Thoughts on a difficult birth

Now that Silas is 6 weeks old, and I have a little more mental space and energy to think about things other than his (or my) immediate needs, my thoughts have turned to his birth.  It's not something I decided to think about, but it keeps coming into my mind.

Before Silas was born, I expected that his birth would be painful, scary or daunting (at least some of the time), that it would surprise me in some ways, that I would find myself rising to whatever challenges were presented, and that whatever happened would be dwarfed by the enormity of new parenthood and the presence of Silas himself in our lives.  Those things all turned out to be true.  I had also read, hundreds of times, that birth can be an empowering experience for women, and that a "good" birth can help women appreciate their bodies, their strength, and the dedication and care they have shown their baby.  I was neither convinced my own labor and delivery experience would be empowering, nor was I desperate for the birth to be a certain way, but of course I hoped that I could say it made me feel strong and capable, whatever happened.

Silas' birth wasn't empowering at all, though.  Instead of powerful, I felt powerless.  I couldn't get labor to start on my own, so at 41 weeks and 4 days my labor was turned over to doctors, medicine and monitors.  (With my informed consent, of course.)  Because of the medications, I was confined to bed.  Not just confined to bed, actually; I had to lie down, and I could hardly move because of the monitors strapped on me - a little wiggle in the wrong direction and the nurse had to re-set them yet again.  It's hard to feel powerful or confident when you can't respond to the pain in your own way.  (My own way DEFINITELY does not involve being confined.) Eventually, I couldn't even just lie on my back, I had to lie on my left side in order to keep Silas' heart rate stable, which was extremely uncomfortable.  The bed was hard, the monitors were bulky, the gown got twisted over and over again, and I was tangled in my IV line and pulse oximeter.  I had to call for my nurse every time I wanted to pee, which, at ~42 weeks pregnant and while laboring with a constant IV drip, is a LOT. There were a few periods when I was allowed to take the monitors off, stand in the shower, and move around, but they were brief and tense, because everybody (including me) worried that the contractions would strengthen when I moved around, requiring the monitors to be placed again.  Most of the time, I was powerless to make myself feel comfortable.

After 48 hours of no sleep and 36 hours of contractions without any dilation, I had little hope left for a normal delivery - I felt sure I would either require an assisted delivery or an emergency c-section.  Even the family practice attending started talking about a c-section after Silas' heartrate took two particularly large dips.  I was still contracting every 3-4 minutes, and between contractions, I lay in my bed and cried as Brian tried to comfort me.  Every hour or so, Silas would experience a heart deceleration and 3-4 nurses would charge into my room all of a sudden, roll me on my side (it takes too long to move around at 42 weeks pregnant, even without an epidural), turn up the flow of oxygen and saline.  After 42 weeks of keeping Silas safe and healthy, I felt as though I couldn't even keep him safe for an hour at a time.  I couldn't keep him healthy inside, and I couldn't get him out.  What was I doing wrong?

It was at that point that I chose to get an epidural, not because the pain was too overwhelming (it hurt, but I was coping), but because I had 9 centimeters of dilation to go and I hadn't slept in days.  There was no way I could sleep through my contractions, and although sleeping through CONSTANT hospital noises, interruptions and interventions is difficult, it's easier than sleeping through labor.  Having the epidural placed allowed me to get an hour or two of much-needed sleep, and even now I think it was the right choice, but of course it took away the small amount of power I had left.  I couldn't roll over on my own.  I had to be catheterized.  And absolutely nothing about "my" labor was on my terms any more.  I was fairly helpless and at the mercy of my caregivers.  The fetal heart monitor beeped away next to my ear, and in order to get an hour of sleep, I had to turn it down and stop listening.  That meant that the only people monitoring Silas' wellbeing - his LIFE - were the nurses looking at their screens in the next room.  If I hadn't been so utterly exhausted, I wouldn't have been able to do it.

The mysterious part of the story is that my water broke on its own shortly after the epidural was placed (after I'd slept for an hour), and then, without any more drugs, I progressed to complete dilation in just 5-6 hours.  This was unusual and unexpected.  In retrospect, and after talking with my midwife, there is a likely explanation.  I was probably in prodromal labor for 1-2 weeks before my induction, and labor was probably not progressing because of Silas' posterior position.  (I had been having regular and painless contractions for months, and painful yet sporadic contractions for weeks.)  I lost my mucus plug and quite a bit of blood on my own the morning of my induction.  Usually, this means that labor will start within 48 hours.  It's quite possible that the Cytotec that I took in the hospital was basically ineffective (aside from the 36 hours of regular, painful contractions...), and that my "real" labor started spontaneously shortly after the epidural was placed.

