We are happy to announce that Ewan Michael David was born on July 19, 2009 at 6:28pm. He was 7 lbs 14.5 oz, 22" long, with auburn hair and navy blue eyes and an Apgar score of 9.9. He was born by c-section, which was fairly traumatic for me and Ross. It was the horror story of the cascade of interventions that we had heard about but never expected to experience first-hand.
I was 41 weeks and 6 days when we went into the hospital for an induction. I really really did not want to be induced, but I was told that I would have to worry about stillbirth if I waited (despite the fact that all the tests thus far had been perfect and we were both entirely healthy). You can imagine how Ross and I felt contemplating that prospect with miscarriage behind us. We tried everything under the sun to get labor going on our own. And it kept starting pretty heavily and we would think we'd be heading to the hospital in a few hours in natural labor, only to have things slow down or stop. We had four long days like that. But labor never kept going on its own. On Saturday morning July 18 at 6:45am, we arrived at the hospital for the induction.
I asked that they use the lowest dosage of Pitocin possible and to shut it off as soon as labor was kick-started. I was told that once the Pitocin was on, it would stay on until the pushing stage, no matter what. I got the IV for the Pit and the antibiotics for Group B Strep. I was immediately attached to continuous EFM. The IV hurt a little because the cord kept pulling and getting tangled with all of the other cords, but other than that I was managing ok. Our doula, Kate, showed up in an hour or two. My contractions were immediately 2 minutes apart, but I could really quite easily handle the pain. We all chatted and listened to music. We even danced around the room (right by my bed for me because of the cords). We had a really great nurse initially. She said that we were her favorite couple ever because we had a good sense of humor, weren't watching TV or glued to our blackberries and were fun and nice. We bought her cups of coffee and gave all the nurses brownies we had baked and brought from home.
I was checked several times. At one point we got really excited - the doctor said I was 7 cm. Then she said she had made a mistake - I was only at 3.5-4. No real progress from the day before. She said she wanted to break my water. I didn't want that to happen because of my nightmares of prolapsed cord and c-section. (The baby was still floating at -3. I was very worried that the cord could slip below his head if my water was broken. Not to mention that I would be on the clock because of the GBS.) She seemed somewhat put out but said that we could discuss it and she would come back later. She said that things were too slow. Our doula advised us that first labors are often slow and reminded me that I had in fact dilated some and was 50% effaced. She said that those things could change quickly, too. So we bought time...
Unfortunately at 1am, though the contractions had grown stronger as they upped the Pitocin, I was still at the same dilation and effacement. The doctor came in and told me that if I didn’t have the baby by 8am, it would be an automatic c-section. She asked me to let her break my water again. I told her that I was concerned about doing that as the baby had not dropped yet. She said that she didn’t think I had much choice. We asked for another 15 minutes to discuss it. We talked about unplugging, calling it a failed induction and going home to await labor to start on its own. We hoped that I wouldn’t be dropped as a patient and could still be monitored closely for the next few days for any problems. The doctor came back in and said that I was risking uterine rupture and hysterectomy by staying on the Pitocin without having my water broken and that a c-section was an almost sure thing. She also said that going home would be "absolutely crazy" and no one in her entire history of obstetrics had ever unplugged from an induction. Ross and I started praying fervently. Kate told us that my very reasonable fears notwithstanding, breaking my water was not an unusual thing to do. I agreed to do it. The doctor came back in and explained that she would insert a catheter to monitor the level of my contractions internally. That way they would know if and how high they could increase the Pitocin. I said ok. I had no way of knowing what I was in for.
The insertion of the catheter was painful. What I didn’t expect was that it would be continuously painful and excruciatingly so every time I tried to walk. They also doubled the amount of Pitocin they were giving me within 15 minutes, from 8 to 15. It went from somewhat painful but bearable contractions with breaks between to unbearable off the charts contractions with no break at all in between. The catheter was so painful that I could not stand or move. I could only sit frozen in place and scream. This went on for an forty-five minutes. I begged them to remove the catheter but they said it would remain in place until I started to push. The new nurse (a very sweet girl) told us that she had never seen them put such a contraction catheter in without the woman having an epidural first, it was known to be so painful.
