Tuesday, May 26, 2009

Eleven Years Ago Today

It was Tuesday, May 26, 1998.  I was living in Atlanta, working at a Montessori school, living with Eric, Caitlin’s bio dad, and about a month away from my most recently assigned due date, which itself was 2 weeks earlier than the first date I was given.  (I didn’t know exactly when I conceived nor the dates of my last period so the dates were set and then changed based on the numerous ultrasounds I had.  More about those ultrasounds shortly.) I had an OB check-up scheduled in the morning and then planned to go to work that afternoon as usual.  For those who don’t know the rough outlines of this story already, I was 22, taking a year off from college to ‘figure out what I wanted to do’ and really not planning on having a baby anytime soon. 

My job didn’t provide medical benefits so I had signed up for Medicaid to pay for the birth.  I was surprised to learn that not many care providers in Atlanta accepted Medicaid, so I started prenatal care at a huge public inner-city hospital with a team of OBs and perinatologists who mostly saw women who didn’t have any other option.  Under their care an ultrasound revealed two choroid plexus cysts in the baby’s brain.  10-plus years ago ultrasound technology was nowhere near as good as it is now and it had recently improved just enough to start revealing things like the cysts.  My care providers had me see a perinatologist and a genetic counselor, fearing that the cysts were caused by a chromosomal abnormality that also caused severe birth defects that would lead to the baby dying within the first year of life.  Yet in order to be sure I would have to undergo an amniocentesis, which brought its own risks; in fact, the risk of negative outcomes due to the amnio was greater than the risk of a chromosomal abnormality.  In the end I opted not to have the amnio, certain that I would not terminate the pregnancy even if the baby did have a chromosomal abnormality.  This was an unpopular decision among my care providers and I felt increasingly uncomfortable with them, so in my second trimester I found a new OB. 

The new OB worked at a private hospital with one of the highest delivery rates in the country.  He saw all sorts of women in his practice, including a handful of us on Medicaid.  At 22 I really didn’t have very nuanced criteria for a care provider but I liked the man and was happy that he’d gone to med school at the UW.  He took a rather authoritarian and paternalistic tack with me, but while I do remember noticing his attitude, I don’t remember being particularly bothered by it.  Certainly, he wasn’t as offensive as the docs in the earlier practice or the numerous strangers who somehow felt it their place to let me know exactly what they thought of me being pregnant, single, and young. 

The new doctor had me coming for weekly visits starting in mid-April because repeated ultrasounds first showed the cysts growing and then one day inexplicably absent and because I hadn’t gained all that much weight during the pregnancy—maybe 20 pounds by April—and he was beginning to worry that the baby wasn’t getting the nourishment she needed.  Still, I turned up on May 26th, expecting nothing more than the usual measuring and whatnot.

At that visit I didn’t weigh any more than I had the previous week, so my OB ordered another ultrasound, to measure the baby.  (I now know that late term ultrasounds are notoriously unreliable at estimating birth weigh and gestational age.  They can be off as much as a pound in either direction.)  The ultrasound was inconclusive so we did a non-stress test, which was also inconclusive.  But in the end my OB said, “If the baby is in trouble we can help her better on the outside than on the inside,” and scheduled me for an induction the next morning. 

I was really shocked and couldn’t think of anything to do other than to just go along with the plan to have an induction, even though it was a full month before my earliest due date, and my OB hadn’t discovered any concrete medical reason for it.  So, I went to work that afternoon, told them I’d be starting my maternity leave early, and got in touch with my parents who were in New Jersey watching my brother row.  They were alarmed and made plans to get down to Atlanta as soon as possible.  I packed my bag for the hospital and tried to get a good night’s sleep.

At 7:00am on Wednesday the 27th I checked into the hospital and they installed me in a birth room and started the induction protocol.  I was on my own at the beginning—Eric, a bartender at the time, wasn’t much of a morning person, my parents were still in transit and my two best girlfriends both had to work.  I really didn’t know what an induction entailed, but I got a fairly thorough education over the next 2 days.  I had a great nurse to get me started and she gave the best description of cervical ripening (also called effacement—the process that has to happen in order for a woman’s cervix to be able to dilate) I’ve ever heard:  (imagine the Georgia drawl, please) “Honey, we’ve got to get you to mushy Spaghettio stage and right now you ain’t nothin’ but a hard Cheerio.”   I had numerous applications of Cervadil to ripen my cervix and finally a Pitocin drip was started to bring on contractions.  Once I got into the birth room I lost all touch with time but I do remember thinking that the whole thing was taking a rather long time.  (No surprise really, given that my body was nowhere near ready to give birth.)  Over the course of the next day the Pitocin was increased, my contractions became incredibly painful, and I quickly got to the point where I needed narcotics and then an epidural to cope with my labor.  I hadn’t taken a childbirth class, didn’t know any comfort measures for labor, and none of my nurses offered anything to help me feel better except drugs. 

