It’s taken me a little while to sit down and write this out. Mostly because of the business of new motherhood, of course, but probably also partly because I’m still processing the experience, and still struggling with some of its fallout.
The short version of the story is, the birth of my daughter didn’t look at all like I thought it would.
Before I found out I was pregnant, I had only the vaguest sense of the kind of labor and delivery experience I wanted. I had a feeling more than concrete thoughts or expectations. I wanted something centered and primal, something “natural,” without really knowing what that looked like or why I wanted it.
Actually, it was the work of a student that helped me clarify specifics. In the year leading up to my pregnancy, one of my most talented nonfiction students devoted herself to intense research and writing into the modern American birth experience, and it was in reading and workshopping the many thoughtful essays she produced as a result that clarified for me what my various birth options were, what kind of environment and care I wanted, and what interventions and experiences I wanted to avoid.
When we moved to Pittsburgh last summer, we knew that starting a family wasn’t far behind, so I began researching prenatal care options. By then, I knew I didn’t want to give birth in a hospital, and I knew I didn’t want to give birth at home. I wanted the magical in between space of a birth center, and I knew for sure that I wanted midwifery care.
Luckily for us, Pittsburgh is home to the nation’s largest, freestanding birth center, staffed with certified nurse midwives, and covered by my insurance. I discovered the existence of The Midwife Center for Birth and Women’s Health literally the day before I discovered I was pregnant. We took a tour. We had our first appointment with one of the midwives. This place was perfect: birthing suites appointed like hotel rooms with queen size beds and freestanding tubs, birth swings and cool blue walls. I’d be able to labor without IVs or monitors, free to move as I wanted, eat and drink as I wanted, wear what I wanted. I could labor in the tub; my husband could be in the bed with me while I labored. We’d be left alone with our baby for as long as we wanted when she arrived, and we’d be free to go home within 12 hours of her birth.
Over the course of the next nine months, my love for and desire to birth at the Midwife only grew. I had an uneventful and low-risk pregnancy (no blood pressure issues, no GD, no Strep-B, etc.) which meant I continued to be a candidate for non-hospital, med-free delivery.
Until I wasn’t anymore.
I never expected to go into labor by my due date. I knew it was early, and that very few women deliver “on time.” But a week after my due date, with still no signs of labor, I started to get impatient. At 41 weeks, the midwives ordered an ultrasound and non-stress test to make sure the baby and my uterus were still healthy. My fluid levels were fine, and the baby’s heart rate was responsive, so I was cleared to go another week. Surely, I thought, something will happen now. I drank lots of red raspberry leaf tea. I bounced on my exercise ball constantly. I did the Miles circuit every day. I meditated in preparation for pain management.
At 41 weeks and 5 days, another non-stress test revealed the baby was still fine. My first (deeply unpleasant) cervical check revealed I was not at all dilated.
Not at all.
The midwives agreed it was time to schedule me for an induction; 42 weeks was as far as they felt comfortable going. They make me an appointment at the hospital where they have admitting privileges for the first day of my 42 week, and sent me home reminding me it was still entirely possible I would go into spontaneous labor before that appointment. I kept walking, kept bouncing. I got an induction massage. And I started to feel really, deeply sad.
On Sunday afternoon, hours before I was to check into the hospital, we went back to the Midwife Center for one last cervical check, one last attempt to stave off a hospital birth. The midwife confirmed I was still not at all dilated.
Jeremy and I spent the afternoon out in Pittsburgh, talking about our fears and expectations, gradually bringing ourselves to terms with the change in venue, and attempting to convince ourselves that a hospital birth didn’t have to be bad. I could still have a med-free birth. I would still have a midwife as my primary care provider. The hospital and an induction didn’t necessarily mean a “cascade of interventions.” It didn’t have to mean a c-section, which, for both of us, had always been a kind of worst-case scenario.
At 10pm Sunday night, we checked into the hospital. By then, I had dilated about one centimeter, and so our fantastic midwife Jatolloa decided to go for a Foley bulb induction. She inserted the catheter, inflated the balloon, and started me on a Pitocin drip. They gave me a Benadryl and told me to try and get some rest. Jeremy went home to try for sleep, too. We both expected that things would get going the next morning.
I had a fitful night of not much sleep. Contractions kept me awake and squirmy, which meant the nurses had to come in every half hour or so to adjust my external monitors. I threw up. They kept me at a steady dose of Pitocin without increasing it, because the baby hadn’t responded well initially. We waited.
Finally, around 9am, the new midwife on shift, Kara, was able to remove my catheter, indicating I had dilated to about four centimeters. She warned me that this didn’t mean I was in labor yet; the balloons had done all the work, and now we needed to see if my cervix would catch up on its own. The good news was, with a little dilation, other, non-medical interventions were available. When Jeremy returned, we decided the midwife would manually break my bag of waters. This, she said, is when things would really get going.
This turned out to be pretty anti-climatic. The only significant result of the breaking of my waters was the discovery of meconium — not surprising for how far past my due date I was, but an indication that we really needed to get labor started. I was still experiencing regular Pitocin contractions, but they weren’t intense — I could still talk through them — and more significantly, they weren’t resulting in any more dilation.