I finally told Ross that I wanted an epidural. It kept running through my head that we were now so far gone from natural that there was nothing natural about what was happening to me. I couldn’t cope because just about every coping mechanism had been removed from me by the insertion of the catheter which forced me into immobility. I gave him our code word. He very heroically waited our agreed 15 minutes before calling the anesthesiologist, giving me time to change my mind.
When the anesthesiology team came in, they told me that I had broken the record by DOUBLE the level of Pitocin any woman had had in that hospital before asking for an epidural, and they couldn’t believe how strong I was or that I had waited as long as I had once it had reached that level. I got the epidural and then slept for two hours.
When I awoke, I was at 8 cm, 100% effaced. They had taken my dosage of Pitocin up to 20 and then up to 24 when I reached 10cm, which is 4 past their own hospital limit. I was worried since they had already told me that they thought I was at risk for rupture and hysterectomy from the Pitocin as it was. But the baby was tolerating everything just fine. They started preparing the room for me to push. The baby nurse (a nurse we had met before and really liked) came in to say hi to us. Ross was elated, but something in my head told me not to get excited. There were still no guarantees. We were not at the finish line yet.
I asked to push on my side, telling them the problems I have with my tailbone and worries about fracturing it if I had to push on my back. They said I could change positions if I just tried pushing on my back twice. I tried. And then they still wouldn’t let me move. Six contractions went by, with me still on my back before I started to get angry and demand to be allowed to move. They also insisted that I hold my breath while pushing to a count of 10 while they screamed PUSH! at me and while the nurse told me I wasn't working hard enough. (I wanted to kick her in the head, but she was too far away - smart girl.) Because I'm a singer, I knew it was stupid to hold my breath while doing anything strenuous physically or bearing down, so I very, very quietly exhaled on each push while making it look like I was holding my breath. I'm glad I did that because I now know that holding your breath for 10 seconds can cut off oxygen to the baby. Anyway, I lay on my side for four contractions. The doctor came in and said that the baby was at +3, but no head could be seen. So no progress. The new nurse at this point was horrible. She seemed annoyed that Kate was there. She was irritated that we wanted to try different things. She said we could “do it [our] way a couple of times” and then we would have to do it her way. I tried to squat on the bed, but the swelling in my legs from the Pitocin and the numbness from the epidural made it virtually impossible. I went back to lying on my side until they then forced me back on my back. I pushed for 2 ½ hours. The nurse kept telling me that my pelvis was “inadequate” and that I wasn’t pushing hard enough. Whenever the doctor would peek in, she would tell him in an annoyed and impatient tone that I wasn’t doing well and should just have a c-section. Kate and Ross were cheerleading me on, while she sat at the computer alternately reading a newspaper or surfing the internet. I kept asking her if a contraction was starting and if I should push (difficult to feel with the epidural) and her response was to do whatever I wanted, as though she couldn’t care less.
At 2 ½ hours, the doctor came in and told me I was having a c-section. I had been in labor at that point for 36 hours. I started sobbing hysterically. I couldn’t look at him or anyone. I just lay there and cried. He essentially implied that I was being a baby, that c-section is totally safe, and that my goal should be a healthy baby (as though it wasn’t). The nurse insisted that my pelvis was “unproven” (I thought that simply meant a first birth!) and was not large enough to deliver vaginally. (I’m a very average-sized woman.) The doctor said that the baby was sunny-side up and could only be delivered by c-section. (Ross and his sister were both sunny-side up and were delivered vaginally over 30 years ago.) He kept saying he wanted a healthy baby and healthy “mommy” and couldn’t in good conscience allow me to continue pushing and that it is highly unusual to push as long as I had.
I was so spent physically and emotionally, I just couldn’t fight back anymore. They shoved a consent form under my nose and told me to read and sign. I couldn’t do it. I asked Ross to read it and tell me if I should or shouldn’t sign it. He told me that he didn’t think there was anything strange in the form. Kate stroked my hair and told me how strong and brave I had been. I signed the form and was immediately prepped for surgery while Ross put on his scrubs. When they were finished in the L&D room, Kate said, “I think we should all leave and give them a minute to be alone and compose themselves.” And she ushered everyone out of the room. For that act alone, I will forever be grateful to her.
