Baby, Birth, birthday letters, gratitude, Norah

Birth Story: A Letter

Dear Norah,

I’ve written letters to your brother on each of his birthdays, and I intend to do the same to you.  Your first letter though will be for this first Birth Day when you entered the world, and I’m writing it now when it’s only been a few weeks, and I can clearly remember all the sights and feelings of those first few hours.  I know a day will come when I might forget some of these tiny details, but there are so many things about that moment that will remain stamped in my mind forever; I know it.

Your brother’s birth cracked me wide open, in every sense of that phrase.  It was a long process and ended with some details I did not anticipate, and as surgeons pulled his little body from my belly, I was ripped open literally and figuratively. All kinds of new love came from the cracks in my broken heart, and I love him for it.  His birth taught me a million things I didn’t know before and gave me new eyes for so many things I’d never seen, but sadly, I didn’t really believe in my ability to do everything I needed to do to consider myself a real mama, and part of me assumed I just wasn’t made for birth.  The scar on my belly and in my heart stayed there for a long time.

Then you came and you grew and that scar literally disappeared from my view as the nine months progressed.  I think you were already whispering to me from where you were, telling me that I was every bit the woman I wanted to be and that we could do this together.

When May 18, 2012 arrived, and I felt that first contraction, I really thought it would be a slow, painful, long process and my nerves started to set in as my old fears crept up a bit.  You didn’t leave time for much of that though.  First a reminder at 11:30am, then another at 11:45, then another about 12 minutes later.  You were telling me that my body was working, and it would work so much faster than I thought it could.  I insisted on a full tummy though, so I made your dad and brother sit with me to eat lunch.  It was our last meal as a family of three, and in typical Jude fashion, he was shouting, “Stop dancing, mama!” as I tried to sway through the contractions.  Your Grammy came to get him, and then Nana arrived and your dad drove us to the hospital.  Drove is an inaccurate depiction really.  He flew like a bat out of Hell and cursed the traffic while envisioning his precious daughter making her entrance on the side of GA 400.  Contractions were coming every three minutes at that point, and he and your Nana were getting nervous that I was close to meeting you and the hospital was too far away.

But we made it, with four hours to spare actually.  I waddled in the door of the hospital and stopped every couple of minutes to grip a wall or a doorway and moan through a contraction.  As you grow, you will find this funny, I think.  I’m typically a fairly private person about that sort of thing, but I didn’t care.  Again, your perfect pace didn’t leave time for self-doubt or second guessing, and I am so grateful for that gift.  A surly woman checked us in and took too long on the monitor strip, but once she was done, we got settled in our Labor and Delivery suite with a kind nurse and our awesome doula Pam, and things really took off.

earlier labor

Contractions were coming one on top of the other, and I started shaking and became very demanding of your father, which is a trait you will see the rest of your life.  It hurt.  And I was starting to wonder why it hurt so badly when my dilation was only a “four or a five” when I was checked minutes ago.  I thought a hot shower might help, so I stepped in and let the water pour over my back and I did find some comfort, but you were still being heard so much more loudly than I expected at this stage of the game.  I asked to be checked again since I really wanted the warm comfort of the tub.  My midwife told me that I was progressing well, so I stepped in the warm water.

my team.  :)

I think you had your sights on being a water baby from the start because often the warm tub will slow down a laboring mom, but for us, this is where things really picked up.  Your dad was playing a soundtrack of El Ten Eleven and City and Colour, and I just listened and pretty much held on to him for dear life, and before long I found myself loudly vocalizing to get through the contractions.  With your brother, I endured nineteen hours of unmedicated labor and a surgery following that, and the whole time I remained so silent you could hear a pin drop.  I tend to turn inward when dealing with discomfort of any kind, but you sent me a message that sometimes we surprise ourselves, and I found that vocalizing really helped me with the pain.

This is getting hard.

