Thursday, May 28, 2009

Where Babies Come From, Part Four

Part Three is here.

One of the first things they do after the birth is over and the sewing up and the general painfulness is over is turn off your epidural. An epidural is, in essence, safe, but I can't imagine that an open door into your spinal column is something that they want to remain open for that long. That's what they did with me, while Max was having his first bath and being checked out in the NICU and his blood glucose was being monitored and we tried nursing a little, and slowly the numbness began to fade away, starting at the tips of my toes and working its way up.

Except. Except that the numbness was fading away from my right toes, but not my left. I could feel my right foot, flex it and point it. I could point my left foot, sort of, but I couldn't flex it at all. It was as if those muscles had totally forgotten what they were ever there to do, had gone missing.

"This doesn't feel right," I kept telling people. "I should be able to feel both of my feet by now, shouldn't I?" The nurses were changing shifts and the nurse who'd been there for my epidural the day before was back. I was hungry and it was dinnertime; why the hell wasn't my foot working yet?

A NICU nurse came down to tell me that Max was hypoglycemic: it's a common side effect for new babies of diabetic mothers in the few hours after birth. Would I prefer that he receive a bottle or an IV? To be honest, I didn't care really, just as long as the problem was solved (it's not serious, but it can be if it's not handled.) They checked with me, though, because they knew I was planning to nurse, which I appreciated. "Whatever's quickest," I told the nurse. "Just fix it."

The nurse took out my Foley catheter and wanted me to get up and go to the bathroom. I felt pressured. "I don't know if I can," I admitted. "I still can't feel my foot."

"You really should by now," she said disapprovingly. Did she think this was my fault for some reason? She practically dragged me out of bed and to the bathroom, and I felt tentative and anxious about dealing with the realities of any of the aftermath of birth: stitches, blood, pee, or any of the other, ahem, scariness. I was presented with a whole bunch of unexpected equipment: a spray bottle of warm water instead of toilet paper, an adult-diaper-sized maxi pad, a pair of giant-sized mesh underpants with a pocket in the crotch for an icepack. Talk about things that nobody tells you, I told myself. I knew there'd be blood; I didn't know it'd look like a mass murder scene. I felt like I was floundering around like an idiot and I could barely stand up off the toilet and get the whole arrangement of giant underwear and pad and icepack pulled up, let alone walk across the room on my still-numb (Still numb!) foot. My hospital gown was spattered with gore and blood. The nurse handed me a new one. "I still can't feel my foot," I told her. "I think there's something wrong."

Those became the two sentences I repeated more often over the next 72 hours than any other, and to almost no effect. The L&D unit was at capacity and they wanted me shifted to post-partum post-haste, and off I went, to one of the few private rooms in the unit. Can you imagine a post-partum unit without private rooms? I couldn't. The thought of having a roommate was absolutely awful, so bad I had trouble wrapping my head around it, and I was relieved I didn't have one. I told the post-partum unit nurse that I still couldn't feel my foot and she seemed less concerned with that than with my dinner order.

My dinner order didn't arrive. It was after 8 and I was starved. Dan hadn't eaten in hours either. Nobody seemed particularly receptive to my complaints, and eventually someone located a couple of dried-out turkey sandwiches, leftover from the previous day's lunch, by the look of things, but then nobody seemed to know how much insulin I should take with it. My insulin needs had grown exponentially over the last few weeks of pregnancy and I knew I wouldn't need that much anymore, but should I take half as much? A third? "Where's your endocrinologist?" the nurse demanded. "I'm quite sure he doesn't know he's supposed to be here," I told her, not particularly appreciating her tone. "I've been a little busy. If you've got a question for him, go ahead and give him a call."

At this point, it had been a couple hours since I'd seen Max or received any kind of an update on his condition, and Dan called the NICU, asked for him to be brought to my room. Two nurses showed up without a baby. "He's sleeping," one of them told me. "We were told you wanted to rest and didn't want him down here."

I was dumbstruck by the lack of professionalism. "Bring my son in here now," I told her, "or get me the name and number of your supervisor."

"Why don't you go ahead and do both?" Dan suggested. He was at least as upset as I was. The two nurses eyed each other apprehensively and disappeared. The NICU supervisor appeared a few minutes later, still without Max. "His blood glucose is still being monitored," she said. "I don't know who told them that you wanted to sleep and didn't want him in your room. I'll check it out though."

It was one fiasco after another for the next three days. Nobody seemed to know who my doctor was or why I hadn't been checked on by an actual physician until 48 hours after I gave birth, when Dr. Kane finally showed up, sheepishly apologetic. Because I'd come in while Dr. Hassan was the on-call doc for the practice, he explained, I'd been listed as his patient, not Dr. Kane's or Dr. Bushrod, the doctor who'd actually delivered Max. Was I ready to go home?

