the birth of Morris Eugene

Friday, January 16, 2015. I had arranged to have the day off work, so that I could attend a Continuing Legal Education seminar in the morning, and use the afternoon to get ready to leave town. We were going to Jackson for the baby shower planned by my mother-in-law and her sister. The seminar was informative, and afterwards I grabbed a sandwich from Between the Bread before heading back uptown. On my way to the bus stop, I spotted a man in the neutral ground at Poydras & St. Charles wearing a kilt and playing a bagpipe as the traffic rolled by. I snapped a photo and thought: “Only in New Orleans!”

Adam was getting off work early, but not until 5 o’clock-ish, so I spent the afternoon packing and straightening up, because I hate returning from an out of town trip to an untidy home. I set out two extra bowls of catfood, since we only planned to be gone for two mornings. When Adam got home we loaded up the car, including the dogs, and hit the road at dusk. We stopped in Pontchatoula at Wendy’s for a quick supper. It was a dark night; the moon was old and didn’t provide much light. Somewhere in rural southern Mississippi we encountered a wreck, and traffic slowed to a crawl for about 15 minutes, but otherwise the journey was uneventful.

When we arrived at my mother-in-law’s condo, I downed a few glasses of water because I was making a conscious effort to stay hydrated in the third trimester; I had avoided drinking much on the road to avoid impeding our progress with frequent bathroom breaks necessitated by the baby resting on my bladder. I was hungry but nothing sounded apptetizing, so I decided to just go to bed and have breakfast in the morning.

Mid-night. Adam came to bed around 1:30 am, and I wiggled around a bit to get comfortable; at this point in the pregnancy, I was really missing sleeping on my back. As I re-situated myself, I felt liquid between my legs. I tried to convince myself that maybe it was an accidental pregnancy pee, but my intuition knew better: I know what it feels like to urinate, on purpose or otherwise, and this was not that. All week I had been experiencing increased discharge, which I knew was normal for the third trimester, and this was more like that than urination, except it was more. A lot more. Comparatively copious. My panties were soaked, and when I stood up, fluid seeped down my legs, and trickled quickly to my feet before I could get to the toilet. The fluid was clear, neither brown nor pink, but my heart was racing, because I knew it was amniotic fluid.

I was just shy of 34 weeks gestation, and I was 3 hours away from my midwives; the thought of having the baby in these circumstances was absolutely terrifying. Not to mention that we had a baby shower the next day, and if this was a false alarm I didn’t want to disappoint all the guests who were expecting us. I probably spent 10 minutes in the bathroom investigating the fluid (smelling it, and, yes, even licking it) and generally freaking out.

Finally, I went back to bed, and Adam asked if everything was okay. By this time I was feeling mild cramps that were distinctly not Braxton-Hicks. I told him about the fluid, and the cramping. We decided to get some rest, because whatever was happening it wasn’t urgent, and we would need rest for whatever the next day might hold. Although the cramping continued intermittenly, I was able to sleep through it and get a decent amount of rest.

Saturday, January 17, 2015. Daylight dawned and I awakened. I immediately went to the toilet to investigate the situation between my legs. There was still a good bit of moisture, with the only slightest pink tinge, nowhere near a bloody show. The intermittent cramping continued, low in my belly, like menstrual cramps. I started timing these sensations which I was increasingly inclined to call contractions. I went back to bed and sat still for a moment, communing with my body and my baby, and my intuition told me that everything was going to be okay. The contractions were coming irregularly, anywhere from 10-15 minutes apart, and lasting only about 15-30 seconds. It was a struggle to keep my heart from racing, because I knew that this was labor, and it was not what I had envisioned or prepared for in oh so many ways.

I woke Adam up, and we decided to call our midwives. Since it was the weekend we had to go through the answering service, but Esther called us back within 5 minutes. After hearing my story and asking some questions, she advised that we go to the nearest hospital to get checked. I was loathe to go to a random hospital in Mississippi and deliver with a doctor I had never met, but she said that, even if we were at home in NOLA, she couldn’t manage labor and delivery at this early gestation. So I next called my insurance company to see which local hospitals were in-network. Adam and I went through the list and decided on River Oaks.

We brought my mother-in-law up to date on the situation, and asked her not to cancel the party, but rather to explain our absence to the guests. We walked the dogs, since we didn’t know how long we’d be gone. We each ate a bowl of cheesy grits.