Sometimes I lamented that “Oooooooch this huuuuuurts.”  And sometimes I told my body to “open, open, open.”  And at one point, I started talking to you and telling you to “come on baby, come on Norah.”  And with every all-consuming contraction, you were talking back to me and telling me it wouldn’t be long.  I think we are going to talk a lot, you and I, because we were doing it from the very beginning.

Then next thing I know, my body starts pushing a bit with each contraction as you move downward.  And then pushing a lot.  I push and I push, and I thought I would be so anxious at this point of the delivery because it’s where things went awry last time.  But again you were looking out for me.  No time to be anxious or question or even think really.  I just rode the wave of each contraction and listened to my body and pushed when it told me to.  And for the first time in thirty-one months, I began to think maybe I really was strong enough to do anything I wanted and perfectly created to do this.  I started saying so aloud, “I can do this;  I can do this;  I can do this,” like a chant.  Everyone in the room was assuring me that “You are doing this,” and I gladly hung some hope on their words of encouragement.

With each push, you came closer to meeting me, and it hurt more and more.  I began yelling loudly, or I remember it that way.  Your dad assures me it wasn’t that out-of-control, but I swear he is just being kind to me because I seemed to remember screaming like a banshee as you moved through my pelvis.  I started to waver a bit on my confidence, but my midwife looked right at me and assured me that I was doing it and you were minutes away from my arms.  She told me your hair was waving in the water as I would sway between contractions, and a smile emerged for me because I knew we were close.  With another push, she encouraged me to feel your head, and so I did.  You were partially out and all soft and warm from the water and from your place in my own body. That moment of feeling your fuzzy little head in that water while the rest of you was still part of me will forever remain in my memory, Norah.  Someone in the room commented on how amazing it was that the perfect song was playing at just the right time, and I like to think that was another little nudge from you that everything was coming together exactly as it should to make this magic moment.  The next contraction came, and I gave it a few good pushes, and out popped your shoulders and the rest of your tiny little frame, and with the help of my midwives, I lifted your beautiful body right from that water to my own chest.

Norah

And you did not utter a sound or make a cry yet, but I felt as if you had been talking to me for months, telling me that we could do this together and I was not broken and that I was every bit the mama you needed.  And you looked at me.  Just looked.  For the longest time.  Those big silent eyes just looked and blinked a bit as if to say that you completely expected this moment and there was nothing surprising about it.  I talked to you and I kissed you, even with all of your gooey birth stuff on your sweet little head.  And I remember saying aloud that I felt like a new woman.  I think what I meant at the time was that the all-consuming pain of the work of labor was over in an instant.  But now I hear that statement with new ears because I really was a new woman in that second, one who knew that she wasn’t broken.  And I can never explain to you in enough words or long-winded letters how much gratitude I have for that lesson, Norah.

Norah
Being a woman is hard.  We judge ourselves and we expect too much and we internalize everything.  It breaks my heart that you will learn these lessons someday, but I know you will.  All I pray for in my life with you, in my years of being your mama, is that I can somehow give you the confidence and love and overwhelming gratitude that you gave me at 6:39 pm on that day.  I look at you and I know with all certainty that you are beautiful and perfect and created to do anything in the world that you set your mind to, and apparently so am I.  Thank you for teaching me that and for loving me before you even arrived.

Love,

Mama

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Birth

Sibling Love. And postpartum rambling.

She's here!
our final photo from the pregnancy series

We are home and getting settled a bit as a family of four.

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Our first family photo. Norah is about 25 hours old here, and Jude about 31 months.

Having two under three years old isn’t crazy chaos all the time, but it is definitely crazy chaos sometimes. We are rolling with it though, and Jude is being super sweet to little sister.

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The first time they met, last Saturday night.

I have so much to say, and I am dying to write the birth story, but everything happened really fast once we got to the hospital, so I’ll need my doula’s timeline and photos to write a proper one. I’ll say that it made me feel high and powerful and vindicated and confident and all of the things I thought it would. As it turns out, I’m not broken after all. My body works and it works best without intervention. Last Friday was an amazing day.