No, I wasn't, I said. I'd been complaining for for the past two days that I still couldn't feel my left foot, and people seemed more concerned with the elaborate and humiliating ritual of checking my episiotomy stitches than with the fact that I couldn't make it to the bathroom and back without the assistance of my husband. Was someone going to do something about that? And would someone please, please address the fact that I could not get a meal menu, let alone any food delivered to my room? For the past two days, I'd been getting whatever was leftover on the meal trays for three meals a day, several hours after anyone else was fed. It usually meant oatmeal in the morning (which I loathe and never eat), some kind of dried-out sandwich at lunch, and an inedible entree of some kind at dinner, cold and long-forgotten and consisting of mostly simple carbs--not an ideal diet for a diabetic or someone who was still waiting to poop for the first time after giving birth. My mother and Dan had been bringing me sandwiches and salads from the hospital cafeteria and the deli from the local Safeway, so I wasn't going hungry, but I also wasn't exactly amenable to the fact that the hospital was going to be charging my insurance company for meals that I wasn't getting.

The doctor agreed that, based on the condition of my still-numb foot, that I certainly wasn't ready to be discharged. "Let me call a neurologist I know," he said. "We'll get to the bottom of this." He patted my foot. I couldn't feel it.

The nurse-supervisor showed up the next morning in response to the litany of complaints Dan and I were waging. Several minutes after she left, I got a phone call from the head of the nutritional services department, who apologized for the fact that I hadn't been fed in several days. I was not feeling particularly gracious at this point. She read off a menu to me and took my order for lunch personally. It never arrived.

The nurse-supervisor came back to my room with "some concerns" to address with me. One of the nursing aides had complained that she'd seen me doing "something inappropriate" with my husband that morning. I was stunned and uncomfortable and overwhelmed and full of loathing for this awful, stupid bitch, not to mention the fact that I had no idea what she was talking about and broke down in tears, unable to even respond to her accusations. "Your aide," Dan fumed at her, "saw me helping her out of bed to go to the bathroom. She's needed help every single time she's gone and she can't get any from your nurses, no matter how many times she's asked. In fact, any time she's asked for anything, any time either of us has, the only response we've gotten is, 'We'll get to it when we get to it.' She can't see a lactation specialist, she can't get ibuprofen for a headache, she can't get her goddamn breakfast! I've spent the last three days trying to make sure she gets to eat and take the medication she needs to keep her alive and the medical care that she needs. I'm about to start billing your stupid-ass, shitty hospital for my time, because I already have a job and I'm sick of doing yours!"

In my entire life, I've never been more proud of Dan.

I wanted to get the hell out. I wanted to take my baby and go the fuck home and forget this place ever existed. I was grateful, beyond grateful, to the L&D department and the NICU and all of the people who'd gotten us there, but I was at my limit of degradation. "Check me out of this place," I wept furiously to Dan after the nurse withdrew. "I just want to go the fuck home."

It took a little time and I still had to see the neurologist about my foot, but finally we got some action. Max was discharged that afternoon and I was finally discharged at about 9 that night. There was a long, dull session during which a nurse came to our room to make sure I knew how to take care of his umbilical stump, not to take him out of the car seat in a moving car, even if he cried (duh.), and under what circumstances I should bring him or myself back to the emergency room. One of the last things that they did was dress him in the clothes I had brought for him to go home in (a little red sleeper with bumblebees on it, the smallest piece of newborn clothing I had and the one that came the closest to fitting him; I'd never have guessed he would be so tiny) and at that point, the strangest thing happened.

He became mine. Up until that point he'd just been a little stranger who I was sort of partially responsible for caring for, when he wasn't in the NICU or having a hearing test or doing something else that took him out of my room, where I was confined by the fact that I couldn't walk without quite a bit of assistance. One night they'd brought him down to my room at around 1 a.m., where I was suffering from insomnia (and the fact that I hadn't had dinner) and watching a Discovery Channel marathon of some show or another. He was crying. "He's waking all the other babies up," the nurse told me. "Can he stay here with you for awhile?"

Of course he could. I tried everything I could think of to get him to stop crying, but he seemed miserably unhappy. I felt terrible and Dan and I couldn't think of anything that we could do to make him happy. Finally I turned off the TV, turned the lights down, and just cuddled him, and he drifted off to sleep in about thirty seconds. At that point, I felt more like a parent than I ever had before, but he still didn't feel like mine, despite the fact that he looked absurdly like a little-old-man version of Dan. It felt like Mom Boot Camp.