On the ride to the hospital, I played Björk’s “It’s Not Up to You”

I can decide / What I give / But it’s not up to me / What I get given / Unthinkable surprises / About to happen / But what they are / It’s not up to you / Well it never really was

My over-thinking mind was racing with worry, despite my earlier intuition that it was all going to be okay. I feared so much: that I would have to be cut open to get the baby out, that the baby was in danger being so early, that one or both of us might not survive. I was not prepared for potential catastrophe; this was supposed to be a natural physiological function with minimal medical intervention. I thought I had over a month still to prepare myself, body and mind. The only thing I knew with absolute certainty at that point was that I had to face this day with courage and strength.

Walking into the Emergency Room, I was filled to the brim with anxiety. Luckily, we didn’t wait 5 minutes after checking in, despite a waiting room with about half a dozen people in it. Labor and delivery issues are expedited from the ER to the appropriate department of the hospital, so after the briefest triage, I was literally whisked away to the L&D ward, in a wheelchair as per hospital policy. I was not happy being in the wheelchair, since I felt perfectly capable of walking. I feared that this was indicative that “hospital policy” would override individualized care for myself and the baby.

In L&D, I was invited to get out of the wheelchair if I felt up to it. That was encouraging! After giving our insurance information, we were sent to a room. I peed in a cup, and had my vitals taken. The nurse was really kind and compassionate. She swabbed the fluid I was still slowly leaking, and got me hooked up to the fetal & uterine monitors. While we waited on the lab results, I checked in with my mom and my boss to let them know what was going on.

Noontime. The results came back: I’d been leaking amniotic fluid, as suspected. The monitors confirmed that the cramps I had been feeling were indeed contractions; at this point they were quite regular, about every 10 minutes. Happily, baby’s heart rate was strong and normal. When the nurse came in and placed a bar-code bracelet on my wrist, I was officially admitted, and I began to process the fact that my labor and delivery would be nothing like I had planned or imagined. This baby was coming early, far away from my home, my midwives, and my doula.

The head nurse came in with my nurse and a third nurse to check on me, and while I was being prepped with an intravenous catheter in my left arm, the nurses told me that the on-call obstetrician, who was male, would be inclined to follow hospital protocol rather than provide me with individualized care. These women, strangers to me, supported my efforts to bring my baby into the world without any unnecessary interventions. Here they were, warning me that the person ostensibly in charge of the show would derail my efforts with “routine procedures.” I was disheartened.

But, wait! There was another OB! And she was possessed of a uterus all her own! And she would be unlikely to suggest any interventions that were not medically indicated based on my and the baby’s situation! Hoorah! This saving grace was not on-call, but she was physically present at the hospital and would likely attend my birth if I expressed a preference to have a female OB. I emphatically explained that I had never seen a male gynecologist, and I would not be comfortable having a male OB attend my labor and delivery.

Once we knew we were settling in for an undetermined amount of time, Adam went to get some things to help us be comfortable. He had to go a few different places to create an ad hoc hospital bag for me. I had already started packing my hospital bag, in fact, but of course I hadn’t brought that bag; why would I have?! He wasn’t able to scrounge up everything I would have packed had we been at home, but he did manage to get an exercise ball, which would really come in handy later.

While Adam was gone, I checked in with Esther, just to bring her up to date, and also with my doula, for some emotional support. Despite the surprises and the deviation from my plan, I was feeling pretty good. An ultrasound showed that not only was the baby head-down, but also very low in my pelvis; perfectly in position to make its grand appearance via the intended route. The heaven-sent Dr. Edwards did not suggest any interventions to speed up labor, and was content to take a wait-and-see approach. It was not early enough in the pregnancy to try to stop labor, which was good; at least I wouldn’t have to stay in the hospital on bed rest.

I was put on IV antibiotics, though, since I had not yet had my group B strep test, and also because of the premature rupture of the amniotic sac. I was given a steroid shot to help the baby’s lungs develop; the baby’s ability to breathe on its own was one of the major concerns about delivery this early. I was able to eat, and Adam brought me a cheesy potato from McAllister’s, and some broccoli-cheese soup. I wanted to avoid routine vaginal exams, and Dr. Edwards agreed. She was even on board with intermittent fetal monitoring, to allow me sufficient opportunity to move freely.

Twilight. Just as the sun was setting the nurses suggested we move into a bigger room. Since the Big Room was empty, and I was determined to have a natural birth, the nurses wanted me to have more space in which to move about, which was very thoughtful. The Big Room was on the corner of the L&D floor, with windows facing west and south; perfect for winter. I brought my birth ball over to the western window, set up my phone to play relaxing music, and watched the sunset while doing pelvic rocks. I was feeling very good; birth endorphins were flowing, and I felt loved and supported. I was excited to meet my baby; my intuition told me that the baby would be fine even though it was early. I remember thinking about how this was the last sunset I would see without my child earthside, and how in the coming night I would be joining the endless chain of laboring women, navigating the precarious precipice of motherhood.