But I am finding myself sad in a different way about my cesarean lately. The postpartum hormones don’t help, I’m sure. But before, I was sad for some lost early moments with my son, but mostly just sad for myself if I’m being completely honest here.  I had such a pervading feeling of failure and inadequacy that is completely erased now.  But after Friday’s moments of holding my baby just as she came from me and pulling her from that water myself to lock eyes with her for the first time, I am suddenly reminded of that missing moment in my life with my firstborn.

And then I worry that he will grow up to know how powerful his sister’s birth was for me and how disappointing his was in ways.  And it doesn’t mean that I am disappointed with him in any way, of course.  I would hate it if he grew up to think that.  And I’m sure I am overanalyzing all of this since he is a boy after all, and he doesn’t want to know his mom even has a vagina, much less how I feel about babies coming out of it.  And in this haze of postpartum hormones, I know I am a little sad to see him feeling “left out” or not special anymore, even for a moment.  And that is spilling over into my memories of my kids’ births now, too.
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But what I am realizing is that it took a certain path for me to get to that place I was at last Friday afternoon.  The feelings of joy and elation and amazement are there for every mother, I know.  But my particular joy only came from the path I walked to get there.  I had to walk that road to bring me to that moment.  And I will never be grateful for how it all began for me, but I am so grateful for the path it took me down.  For the experience it gave me and the lessons I learned.  It shaped the type of mother  I became, and that person is still growing and would not have begun this path without what happened in October of 2009.  And that moment, crushing though it was at the time, made me a mother.  And as amazing and transforming as last Friday was for me, that is a claim Norah can never make.  My first birth made me a mama and that is a joy all its own.

Birth

We did it!

Welcome to the world, baby Norah!
We did it!

May 18, 2012
6:39 pm
7 pounds, 10.5 ounces and 20 inches long

She was born in the water without a single medical intervention. I have so much to say when I have the time to string together words and photos and details of the birth. For now, I’ll say that I am blessed beyond measure. She is perfect and healthy and it was every bit the amazing, healing experience I hoped it would be.  We are elated.

pregnancy

Happy No-Surgery Day to Me

Today I am 39 weeks.

Last Friday, I had a pretty intense bout of prodromal labor that didn’t have me calling my midwife yet or rushing to the hospital, but it did leave me thinking labor might be imminent in the days following.  Then Saturday it sort of puttered out, and it all eventually stopped.  Now I am back to being large and still pregnant and completely unable to get comfortable.  I’m also back to assuming she will follow big brother’s timing and arrive something like two weeks from now.  I think I must take a long time to cook a baby.

Do I love being pregnant?  No.  Especially at this stage.  But I realized last night as I was aimlessly cleaning the kitchen and thinking about what we were going to have for dinner that I would be feeling very differently if I wasn’t making the choice to let her come on her own.  Repeat cesareans used to be performed as early as 37 or 38 weeks, but since March of Dimes’ 39 Weeks Campaign has affected hospital regulations recently, most doctors choose to do the surgery at 39 weeks.

Which means, of course, I’d be on an operating table about now.  Or I’d be finally holding my newborn maybe after the hours of separation it takes to recover from surgery.

And while finally holding my newborn sounds really good right now, the idea of CHOICE is sounding pretty good right now, too.  I’m so grateful for the choice to deliver my baby in a way that is accepted by ACOG as safe.  I’m grateful for the research available to help me make that decision.  I’m grateful for the awesome provider I’ve found who supports my choices 100%.  I’m so grateful for the opportunity to let my baby choose her own birthday.

Happy 39 Weeks to me!  Still pregnant.  And happy about that.

Birth

The VBAC Question, otherwise known as the chip on my shoulder

Stopping by today to post something I wrote 5 weeks ago.  Now that I am out of the pregnancy closet, so to speak, I can finally publish it. Most of these statistics and facts can be found in numerous places, but I’ve sourced a few references here to be direct.  It’s an issue that I never thought would affect me and one that affects one in three American mothers.