But as they wheeled me out of the maternity ward, Dan and my mother behind me with the assortment of stuff that we'd arrived with and were being sent home with, me with a semi-awake, squeaking baby in my arms, as people who passed by cooed at us, where we were left in front of the hospital to deal with the proper snapping-in of the car seat and the fact that I wasn't ready to sit in the passenger seat of my mother's car while my son sat in the back, the next six sleep-deprived and blurry weeks looming in front of us, for the first time, I remember looking down at him and thinking, I think this is how it's supposed to feel. I can walk away--or limp away--from this awful place and be this person's mother.

It's four years later, and I've watched him go from that little stranger, the little 7-1/2-pound meatloaf who doesn't do anything to the person who's driving me crazy this morning jumping on the couch while I just want to sit here, the person who wants to sing "You are my Sunshine" to my pregnant belly every night before he goes to bed, the person who wants a peanut-butter-and-lettuce sandwich for lunch today. The strangest thing has happened in four years: he's gone from being Max, the abstract concept to being Max, the person with opinions, who knows how to spell purple and rectangle and boom, but who, for some reason, spells the word orange O-R-A-N-G-L-E, the totally-potty-training-proof little boy who convinced Dan to shave his head last weekend so that he could have "none hair, like Daddy." I know him forward and backwards. I know when he's trying to manipulate me. I know when he's fake-crying and when he's really upset. I know when a kid at the playground is really getting on his nerves and when he can let something roll off his back. He says things that astound me. He uses Brickle Blocks to build a camera to take pictures of me. His imagination is humongous. He likes to play ice cream store. Sometimes he comes walking up to me and says, "Mom? I want something," and I'm supposed to know what it is, and I almost never do, mostly because he almost never does either.

He's mine, in ways that no other kid could possibly be, and being Max's mother has been an honor and a privilege I couldn't have ever imagined before becoming his mother. I am having a hard time wrapping my brain around the idea that soon I will be The New Girl's mother too, that she will go from being the annoyingly-active, kicking, flipping fetus who is still, at 34 weeks and 2 days gestation, still not head-down, to being a real person. She feels as unreal to me right now as Max ever did, despite my freakishly large belly, despite my myriad discomforts, despite the fact that earlier today she had the hiccups until I thought I was going to go out of my mind.

This last chapter of Max's birth story has been a long time coming, and it's because I'm not sure how it ends. It didn't end when they handed him to me and sent me home from the hospital. It didn't end in the L&D unit that they were in such a hurry to rush me out of. I feel like I'm still living his birth story, like every day is just an extension of it, how he's still becoming who he is. People ask me what his birth was like and I'm never sure what to tell and what to leave out: the part where my water broke in the middle of Sears? How absurd so much of the experience still seems to me? How awful the post-partum unit was and how much I hated being there?

It all ends up being okay. Now, with the possibility of a C-section looming in front of me, with the still constant threat that pregnancy poses to my health and my health poses to that of my daughter, with the daily discomforts, I keep reminding myself that it all ends up being okay. I've been listening to Rob Thomas singing "Little Wonders" a lot in the last few weeks, especially the part where he says "The hardest part is over." I'm not so dumb as to try to convince myself that the hardest part is over--I'm quite sure that I haven't imagined the hardest part yet, let alone survived it--but I find it incredibly reassuring to hear him say that In the end, We will only just remember how it feels.

Epilogue: the numbness in my left foot was a sciatic nerve injury. When I was having that awful pain in my left hip during the Transition stage of labor, the nerve was being compressed under my tailbone. By the time I went home from the hospital, I could flex my foot very slightly, half an inch maybe. It spent the next six months improving to about 95%, which is where it still is. I have numb spots in the back of my left leg and the sole of my foot, and my toes feel a little like they have rubber bands wrapped around my toes. I've found I can live with 95%.

Southern Maryland Hospital Center in Clinton, the hospital where I gave birth to Max, lost its accreditation as a teaching facility.

I never received an answer as to why the nurses thought I wanted Max kept away from me that first night, why I couldn't get a meal the entire time I was in the hospital, or the nature of the total breakdown in communication or professionalism that waged a completely merciless war on my entire birth experience. I would never be that woman who gave birth in a kiddie pool in my own living room, even if my health allowed for it, but I am still appalled by how truly awful the post-partum unit of Southern Maryland Hospital Center really was, and understand completely why women choose to have babies every day in birthing centers and in their own homes.

The New Girl will be born at Holy Cross in Silver Spring, where more babies are born every day than any other hospital in the D.C. area. I am cautiously optimistic.