I don’t have a sense of when things happened but I remember snapshots:  My parents arrived, worried, and took turns sitting with me as my labor inched along, trying to keep my spirits up with smiles and kindness.  My friends Erin and Jen visited as much as they could around their work schedules, bringing laughter and energy and Indigo Girls cds every time they walked in the door.  And I remember Eric only appearing sporadically and not having any idea what to do when he was there.  (He had even less of a clue than I did and he was not terribly thrilled with his impending fatherhood.)  I was grateful for whatever company I had, but can remember being alone quite a lot and wishing someone would come talk to me.  The tv in my room didn’t work, and though I did have a cd player, I really needed much more company and support than my friends and family could provide. 

After the funny Spaghettio nurse I was cared for by a series of nurses that I really didn’t click with.  Once I had the epidural I couldn’t eat or drink anything (standard protocol), but I remember being terribly hungry and thirsty, and begging my nurse to give me something more than just ice chips.  She got quite angry with me and finally said, “Fine.  Eat whatever you like but you’re going to throw it up and I won’t feel a bit bad for you.”  I took that as permission and dispatched my friend Erin to bring me a chocolate milkshake from the McDonalds in the hospital. It was the best milkshake I have ever had and I paid for it dearly, puking just as the nurse threatened I would. 

Some time later the baby’s heart rate started to dip (decels)—something that I now know is alarmingly common among women who have epidurals—so I was given oxygen and flipped from side to side in an effort to stabilize the baby’s heart rate.  The decels came and went for the rest of my labor and the new heightened sense of medical risk only compounded the sense of loneliness and fear I felt.  External monitoring was no longer sufficient, so internal monitors were put in place, in addition to the oxygen and IV that I already had running. I don’t remember anyone ever explaining what was happening to me, or giving me any reassurance at all.  Without a consistent support person I had no one to help me get what I needed from my care providers, or to confide my fears in.  I remember a strong feeling of helplessness and the sense that the birth was very much happening to me, not at all something I was doing.  I can remember laying there feeling very scared and convinced that my birth was turning into a terrible medical emergency, one my baby and I would be lucky to survive. 

Later still Eric resurfaced, along with my OB.  I was apparently ready to push, though with the epidural I had no sense of my labor progressing or a readiness to deliver.  Pushing was surreal—suddenly the room was filled with people and action, in stark contrast to the previous two days during which I was often alone.  I had no sensation at all and no idea how to actually push a baby out.  No one gave me instructions that made sense and even if they had, I doubt I could’ve done anything with the information since I was totally numb from the waist down.  I had the oxygen mask on during pushing since the baby was still having decels and the whole thing really felt like a medical calamity.  Yet somehow I did manage to push and Caitlin was born at 2:30 pm on Friday, May 29. 

Since she was at least a month early and potentially suffering from birth defects she was taken right to a warmer to be thoroughly examined before I could hold her. I had some smallish tears that needed to be stitched while Caitlin was being examined.  While we were both being tended to I remember my OB saying, “Well, she’s not as small as I thought she’d be.”  Caitlin was perfectly healthy, albeit very small—no birth defects, no nothing—and it seems as if all the prenatal worry was for naught.

Eventually I did get to hold Caitlin for a few minutes, before they took her to the NICU for further observation.  I didn’t nurse her, and neither did the idea occur to me nor did anyone suggest I try it.  Throughout my pregnancy I looked forward to nursing, and was strongly encouraged to do so by many people, so it seems particularly strange that the idea never even crossed my mind when I finally got to hold Caitlin.  As I reflect on this I keep coming back to feelings of dislocation and detachment from what was happening, and from my baby.  During pregnancy I loved feeling her move and kick and I often talked and sang to her.  But somehow that connection was interrupted during labor and I lost sight of the tiny person that I already loved and was so eager to meet.  To this day I can’t explain why or how that happened, but I can’t help but think that the overwhelming tide of medical interventions obscured that bond.  Once Caitlin was born I can remember feeling relief that the birth was over, but not much else –I was physically and emotionally spent – and as a result we both missed out on the vital bonding that happens between mother and child in the first minutes, hours and days after birth.  It is a loss we will never be able to recoup, and though we have moved so far beyond it in many ways, the hole remains for me.

Eric had been present for the delivery and went out to the lobby to tell my parents the good news.  I can’t remember if they got to see Caitlin before she was taken to the NICU, or if Eric even held her at that point. The next thing I remember was learning that I had to leave the birth room and move upstairs to a recovery room and feeling so betrayed—how could they make me move after everything that had just happened?  But move I did.

My friend Christie had come down to visit from Chicago and she and my friends Erin and Jen, along with my parents, all trailed Caitlin to the NICU and kept a close watch as she was bathed and fed.  I was put in a recovery room, and I started asking when I could see my baby.  It was five-ish by then and after what seemed like an unreasonable delay, a nurse finally brought Caitlin in and I had my first good look at her.