At this point my own mother was well on her way to the hospital. When she arrived, Adam went to get some supper for us. I opted for a light but nutritious meal of hummus and pita. I was put on notice that I wouldn’t be allowed to eat after midnight, in case cesarean surgery became necessary. I knew that this was not an evidence-based recommendation, but I felt confident that I wouldn’t be laboring long enough to make it worth negotiating. Besides, Adam had brought some light snacks that I could sneak if I got too hungry. I saved the second half of my pita and hummus to eat right at midnight.

The night shift nurse was nice, but quiet, and we didn’t have as good a rapport as with the day shift nurse. The new nurse was not as inclined to let me spend much time off the monitors, but she didn’t push the point when I would ask for another 15-20 minutes here and there. During the night I paced, I did standing pelvic rocks, and I swayed my hips. I listened to what little soothing classical music I had on my phone. I lamented that the birth music play lists I had been working on were, of course, not loaded, since this premature birth business was wholly not anticipated. So I listened to the most appropriate choices on an endless loop.

The contractions were increasing in intensity, and I was growing weary. Sometime after the 2am vitals check, I reclined in the bed and got some fitful rest. The contractions kept me from sleeping well, but I was able to rest in between them. I even napped a little bit more following the 6am vitals check.

Sunday, January 18, 2015. By 8am, I was ready for a vaginal exam to check dilation, feeling confident that the increasingly uncomfortable contractions had been productive through the night. I was saddened to hear that I was only at 1cm.

Shift change, and I was pleased with the new nurse. She had two natural births herself, and had taken Bradley Method classes just like we had. Even still, augmentation with pitocin was suggested by Dr. Edwards. I was loathe to deviate from my plan for a natural labor, but it had been more than 24 hours since rupture of the membranes, and I knew that, even though the absolute risk of infection was low given the antibiotics and the paucity of vaginal exams, my baby was extra vulnerable, being just barely 34 weeks gestation. So I grudgingly agreed to the pitocin.

Around 9am, I was hooked up to a low-dose pitocin drip. Although we wanted the baby to come, there wasn’t a huge hurry because we wanted to get in another round of steroid shots and to have 24 hours of the IV antibiotics. The pitocin took about an hour to kick in, and the change from natural contractions was acute. Gone was the anticipatory hormone-endorphin pulse-pause feedback loop, leaving my body at the mercy of unrelenting synthetic oxytocin. I was also now tethered to bed; because the unnatural contractions increased risk to the baby, we were now subject to constant monitoring.

I was getting weak from lack of food, and little meaningful rest. Even still, I spent a few hours working through contractions while standing in various positions, and squatting on my birth ball next to the bed. The contractions started being fruitful, as evidenced by some real bloody show, but upon examination, I was only at 2 cm. We made it to the 24-hour mark with the antibiotics, and got another steroid shot. The steroids made me feel hot and bothered.

Transition hit me like a ton of bricks, and I had a few exceptionally unpleasant moments of dry heaves. I didn’t want Adam touching me, or even speaking to me. I couldn’t tolerate listening to music, either; I was wholly inwardly focused. I got back in bed, and arranged it so that I was sitting upright. I told Adam I just wanted to be done. I was managing the pitocin-contractions well enough, but I was tired, and it was painful; the contractions were double-peaked, with hardly a break in between.

Time ceased to have meaning. At some point I consented to increasing the pitocin dose to speed things up. At a subsequent point I wanted another vaginal exam to gauge progress, and I was now at 4cm. The nurse said a part of the bag of waters was bulging through, and the doctor could burst it to speed things up. I was scared of any increase to the intensity of the contractions, but I was ready to be done. When we were alone again, Adam and I talked, and he helped me push through my fear. The nurse got the doctor, and the bulging bag of waters gushed open at the mere touch of her finger. The sensation was bizarre, as there was quite a lot of amniotic fluid remaining despite the leak that sent us to the hospital in the first place.

Dr. Edwards then confirmed I was dilated to 4cm, and remarked that she could stretch me to 6 or 8. While stretching my cervix, she asked if it hurt. I said that it wasn’t comfortable, but it was nothing compared to the sensation of these contractions. She asked if I had ever had any procedures done on my cervix, and I said no. She replied that my cervix was likely just being stubborn, then, because this was my first baby. She smiled and reassured me that the baby would be here soon. It seemed like she had barely left the room when I felt a distinct urge to poop. I told Adam, excitedly, “I feel like I need to poop! Get the nurse!”