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As I write this, I am only 7 weeks pregnant and haven’t told many people at all that there is an exciting new chapter ahead for my family.  I also can’t muster the energy to think about a nursery or baby names or much else that lies at the end of this part of the story because I’m right in the thick of that pregnancy icky-ness that overtakes you at about this stage of the game.  The fatigue.  The “morning sickness” that sticks around too late in the day.  The sore boobs.  The tiny cramps that make you wince in anxiety when it’s probably just the expected growth taking place in your body.  I can’t think much about the end or how this baby will arrive here and how I’ll be at that time.  But despite my inability to really focus on that, I know one thing for certain.  I want a VBAC.

Want really isn’t even the right word to use here.  I yearn.  I hope.  I pray.  I need.  And I have for the past 23 months and two weeks and some-odd days that I’ve lived in my post-cesarean body.  Every time I undress and step in to the shower and glance at that scar, I pray for a VBAC.

Some people surely think I am unhinged, and I’m becoming okay with that fact.  But that doesn’t change my feelings on the issue or what I want for my life as a mother, what I want for the beginning of a new life with the tiny one I’m growing.  It’s so hard to explain to people, why my cesarean threw me so off-track.  Why I hate that it happened.  Why I still cry about it at times.  And the truth is I don’t know why some of us are so affected by surgical birth and some women don’t mind it or even prefer it.  Some movies probably make you cry hysterically, and I don’t even bat an eye.  That’s life.  I don’t know why humans are different beings affected differently by the world around us, but we are.  And I wish I didn’t have a chip on my shoulder about this, but I do.  It’s a wound that heals and reopens again and again, and I expect it to be that way for a long time.

The best I can explain it is that I feel like I missed it.  Like I wasn’t even there for the birth of my own firstborn son.  I wasn’t under general anesthesia, so I was kind of there, I suppose.  But it doesn’t feel that way for me.  My arms were tied down like a crucifix, and my baby was extracted from me.  When I think back to my son’s first moments of life, that is what I remember.  Then the anesthesiologist knocked me under without asking my permission, woke me up three hours later, told me my gown was so bloody my family would think I was massacred, and stripped me naked to change me in the bright lights of a busy recovery room.  Then my husband walked up with my baby and there he was: my newborn son.  I could not touch him or hold him where I was, so we went to get settled in my postpartum room where I could hold him finally.  And as the days passed, I was so grateful for the 20 or so hours of intense pain and real labor that came before surgery because they seemed to tell me that he was really mine and I was really a mother.

I am fully aware that some of you reading this are thinking I should shut up and be grateful for a healthy baby, and you might tell me so in the comments.  And to that I say, I know.  I know I should be grateful for his health, and I am.  I know there are women who don’t have healthy children to tuck in at night and women who have years of trouble conceiving those children in the first place.  And of course my pain would multiply ten times over if he’d emerged from that surgery with health issues.  But grief is not a competition, and while I hold a lot of gratitude for so many things in my life, I hold a lot of grief for the abrupt way that motherhood began for me, for some lost moments and feelings that won’t ever be returned.

Still though, despite a healthy baby, I spent the next month of my life crying daily about how I was defective and my body didn’t even work and I didn’t deserve a baby because I was not a real mother.  I don’t talk about it much, and only my husband and close family really saw the full psychological result of my cesarean, but it was intense and painful.  And slowly these wounds have healed, but I am swallowing a knot in my throat as I type this, so there is still so much work to be done.

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As I was being prepped for the OR after almost four hours of pushing with an occiput posterior baby, I vowed VBAC for my next one, and I heard two voices in the room – both medical professionals – responding to me.  One said, “Oh, VBACs are too dangerous.  Nobody does them anymore” and another said “Of course you can and that would be better than repeat surgery and they are totally safe.”  So immediately, I became acquainted with the VBAC debate, and I have researched so much since then.  You have no idea (or maybe you do for those of you who know me well) how much this issue has consumed me.