When everyone left, we both just held each other and sobbed. Ross kept saying, “I’m so sorry, I’m so so sorry.” And I kept apologizing to him and to the baby for failing. It was agonizing for both of us.
When the doctor returned, I told him that I had several requests for the c-section that I wanted him to honor if at all possible. 1. I wanted a low transverse incision with a double stitch. 2. I wanted the drape lowered when they were lifting my son out so I could see his birth. 3. I did not want morphine. 4. I wanted Ross to cut the cord. 5. I wanted them to bring the baby by my face for a split second so that he could see me and I could see him before they started any procedures or put ointment in his eyes. 6. I wanted to nurse him as soon as they were finished with the immediately necessary procedures, even if they weren’t finished with my surgery. 7. I wanted to see the placenta. 8. I wanted him with me in recovery and in my post-partum room as soon as I was there. The doctor agreed to everything.
They took me into the operating room and were all set to begin, but I shouted that Ross wasn't even in the room! They seemed annoyed again, but sent someone to find him. Someone was supposed to have escorted him to the room as he didn't know where it was, but they had forgotten. If I hadn't said something, they would have done the c-section without him there. In surgery, they did not lower the drape. Ross and I were the only two in the room who missed our son’s birth. We heard him cry and I immediately started crying while Ross said, “That’s our son! That’s our son!” over and over again. He ran on the other side of the drape. I started screaming (Ross said it was only screaming in my head because outside it sounded like very sad pleading), “Let me see him! Let me see him! Bring him to me!” I kept reaching for the drape, trying to pull it down or back so I could see him. But they refused, and the snotty nurse said in an annoyed tone, “We’re just trying to keep him healthy!” as though I didn’t care about that. They had already cut the cord, so Ross couldn’t do it. I asked to see the placenta and was told it had already been disposed of. They announced that they were taking the baby to the nursery and Ross grabbed him and brought him to me. He was already fully dressed, so there was no opportunity for skin-to-skin. I was given two minutes to say hello to him, though he couldn’t see me through the ointment in his eyes. He cried pitifully, and I sang to him and he quieted down. And then they took him away. I could not nurse him.
I was taken to recovery and kept demanding that they bring him to me so I could nurse him. Finally they allowed Ross to bring him to me after what seemed like forever, but they would not let me nurse or hold him until they had administered more pain meds (I felt no pain at that time, though). But it took them forever to get the pain meds since I’m allergic to Tylenol with Codeine, and that is their standard. The pharmacy was giving them problems, I guess. When they finally gave me pain meds, and I asked to nurse him, I was told that he had to be back in the nursery in five minutes and there was no time. I just started crying again.
I was taken to my post-partum room and asked immediately for the baby. I was told I would get him in an hour. My brother Joe and Kate came back and joined me and Ross. They opened a bottle of champagne and toasted Ewan’s birth. Two and a half hours went by, though, and no baby. Finally Ross went to the nursery and demanded him saying, “Give me my child!” He was not in the NICU or the other special nursery. There was no reason that they were keeping him. He was absolutely fine.
They would not give me any more pain medication, though, because of some confusion between anesthesiology and my doctor and the pharmacy and the nurses. I went without even an ibuprofen for 13 hours. They removed the urinary catheter but kept me on IV fluids while encouraging me to drink as much water and Gatorade and juice as possible. I finally had to urinate but could not walk to the bathroom. I called the nurses to help and then discovered that I could not urinate at all, despite feeling like my bladder was about to explode. I was in excruciating pain from the incision and my bladder together. They tried to put a new catheter in, but said my urethra was bent and swollen. They started worrying aloud about bladder rupture and I started getting scared. They called in the “expert” nurse in putting catheters in, and she couldn’t do it, either. She shrugged apologetically and said, “I don’t think this can be done.” They called the chief resident – by this time I was in tears again and couldn’t stop crying – and she was able to get it in, though it was very very painful. And then they finally brought my pain meds and took me off of the IV.