The nurse came in and checked me and told me I could start pushing whenever I felt the urge. She turned off the pitocin. There were suddenly a lot of new people in the room: two folks from neonatology, the doctor, and another tech-person. These people brought in extra equipment and they turned on bright lights, and I started to feel a bit self conscious. I tried to stay focused on the nurse and Adam, who were both encouraging me. I really felt like I was going to poop when I started pushing, and sought reassurance that it was okay if I pooped. The nurse assured me that it was fine, to just relax and let everything come out with the surges.

I was vaguely aware of the doctor getting scrubbed up, and putting on a weird face-mask-thingy to protect her from my birth fluids. Once she was all outfitted, she was in between my legs, looking up at me, smiling, and I thought her face looked rather absurd behind that mask in the bright lights. The nurse asked if I wanted a warm perineum compress, and I said I didn’t know. The doctor asked if I wanted to put my feet in the stirrups, and I said no. I just wanted to stay how I was, in a weird crab-squat at the edge of the bed. She told me that was fine.

I started pushing when the urge came, and it was hard work! I was really hot and sweaty by this point, and I wanted to peel out of my hospital gown. The nurse helped me disrobe, and Adam was swabbing my head and neck with cold rags. The sensation of the baby squeezing through my vagina was really intense, but it was a pleasant change of pace after the rigors of pitocin augmented dilation. I got really vocal during the pushes, gone was my inhibition.

I was scared to stop when the urge to push passed. I asked if it was okay to rest, and everyone told me it was fine, to listen to my body and only push when I felt ready. When the baby’s head became visible, the nurse took over swabbing my head and neck so that Adam could take a look. They asked if I wanted to feel the head and I said no. The nurse was really encouraging, saying that my pushes were stretching my perineum slowly and perfectly. The doctor commented that the baby’s head was full of hair.

At that point, I just wanted the baby out. I was worried about the baby’s fragility because of this premature birth business, and I was about ready to be done with this birth that had not gone at all according to plan. I was never cognizant of a ring of fire, but I would soon learn that I had suffered some second degree tearing. After what seemed like an eternity spent squeezing my child earthside, a baby was finally in my arms. A brand new, squishy little person had entered the world via my body.

5:10 pm, and the sun is setting on my son. The baby let loose a good, healthy cry. A boy! I called him by his name: Morris. He came immediately to my chest, and would have snuggled happily there had not the neonatal team swooped in, removed his blanket, and placed a cold, metal stethoscope on his tiny chest. I cooed in awe at my baby, and time remained meaningless.

The doctor asked if they could cut the cord, telling me that about three minutes had passed, and I said yes. Before I knew it they were taking the baby, I was being prepped with local anesthetic, and it was time to push out the placenta. It plopped out easily. Then I was being stitched up. The lidocaine didn’t cover the area where the last two stitches needed to be, but it wasn’t worth a second injection.

By the time I was all fixed up, the baby was all swaddled, and I was instructed to bid him goodbye. He was whisked away, gone to the Neonatal Intensive Care Unit. Gone with him was our opportunity to spend that first golden hour together, and I grieved that loss. But I knew he was a fragile preemie, and that he was where he needed to be.

I was eager to get my IV port out, but the nurse said it needed to stay in place in the event I needed pitocin to stave off postpartum blood loss. She massaged my abdomen to encourage my uterus to contract back towards regular-size. It was a little tender, but not bad. She had me scoot up, and placed fresh bed linens under me, including a soothing icy-pad between my legs. She asked what I wanted to drink, and I requested orange juice. When she brought it to me, she said to let her know when I felt ready to urinate, and she would be there to help me. Adam and I cheered OJ for a successful birth.

People came in to see me: my mother, and my mother-in-law and her sister. I downed my own OJ as well as Adam’s, and it wasn’t long before I felt ready to pee. The visitors went with Adam to see the baby in the NICU, and I walked to the toilet with the nurse. Walking felt good, and the relief of urination far surpassed any discomfort. The blood was copious, but not alarmingly so. The nurse walked me through using a peri-bottle, and got me situated in some gauze underpants with a diaper-sized pad, an icy-pad, and some tucks pads. She changed out my bed linens again, and palpated my abdomen, noting that my uterus felt good.

