a double suture that goes around the uterus, kind of like braces (US: suspenders) that hold up trousers. I entered a strange headspace where time simultaneously slowed down and seemed to go by quickly. Every time I looked at the clock another 15 minutes had passed. I was aware of tugging and pressure. It seemed different than in the seconds before V’s birth, more intense. I surmised the spinal block was wearing off. No! Come on, that’s not possible, Lauren. I looked at the clock. Spinal blocks last for a couple of hours, and the clock read 10.15am, about two hours after mine was administered. I checked myself, using my experience the Cold/Touch test. I swallowed. I determined that although what I was feeling couldn’t be described as pain, it was definitely a lot more than Touch. The sensations felt not thick and generalized, but more precise. There was a tugging, similar to when V was being lifted out, which I’m guessing was my uterus being lifted out of my abdominal cavity so Dr. D could work on it. I was pretty sure that if I said something to Dr. A he’d give me a general anaesthetic (unlike an epidural which can be topped up, a spinal block is a one-time deal) and I was also pretty sure that if I was put under I’d wake up without a uterus.

I considered my options. I certainly didn’t want to feel the pain of major abdominal surgery. But neither did I want to lose my womb. I thought about the first two of my four hopes that transcended anything on my birth plan…

1. That V be delivered safely. Check.
2. That she be healthy enough not to need extra care. Check.

… and concluded I was at peace with a hysterectomy. I wouldn’t learn until that afternoon that I’d lost 3.6 litres (a smidge less than a gallon) of blood, and would probably have died if I’d delivered in a more rural setting. In the OR, I didn’t feel like I was close to death, but if it got closer to that point then I absolutely trusted Dr. D to make that judgment and save my life. My only thoughts were: V is here and she is healthy. I want to be a mama to this little girl. I want to raise her with my beautiful DH. I just want to live.

I looked at the clock again. I wasn’t imagining things, the two-hour window of anaesthesia was rapidly drawing to a close. I took a deep breath and told Dr. A, I think the spinal block is beginning to wear off. Dr. A looked at me very seriously and said, “I think we need to put you under.” He called over to Dr. D, “We need to give her a general,” but she replied sharply, “One minute!” It wasn’t a barking order so much as a request to buy more time. I waited, drifting along for those sixty-odd seconds, vaguely aware that this important minute was going to mean the difference between keeping my womb or losing it. (For some reason, the last resort of the uterine balloon to stop the bleeding wouldn’t have worked in my case.)

Then, finally, “It worked.” I was passively awash with relief. I lay with my arms slightly outstretched at my sides, like some ghastly Jesus art project, quietly taking in everything that had just happened. I could feel more tugging. For the first time I saw my open abdomen reflected in the giant overhead OR lamp. I studied it. A blurry, red gash shaped like an eye. I studied my reaction. How interesting. At the time I was surprised I wasn’t a little freaked out, but perhaps Dr. A had given me some narcotics to take the edge of the fading spinal block. But right then, looking at the red reflection of my open belly and noticing the vibe in the room was less urgent, I knew I was going to be okay. And I’ve never had more respect and admiration for the entire medical profession than in that moment. (I’ll even forgive whoever violently ripped off the sticky sterile area plastic that left a raised rash and little blood blisters that lasted a week… Maybe they didn’t realise that when I said the spinal was wearing off, I wasn’t exaggerating!)

All sutured up, they were getting ready to wheel me out to recovery. The head of the gurney was raised, the curtain removed. I remember two vivid things: one, someone holding up a large absorbent pad that was saturated with blood; and two, the time…

Early in my pregnancy, I had a dream that my late grandmother spoke to me. (Her death last September released the inheritance that would cover almost all the cost of DEIVF.) Her voice came from my external hard-drive and said “The baby will be born between seven and quarter to eleven.”

…As I left the OR, the clock read 10.45am.

Read Birth Story, Part 2: Recovery, in which V and I are reunited, battle breastfeeding obstacles, and learn why everyone comments on her hair…