She was tiny—5lbs, 7oz—but 21 inches long and terribly bony.  I remember being surprised by how red she was, and how long.  She even had a little bit of red hair.  Everyone was in my room then—my three friends, my parents and Eric—and we all passed the baby and ooh-ed and ahh-ed until a nurse came in and asked if I had fed her yet.  I still remember how at that moment I felt as if I was observing the scene from afar, not a central figure in it who had a vital role to play – feeling shocked and foreign to the whole thing.  And I think everyone else present was a bit shell-shocked too.  What can it possibly be like to watch your daughter go through such a difficult birth, or your partner, or your friend?  (I can remember telling Jen and Erin, “REMEMBER this,” as I labored and puked and cried…)  But Caitlin and I got right down to business and luckily she was an excellent nurser from the very start.

Eric and I were already on thin ice before Caitlin’s birth and the stress of an early induction and tiny baby didn’t help things.  The night she was born he went back to the bar where he worked to share the good news and didn’t come back.  I had sent Caitlin back to the nursery and I can remember, again, feeling all alone, not knowing what to do and having no one to turn to.  I didn’t think I could ask for the baby back and didn’t want to risk confiding in a nurse after all the lousy experiences I’d had during my labor.  The next day brought my parents and friends back to visit, and eventually, Eric, but in retrospect, that was clearly the beginning of the end for us.

Because she was born early and small I had to feed Caitlin every two hours and keep close records of everything—exhausting for any mom, but especially so for me after my long labor and on top of the storm brewing with Eric.  And I remember crying buckets when the perinatologist came to see us 2 days after the birth and announced that he was discharging us.  I still felt so lousy from the induction and so scared at the prospect of caring for a tiny baby on my own.  But he said, “Give me one good reason why I should let you stay,” and when I couldn’t he signed the papers and we were on our way.

Eric insisted on driving us home from the hospital but my parents were waiting for us on the front porch and helped make my homecoming a happy one.  I’m not sure how long they originally planned to stay, but they wound up in Atlanta for at least a month.  They spent everyday with Caitlin and me; helping out with the house and dog and providing me much needed reassurance and company.  I don’t think I did much beyond sleeping, eating, and nursing in that first month, thanks to their help.  And looking back, that was probably the best gift anyone could’ve given me; as a result Caitlin really started to thrive and I was able to begin getting back on my feet without any extraneous worries.  Eric was working an awful lot, seemed to be completely overwhelmed by parenthood, and was definitely not coping with it well.  When my parents finally had to go back to Wisconsin I cried and cried—now I was fairly confident that I could handle Caitlin, but I was so sad to be losing my best support people.  It wasn’t any surprise, then, that Caitlin and I moved back to Wisconsin in August, leaving Atlanta for good and starting our new life together on my home turf. 

Looking back I see Caitlin’s birth as a pivotal moment, if not the pivotal moment in my life.  Without experiencing a lonely and terrifying induction I doubt that I would’ve been lead to do birth work.  The labor itself distilled so many things about how I had been living and the choices I had (or rather, had not) been making and pushed me to choose a new way of being. Instead of taking for granted the authority of others and putting their ideas and opinions ahead of my own, I began to really question the options before me, and then chart my own course.  There were some incredibly difficult years on the horizon but I think that Caitlin’s birth galvanized me and gave me the strength to weather the storms that were brewing.  Many people told me then that having a baby, as a young, low-income, single woman was one of the dumbest things I could do, but for me it was undoubtedly the best choice I ever made.  I am incredibly grateful for the experience, as difficult and ugly as it was, because without it I know I would not have the amazing life and family that I am blessed with today.



Susannah said...

Again, with the tears.

Thanks so much for sharing this (and Ben's). Being that you and I have birthdays less than 2 weeks apart, I am just about the exact age you were when Caitlin was born. WOW, when I realized that, it really put this in a different light for me.

much love!

Heather! said...

She is an amazing girl and though I wish it had been a different kind of experience for you both, as you said, it might not have led you to where you both are today. Hope she's had a lovely day of celebrating!

margaret said...

Thanks for sharing this story, Maggie. It's a heavy one, indeed. You are amazing.

Big hug! And an early Happy Birthday to Caitlin!

Hannah said...

i could feel my heart breaking for you. what a lovely, honest story. i can tell that even though different, the tale of caitlin's birth was no less resonant to your life than that of ben. i'm glad to have heard it.

Lynch Family said...

You are so strong and so fierce and your whole family is blessed by your power and strength of mind. Your mama powers should be much admired.

katie said...

Thanks for sharing your story, Maggie. The best rewards come from difficult journeys.

And speaking of rewards: Happy 11th birthday, Caitlin! I hope you have a fantastic day.

paul said...

happy late birthday caitlin!! maggie, i'm glad you decided to share this story as well. thank you.

margaret said...

holy shnipies! it just hit me! 11 years!!

Sunflower Hill Farm said...

Maggie, you have nothing to apologize for. You are right. It is part of you, as all of our births are. The thrill for me was to hear what you learned, how you turned that experience into an empowerment for you. And, I have an extra insight considering I've seen you teach and work with pregnant women/couples. You could never be the wonderfully, effective teacher without this birth experience.
So many women, especially when they are younger, would take this and repeat it to themselves without being able to use it to their benefit. It is just one more piece of evidence of your strength as a person and a mother. Thank you for sharing both of your births (but you know me, the birth junkie, I love to hear birth stories!).

Happy Birthday to all of you!