I brushed my teeth, splashed cold water on my face, and re-did my bun. I felt amazing, sailing on the hormonal high of a mostly natural childbirth. I was so grateful to have no narcotics in my system, no incisions in my abdomen. I felt capable and strong, in full control of my body and mind. I was the goddess embodied, resplendent in my ability to bring forth life.

My husband and my mother returned to my room. Adam asked what I wanted to eat, and reminded me that it was getting late on a Sunday evening, such that my choices for take-out were growing fewer with each moment that passed. I requested a steak and potato, figuring that he could procure a decent version at any number of chain restaurants. My mother stayed and chatted with me while he was gone, my teeth chattering a bit as I worked through the after-birth shakes.

I wanted to visit the baby, so a wheelchair was brought, and my mommy took me to my own child. He was so small and pink, and it was surreal to see him lying there in a plastic box, connected to wires and tubes like some kind of bionic creature. I spoke to him through the port-holes in his isolette, and he turned toward my voice. A nurse removed him from the box and placed him in my arms. We communed for a few moments, my mommy, my baby, and me. And the nurse. With her hovering, I felt as if he wasn’t really mine to hold and adore. And so I let her put him back in his isolette, and let myself be wheeled back to my room.

About the time we got back, Adam had returned with my feast. I said goodbye to my mommy, and we ate our supper before being moved to the postpartum floor. The nurse there seemed confused by my refusal of routine pitocin and pain medication. I did take the stool softener she offered, though, because I didn’t want to put any undue exertion on those stitches. She wouldn’t remove my IV port until morning, on the condition that my uterus continued to do right on its own. She got me an electric breastpump, and explained how to use it.

I wanted to go see the baby before bed, so we did. Looking at him I was enormously proud that he was doing so well, but also heartbroken that he was too fragile to be in my arms. I wanted to put him to my breast, but the nurse said his breathing was too irregular to try just yet. The neonatal nurse practitioner came to ask us if we wanted him on formula or IV fluids to start out, and we agreed on IV fluids, knowing that I would start pumping immediately to get him some liquid gold instead of formula. We said goodnight to our precious preemie, and made our way back to my room on the postpartum floor. In the hallways you could hear crying babies in their mothers’ rooms, and I was acutely envious of mothers whose babies were well enough to be rooming in.

We settled in the postpartum room, and I hooked myself up for my first pumping session. It produced only minuscule drops of colostrum which were not even collectible in a syringe. I set an alarm to wake up in the middle of the night to try again. Still, only minuscule drops came. By the 5:30am session, however, I was able to collect 1ml of colostrum.

Adam went to get some breakfast and snacks, and I felt the urge to poop. I was a little scared, having heard horror stories about the first postpartum bowl movement, but I remembered that the advice was to not put it off; go when the urge strikes. So I braved the toilet, and it wasn’t bad at all. The stool softener helped, and I felt much better afterwards. I drew myself a sitz bath in the tub, and soaked until the water cooled off. Then I was off to see the baby.

Baby Morris and I were able to do some skin to skin, and when he was in my arms his vital signs all hovered steadily in the normal range. So encouraging! The neonatal nurse practitioner again brought up formula; she said that what I had produced so far was not enough for him, that he needed something to fill his little belly, and that it was unlikely I would be producing enough by the time he was ready for more than IV fluids. I agreed that we didn’t want his belly empty, and that he could have formula if it was necessary. In my heart, though, I was determined to ensure that it would not be necessary.

Back up in my room, I looked at my baby’s picture and listened to relaxing music during the next pumping session. I got about 3mls of colostrum! Just in time for his transition to a nasal-gastric tube for feedings. I was encouraged to put him to my breast during the tube feedings so he associated being there with getting full. I kept up a demanding pumping schedule, did as much skin to skin as possible before my discharge, and I was able to stay one feeding ahead of his needs.

When it was time for me to leave the hospital with my baby still in the NICU, I was devastated. Going to the hospital pregnant and leaving without a baby felt wholly wrong. I tried to be strong, but there were tears. Adam had gone back to New Orleans to feed the cats and to rent a hospital-grade breast pump for me to use at home, so it was just myself and my mother-in-law leaving the hospital. No baby. No husband. In the middle of the night, I drove back to the hospital to use the pump, and to put my baby to my breast for his feeding. Afterwards I went home to sleep, but I was there again in less than 12 hours.

Morris would spent one week in the NICU; he was discharged on his seventh day of life. It was the hardest week of my life, balancing pumping, spending time with him, and self-care. With lots of moral and physical support from my family, I got through it. And Morris has been an absolute pleasure ever since.