Monday, May 4, 2009

Where Babies Come From, Part Three

Continued from here.

That night, and the early part of the next day, is fuzzy to me, and probably for good reason. I was on drugs. I understand the appeal to those people who get addicted: you feel sort of disconnected, and though I was summoned regularly to check my blood sugar or give myself a couple of units of insulin throughout the next 18 or so hours, I did so with a sort of detachment. One of my clearest memories is injecting insulin into my upper thigh, a spot I typically avoided because it's painful to give shots there. I couldn't feel my upper thigh at the time. It's a weird thing: when you're looking at your own hand gripping your own leg, and your hand can feel your leg, your brain doesn't necessarily get the message that your leg can't feel your hand. It felt like someone else's leg in my hand--I remember feeling surprised that it felt a little cold, but I'd complained since I arrived of how hot it was in my room, and they kept ratcheting up the air conditioning. My flesh felt a little like how I'd imagine a dead fish would feel.

They were giving me increasing amounts of pitocin, and as they'd turn up the amount I was getting, the contractions would start to hurt and I'd ask for more medication. I was relishing the feeling of being comfortable, after nine months of heartburn and backache and insomnia and various other complaints. I liked being reclined at 45 degrees, my feet slightly elevated, having ice chips brought to me. It was a little like being on vacation in a nice hotel except for the medical interventions, none of which phased me.

It was now June 21, 2005, and by noon, I'd officially been in labor for 20 hours. June 21 is the summer solstice, and believe me when I say that giving birth on that day brings new meaning to the words "longest day of the year." I kept waiting and waiting to feel different somehow, but with medication managing any pain I might have otherwise been feeling, I just didn't. I remember settling back after checking my blood sugar once with my blood sugar meter still balanced at the apex of my belly just as a contraction started, and watching the it on the monitor I was hooked to and the meter balanced on my belly, both rising exponentially as the contraction that I couldn't feel at all built and built and then falling as it receeded. I watched it with a sort of detached fascination, sort of a "Whoa, that was completely weird."

I don't like to throw up, not at all. I am one of those thoroughly perverse people who would prefer to sit miserably curled over myself for hours, sweating buckets of cold sweat, than throw up, feel better, and drive on. I was warned while I was still pregnant, that all women in labor throw up; it was a veteran L&D nurse who warned me, so I believed her. I threw up once shortly after I arrived at the hospital--just the remains of the leftover barbecue that I'd had for lunch that day, and then again in the early afternoon--that time it was just water, since all they'd let me have was ice chips.

That second throwing-up seemed to trigger an extra flurry of activity in my room. At that point, I had two nurses: a long-time L&D nurse who was training a student. "We need to check your cervix," she told me after I threw up. "You might be in transition."

They had been avoiding doing pelvic exams as much as possible. Since I'd come in with my water already broken, they wanted to avoid forcing any bacteria or anything else any closer to my cervix, and they were treating me with antibiotics, since now I'd been in labor so long. The veteran nurse gave directions to the student nurse on how to check for dilation. "You're eight centimeters, easy, maybe eight and a half," she told me. She snapped off the rubber glove and patted me on the leg. "Not long now."

It was right around this time that I began to feel a pain that was centered on my left hip that I didn't think should be there. Wasn't I supposed to be numb in that whole area? Why could I feel nothing but that one pain? Why did it coincide with every contraction I had? Why was I the only one who seemed concerned by it? And who the hell was making that awful wailing noise every time I had a contraction?

It was me, of course, who was wailing. Maybe the wailing was all in my head; I don't remember it bothering anyone else in the room, including my husband or my mother. Dan said I mentioned a pain in my hip sort of offhandedly; it was why he wasn't aware that anything had happened to me. I also remember it going on for hours and hours, when in reality, it was evidently just a few minutes. Dan tells me, still, though, that I didn't complain, although I began asking for more medication than they were willing to give me at that point. They did put more medication into my epidural line at one point, and it didn't help significantly. "This isn't working," I told them over and over again. "It only hurts in my hip." And it hurt a lot. It hurt like a knife stabbing me in the meaty part of my left hip. Apparently, though, I never complained.