Here, I start to lose track of time. They increased my Pitocin. We wait. They check my cervix. I’m still at four centimeters. They increase my Pitocin again, and the contractions intensify dramatically. I start to panic from the pain and take an oxygen mask for a few minutes. The midwife tells us she won’t be back for a couple of hours; the woman next door needs to push. At some point I tell Jeremy I’m going someplace else, and I stop being able to talk to him at all. The nurses want me to lie down so the fetal monitor doesn’t move. But the contractions are only about a minute apart now, and I can only bear them sitting up. I’m so exhausted but I can’t lie down. Jeremy stands beside me, rubbing my back and helping me breathe. I fall asleep against him, sitting up, between contractions.
When the midwife returns, she’s encouraged by my contractions. She sits on the bed with me to check me again, waiting patiently for a contraction to subside, checking me quickly, helping me back to sitting. She’s rubbing my back when she tells me she’d say I’m only about two centimeters dilated.
Two. I’m not dilating. I’m closing back up.
I’m surprisingly calm. We ask what this means. What do we do now.
And Kara says she thinks it’s time to move forward with a c-section.
She had prepared us for this over the course of the day, explaining with each step she took what she hoped would happen, what might not happen, and what every possible outcome was, so I wasn’t surprised. I actually felt completely ready. I immediately said, yes, ok, let’s do it.
Because by then, thanks to the way midwifery care works, I understood that the c-section was a best case scenario. I understood what was happening, or rather, what wasn’t. No matter what they did, I wasn’t progressing into spontaneous labor. I couldn’t push a baby out at four, or two centimeters, and even with intense Pitocin contractions, I wasn’t dilated.
But more significantly, all the monitoring suggested the baby was starting to become exhausted. Her heart rate was dropping with every contraction; that, combined with the presence of meconium in her amniotic fluid, meant we couldn’t just keep increasing my dose of Pitocin and keep waiting. If I had been making progress, maybe. But my body was at a standstill and the both of us were exhausted. We needed the c-section. I just knew it.
Everything after this happened very quickly. Suddenly, a cavalry of doctors were in my room, asking about allergies, asking for my signature, prepping me for surgery. This was everything I hadn’t wanted. But Kara sat on the bed beside me, rubbing my back and explaining everything. I wasn’t scared. I was ready. I held Jeremy’s hand and we walked very slowly to the operating room.
I got an epidural which finally stopped the horrible contractions. I laid down, and they put up the sheet. They gave me oxygen and something for nausea in my IV. Once I was set up, Jeremy came in and sat beside my head and I told him to talk to me about something, anything beside what was happening below my chest, because while I felt no pain, I could feel them moving around inside of me, and I needed not to think about that. So Jeremy talked to me about the plot holes and soundtrack choices of the movie Baby Driver, which we’d watched at home the night before, before we’d come to the hospital, while Kara told us it wouldn’t be much longer, just a few minutes.
And then there was a squawk like a goose and our daughter was born.
She had swallowed so much meconium they had to pump her stomach, but she cried right away. Kara pulled back the sheet so I could see her tiny pink body under the warmer while she was quickly cleaned and treated. The NICU staff left; she was ok. And within minutes she was swaddled in that same striped blanket that literally every hospital uses and in Jeremy’s arms. I couldn’t hold her yet because they were still closing me up so he held us together, cheek to cheek and we spoke to her and she stopped crying and we just stared in awe at her slate blue eyes and wet, matted ginger curls and the tiniest ears and I told her this is it baby, the wild rumpus, this is where it all begins.
And soon, I was finished and they lifted me into a new hospital bed and they unwrapped her and put her on my chest. The next few hours are a complete blur. She breastfed immediately, and for a long time. Jeremy sent everyone pictures. My body trembled. We slept. Nurses checked her blood sugar. She was here.
It would be a long time before we had a chance to process the way her birth had happened, and how different it had been from what I once imagined. We were in the hospital for days, and then we had a newborn, and then our families came to meet her, my milk came in, and Jeremy went back to work, and our whole lives changed. But the thing I’ve continued to be amazed by, the thing that’s stuck, is how easily I was ok with the c-section in those moments. How sure I was, despite the fact that was the antithesis of the birth I’d wanted. I knew, absolutely, it was what we needed.
This is not to say it hasn’t been hard. In the months since, now that I have time to think about it, I still feel a deep sadness for the birth I didn’t have. She lived inside me, and then she didn’t, and I missed out on any sense of transition. I never got the experience of moving her from one phase of her life to the next. Lately, I’ve been reading a lot of dystopian novels that involve pregnancy and motherhood, and because these are stories of women giving birth after the world has ended, the births don’t happen like mine did. They happen in caves and on subway cars, without medication or intervention. In each one, the mother enters a primal space, becomes animal, works as one with the baby, with some infinite life source, with the universe, to usher out new life.
I never really entered that primal place I imagined, and I might never. I never got the chance to discover what my body might be capable of withstanding. My pregnancy — which was not easy, which challenged my relationship to my body, which I struggled through in many ways — ended abruptly. I was more a passive observer than I thought I’d be.
I’ll never know why my body didn’t go into spontaneous labor. I’ll never know what would have happened — good or bad — if we’d kept waiting, past 42 weeks. And I’ve definitely grappled with a sense of shame, like I couldn’t do this deeply natural, instinctive thing women have been doing for millennia. I wanted to share my own story for anyone else who has felt some sense of shame or disappointment in their own body. To own it and to counter it, at the same time.
I will always miss the birth I didn’t have; I absolutely gave birth the way I needed to. Both these things are true.
What’s most true of all is that I have a strong, healthy, vibrant daughter, and I’m so grateful for all the care providers, all the facilities, and all the modern medical technology that allowed her to arrive in this world that way.