In part, I was simply confused.  Typically the medical community can agree on such a straightforward thing, right?  Yet even as I was just beginning discussion of the idea, right there in my labor and delivery room, I was getting two vastly different answers.  My cesarean was really emotionally scarring for me, and I yearn for a vaginal birth to replace some of those memories with a birth the way nature provides, but I also know that doing something dangerous would not be the solution, and I truly wanted to make a decision that (my emotions and baggage aside) would bring us the best chances of a safe outcome for mother and baby.  So as the months have gone by, and I am reading and reading and reading every medical article I can get my hands on, I find this:

  • ACOG endorses vaginal birth after cesarean (or VBAC), and ACOG is the governing organization of every OB in America. (source)
  • Yet it is estimated that between 50-80% of OBs in America refuse to do VBACs. (source)  I speak from personal experience that here in Atlanta, it’s more like 95% won’t even touch it.
  • VBAC is an assumed course of action in other countries such as England, Australia, and the Netherlands, and every study you see lists their maternal care rates as far higher than ours.  We have one of the highest cesarean rates in the world, and our maternal morbidity rate is the worst of any developed nation.  (source)
  • As a woman with a scarred uterus, I have a 0.4% chance that my uterus will rupture during labor.  (Some studies show a bit lower for a mom with only one prior cesarean.)  To put that in perspective, I have a 99.6% chance that my uterus will not rupture in labor.  By comparison, as a first time, unscarred mom, I’d have a 0.7% chance that the placenta will detach from my uterine wall (source) which has dire consequences like hemorrhage, yet none of us think about that going in to labor, and doctors don’t just section everyone to avoid it.  As a first time, unscarred mom, I’d have a 0.5% chance of dangerous placenta previa occurring (source), yet doctors don’t say surgery is necessary for all unscarred women and we should all avoid labor just in case it happens.  Are you following me here, reader?  American women are repeatedly cut for fear of uterine rupture when other dangerous complications are actually more common, yet we don’t worry or sign up for surgery to avoid those risks.  Essentially, the risk associated with VBAC is about the same, or in some cases lower than, the risk of various other complications in birth.   This table explains what I’ve just said in a simple and perhaps more easily understood way.
  • Cesareans do not come without physical risks.  It is major abdominal surgery where your internal organs are removed and reinserted.  Compared with a vaginal birth, cesarean mothers are at a sharply increased risk for hemorrhage, blood clots, bowel obstruction, and infection.  (source)  None of these things are harmless or pleasant.  Future reproductive problems also sharply increase with each cesarean birth – placenta accreta, ectopic pregnancies, and placenta previa. (source)
  • While I thought I was bizarre and defective for feeling so many psychological implications after my surgery, I’ve since found that there is a correlation between cesarean sections and rising rates of postpartum depression.  While every cesarean mother doesn’t feel this way, many of us do.  In fact, even orangutans with cesarean surgeries often don’t recognize their own offspring.  (source) Clearly I am not a monkey, and I sometimes feel like I bonded with my son even more powerfully in a we-went-through-hell-together sort of way in those early days.  But my point is that nature provides an exit route for our babies, and the cocktail of hormones that facilitate early bonding doesn’t happen with a cesarean.  It makes the early days much, much harder for many mothers.
  • It is essentially common knowledge by now that babies born by cesarean are more likely to have asthma, allergies, and breathing problems for the rest of their lives. (source)
  • Infections result from cesareans in about 1 out of every 20 surgeries.  (source)
  • I am three times more likely to die from a cesarean birth than a vaginal birth. (source)

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So if VBACs are safe, I hear you say, why do doctors refuse to perform them?  Litigation, ignorance, insurance.

VBACs were in vogue in the late 80’s and early 90’s here in America, and doctors were using Cytotec constantly in VBAC inductions.  (For more on the dangers of Ctyotec, read here.) If you look at the statistics from that time period, using Cytotec to induce a VBAC patient multiplies their risk of rupture more than twenty times over.(source)  Yet instead of just assuming it was the off-label use of the drug that led to ruptures (eventually realized because nobody uses Cytotec any longer, even on non c/s moms), doctors stopped doing VBACs all together and assumed they were dangerous. [Tangent, but the drug is supposed to be used for the treatment of ulcers.  It wasn’t even developed for use on pregnant women, and the packaging actually lists a warning that pregnant women should not use it, but it was used by doctors in labor inductions for over a decade!]