I feel a bit better about the delivery phase of Silas' birth than I do about the labor.  I didn't want to deliver with an epidural, but epidural or not, I did the work, and I'm glad that I did, even if I have a lingering sense that I "cheated", or possibly that I "was cheated"...  I'm not sure which.  It took two hours; that's not particularly unusual.  Yes, I tore (a 2nd degree sulcal tear, a 1st degree tear, and the episiotomy), but that's OK.  Wounds can heal.  It's heartbreaking, though, to remember how Silas was taken to the warmer to be resuscitated immediately after he was born.  I wasn't the first person to hold him, and his first moments were not peaceful.  And I was so utterly, utterly exhausted that I was spending 75% of my energy desperately trying not to pass out.  (My midwife feels that this is probably because I'd had weeks of prodromal labor on top of the actual 40+ hours of induced labor with almost no sleep.)  I couldn't even hold up my arms and I could barely hear what was going on around me.  There was no triumphant moment, no pride, no sense of accomplishment... just a feeling that all I had done was (barely) adapt, (barely) keep up with what I absolutely, unquestionably had to do.  But not on my own, and not because I was powerful or capable.  At least that's how it feels.  And that's what makes me sad.

Now that it's been 6 weeks, I've had time to go over the "what ifs".  The most attractive "what if" to obsess over is, what if I'd just waited one more day?  It seems like I might have gone into labor on my own, and the whole experience could have been so different.  (This is an especially attractive "what if" now that I know my placenta was not deteriorating despite being postdates.  Possible placental degradation was the precautionary reason for my induction, and it's only after the fact that I know it wasn't necessary.)  What if Silas had been anterior?  Could I have turned him somehow?  Would he have been born nearly a month earlier?  (I had labor symptoms starting at 37 weeks, nearly 5 weeks before delivery.)  What if I hadn't had all those monitors on me?  Would he have been perfectly fine?  Would he still have needed resuscitation? It's exhausting to think about.

The funny thing is, labor is always out of your control.  If I'd given birth at home, on my own terms, I still wouldn't have been "in control" and things might have gone terribly; who knows?  It's not the specifics of Silas' birth that are the most difficult part.  It's the fact that so much of it was dictated by hospital procedures and regulations that it hardly seems like it was my experience or my accomplishment in any way.  I think that's the catch.  It was a difficult thing that I did, or experienced, depending on how you look at it, and, getting no sense of recognition from myself, I find I'm looking for it somewhere in the story.

I haven't thought about all of this much until the last few days.  Today, I went out alone for the first time since Silas was born.  I walked through the rain to a cafe and got a hot chocolate.  Without Silas' constant needs to consider, I found my thoughts turning inward.  Well, sort of.  It was strange to be out without Silas.  I felt so diminished ordering my hot chocolate, all alone, without my baby to show the world.  Did I look tired, or harried?  What if I simply appeared to be a tired and worn woman, rather than the proud (if sleepy) mother of that beautiful, rosy-cheeked baby?  New motherhood is a time when you give a lot, and the reward is (hopefully for all, and fortunately for me) a thriving baby. Without Silas alongside me, pink and glowing and smiling peacefully in his sleep, all I present is the other side of the equation - a young woman (do I still appear young?) whose body is still healing, who hasn't slept more than 3.5 hours continuously in 6 weeks, who hasn't thought a whole lot about herself recently, and whose hair may not have been brushed since yesterday noon.  Not some sort of special woman with secret knowledge or power inside, underneath the sleep deprivation.  That's why it was so strange, and a bit sad, to be alone, walking in the rain, thinking about myself and what this has all meant in terms of my own personal identity.  In the most meaningful sense, I truly think it doesn't matter.  But I do think it's necessary to process the whole experience and come to some kind of understanding, and I guess that process is happening now, like it or not.

Once a baby is born, everybody says "it was all worth it, wasn't it?"  And they are absolutely correct.  But that doesn't mean the struggles are forgotten, and I think it is important for women who had difficult birth experiences to honor those struggles.  Labor pain may be hard to remember after the fact, but a challenging birth is not erased from memory, and that's OK.