Most of our nurses in post-partum were wonderful, but we had one nurse who routinely delayed my pain meds by several hours and implied that I was a drug-seeker (!!) despite the fact that I was only asking for what my doctor had prescribed and was merely following her orders. She even gave me problems over taking ibuprofen. She seemed to think that women should be able to handle post-surgical pain without pain medication. I wonder if she would think the same about men who had major abdominal surgery!
Ewan and I had a few problems with breastfeeding initially and had to supplement at the hospital. We quit the suplementation as soon as we left the hospital - intuiton told me it was not a great idea for either of us - and we called a wonderful LC. She fixed our latch problem in about 5 minutes and was thoroughly reassuring to us. She was worth every penny. Because of her help, I now experience no pain when feeding Ewan, and he is thriving. His pediatrican says he is perfect in every way and right on target for weight gain.
My doctor told me the official reason for the section was “failure to progress”, although they could probably add in CPD and poor fetal presentation. They also told us the baby was in distress because his heart rate was “variable” and “high”. But we watched the monitor like a hawk, and it never exceed the variability or range of the NSTs of the previous two weeks which were all deemed excellent and healthy. She said that she thinks I will never be able to give birth naturally and not to get my hopes up about future pregnancies. She says that I am probably just not equipped physically to give birth. Which means that I will not allow her to be my provider anymore. As soon as I am fully recovered from the c-section, I will switch to a midwifery practice.
I was devastated by the c-section and by the way I was treated in the hospital. I determined that if I can help it, I will never have another child in a hospital as long as I live. I told Ross that I want to go to Ina May Gaskin’s Farm for the birth of our next child. He said that we will move heaven and earth to make that happen. We've already spoken with one of the midwives there. She said that she thinks I am a perfect candidate for VBAC. She recommended that we wait a year before trying to conceive again in order to allow my incision to fully heal and the wall of my uterus to grow strong again. In the meantime, I will try to get as physically and emotionally as healthy as possible, and spend a lot of time cuddling our sweet little boy.
I’m still having nightmares about the surgery. In every nightmare I am in some way paralyzed or out of control. I am being swept away from Ross. In one dream, a man told me I was weak and pathetic and couldn’t escape his knife. He proceeded to sharpen it in front of me and then slice me open. I apparently was screaming in my sleep and Ross woke me up. I started sobbing. In another, I was being swept away by a strong wind with an evil presence. Ross was trying to hold onto me but couldn't. I told him that the labor and c-section were events that in my mind are distinct and quite separate from my son. It’s like I endured this horrible ordeal and then randomly was handed a baby and told this is yours. There is no connection for me at all.
All that said, I adore Ewan. He is the most adorable child I have ever seen. He is so precocious and so sweet-tempered. I can stare at him for hours. I love the way he smells. I love the way his skin feels and the silkiness of his hair. I can’t imagine not having him in my life. Ross has taken to fatherhood like a duck to water. They are already very well bonded. Ewan knows his father. And Ross is just a natural at soothing him. I can’t wait for the whole life the three of us will share. And it is already passing so quickly!
I’m recovering slowly but determinedly. I’m probably going to try to find some kind of counseling or support group for c-section recovery. And I’m going to thoroughly educate myself about all of this…. It will take a while to process it all. Physically, I’m in pain. The incision became infected and they had to reopen it. I knew it was infected in the hospital but no one believed me. It took days and me running a fever and being in quite a lot of pain before they would even see me, much less do anything. Now I have a nurse that comes every day to dress the wound, and Ross dresses it twice every day. The infection seemed to recede and we felt that we were finally seeing that end-of-tunnel light, but the infection has come back. I had an u/s and a CT-scan yesterday, and it looks like something was left in the wound during the surgery. It's likely I will need another surgery to remove the object and stop the infection. It's very draining to take this long to heal.
I have to say though, that even though post-partum has not been what I expected, I am so RELIEVED that morning sickness is overwith! I’m relishing eating again.
And our baby is so, so precious. He is the light of our lives.
Photos by Jenny Darina.
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