So fast forward a decade or two, and you have the National Institute of Health, the World Health Organization, and the American Congress of Obstetricians and Gynecologists all telling physicians that VBAC is safe and even preferable, yet most obstetricians still won’t touch the VBAC question, and they’ll quickly tell patients that vaginal birth would just be far too dangerous because of a risk that is 99.6% likely NOT to happen.  As Dr. Shelley Binkley says, “It’s a numbers thing.   You don’t get sued for doing a C-section. You get sued for not doing a C-section.” (source)

So safety and the recommendations of professional accrediting organizations are cast aside, and my personal health decisions are left to the preference of insurance companies and doctors who have more regard for litigation-shaped practice than they do for research-based practice.  Obviously, some doctors see a problem with this, and the debate continues.  Dr Robert DeMott of Bellin Memorial Hospital explains, “Patients are being hoodwinked into choosing cesareans by overblown fears …… Putting it bluntly, it’s unethical to recommend a practice that leads to more patient deaths.” (source)

So this pregnancy, I am driving 50 minutes to and from my provider for standard pregnancy appointments.  On the way there, I pass countless other offices who refuse to do VBACs or say that they do, but records indicate they see only a handful every year which is not a level of expertise I am comfortable with.  If you want to go with a tried and true VBAC provider in the metro Atlanta area, one who has seen hundreds and is experienced in how to handle them and how not to handle them, you have two choices.  Two.  In a major metropolitan area swimming with babies and obstetricians.

So do I have a chip on my shoulder about the VBAC issue?  Absolutely.  But not because I am some nutcase who measures my macho maturity by my ability to push a baby out my vagina.  Not because I am willing to put my baby’s life at risk for my own experience.  I have a serious issue with this subject because I am forced to fight so hard to achieve something that is a standard of care in many other developed nations, something that major research institutions have proven is safe.  Something that, plain and true, leaves me with a lower risk of death and complication than the alternative.

I don’t think well-informed women who choose a repeat cesarean section are necessarily making the wrong choice.  They are entitled to choose what works best for their health and their own family.  What I desire is that same choice for myself.  If a vaginal birth is possible and, according to leading health agencies, not posing incredible risk to myself or my infant, I should be entitled to make that decision about my own health and my own body.

Birth comes with no guarantee.  It can go beautifully with absolutely no complications (as it usually does) or difficult and dangerous things can happen.  I find that’s the case with most things in life though, no?  All we can do is research, make the decision that leaves the lowest foreseen chance of damage, and trust that things will unfold as they should. For me and for the baby I’m carrying, I’m confident that choice is to pursue a vaginal birth.  And do I know I will have a vaginal birth?  Of course not.  It’s why I am giving birth in a hospital with an OR in the case that I need to have surgery to save the life of that baby.  But unless that surgery is truly necessary, I don’t see why I should sign up for something that is no trivial matter.

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ETA:  I did have a beautiful vaginal delivery about 7 months after I published this post.  To read my birth story, click here.

Birth

Not much to say today….

Things have been quiet here because things have been not-so-quiet at home, and I’ve not had the time to write.  I’ll be doing that soon though.

For now, I’ve not got much to say, but I would like to share this video with you. I’m honored to be a part of one of the organizations featured here, and of course it’s a cause close to my heart.  I don’t think most women realize how constricted my choices are in terms of birth, and this film does a great job of conveying that.  I love that Atlanta is featured in this film, but I ache for the women who don’t have any choices at all.  And I can’t believe that TWO reputable physicians doing VBACs in Atlanta is a high number compared to other US cities.

Anyway, I’ll stop rambling so you can watch.  It’s not embedding for me, so you’ll have to click here to see it.  Yes, it’s 24 minutes long, but it’s worth it.

(Oh, and I should add that the triplet mama you see in the video did deliver them vaginally a few weeks ago!)