"You're ready to push," the nurse told me. I felt like I'd been in terrible pain for hours, and I had no intention of pushing until I had more drugs. I was afraid pushing would make the pain worse, if that was possible; worse pain seemed inconceivable to me at this point. "What if you tried just one push?" she asked. "You're dilated to ten, this baby is coming." I hadn't felt any irresistable urge to push like I'd heard other women describe; I was focused on the pain in my hip and getting from one break between contractions to the next and just surviving the pain in between. There was beginning to be a lot more activity in the room, NICU nurses were coming in and setting up the table and scales across the room in the little nook that was reserved for the baby; other people were coming and going. Some of them looked vaguely familiar to me; most of them I'd never seen before. It seemed like a strange time and place for me to feel so exposed, although I wasn't really: I was wearing a hospital gown, and had blankets and pillows. I only felt like an obscene, crazed spectacle. I was still watching things with a sort of detached fascination; I don't know if it was an effect of all the drugs I'd taken or if I really was just much calmer than I remember feeling at the time. I had a short chat with a NICU nurse who'd seen me just after I'd gotten the first hit of narcotics; she poked a little good-natured fun at me for having not much of a head for the drugs.

The nurse finally convinced me to push. "Did you take a childbirth class?" she asked. We hadn't; everyone who I'd ever talked to said that they were a waste of time and money and they never used anything they'd learned in them. I shook my head no. "You'll want to push down with the same muscles you use to poop," she said. "When you have a contraction, you'll bring your knees up and tuck your chin into your chest and push from your middle, not from your head. Take a couple of big deep breaths, then push out the last breath."

Knees? Chin? Middle? Poop? What the hell? I was thinking. "I can't pull my knees up," I said. My legs and any muscular control I'd once had over them had left the building.

"We'll do it for you," she said. She grabbed one and the student nurse grabbed the other, my mother was standing down by my left foot. The end of the bed detached and rolled away; most of the parts of my anatomy I have never been eager to display publicly were now public domain in the middle of the room. There were bright lights focused on it and lots of people seemed to be gathering around it and I found myself wishing my mother would stand somewhere else, although I didn't say anything at the time because I was hoping she wouldn't notice it and I would prefer not to call attention to it. I can't fathom what I was thinking.

A contraction started and the nurse instructed Dan how to count backward from ten slowly for me, staying close to me so I'd focus on his face. He drew a chair close to the right side of my bed and put his chin on the rail of the bed, reached for my hand. One of the things I've always loved about Dan has been his ability to convey whatever he was thinking with a touch. I instantly felt better and more confident and secure; his faith in me came through as soon as I grabbed for him. I gamely followed all the directions they'd given me. "Good, good, good," the nurses were all saying. The pain in my hip was gone as soon as they'd flexed my knees back towards me and it felt exhilarating to be doing something, finally, after lying there for so long waiting for something besides the drugs wearing off to happen. I pushed maybe three times before they released my knees and put my feet in the stirrups that were at the end of the bed. "The doctor's not in here yet," the nurse told me. "I can do it without her, but I don't want to. So don't push."

Don't push? Whattayoumean, don't push? Pushing was doing something, I wanted to do something. I flicked on the television to distract myself while I waited and talked myself through the contractions. "Don't push," I hummed to myself. It felt like there was a grapefruit stuck in my butt; I wanted to push but I didn't dare.

Dr. Bushrod strode efficiently into the room wearing scrubs, shedding her white coat and exchanging it for a long-sleeved, cuffed blue cover-up sort of thing, donning gloves and a big plastic faceshield. "Do you want a mirror?" one of the nurses asked me. A mirror? I thought. Is my hair really awful? She must be thinking about pictures That's not what she was thinking of. She was thinking of a mirror so I could see what was happening. And, no. I very much didn't want a mirror. As much as I didn't want all my parts on display to the whole world, I didn't want to see them myself. Dr. Bushrod pulled up a stool, positioning it between my feet. The first thing I noticed was that the mirror would have been totally unnecessary; the plastic faceshield she was wearing was conspiring with the bright lights to become totally reflective; anything I didn't want to see I could now see as clearly as I could see Dr. Phil and his big stupid moustache still on the TV across the room. I had lost the remote control and frankly, I realized, I didn't care. I'd rather look at Dr. Phil than a reflection of my own gory genitals, especially after Dr. Bushrod picked up a tiny pair of scissors--no kidding, little scissors--and snipped an episiotomy.

A word about the episiotomy: yeah, I didn't really care. A lot of women take it as some kind of a personal affront; I just didn't care. Either I was going to tear or I wasn't, and I'd been hearing for weeks about how enormous Max's head was on ultrasound. I was picturing the Hamburgler in there; I didn't really care that much about how he came out. I guess I don't understand the women who are so horrified by their episiotomy; I picked good doctors that I was comfortable with and got educated and didn't let all of my control issues totally take over my head in the moment. I trusted them to do the right thing, and they did. It was fine.

"Here we go," said Dr. Bushrod.

It all happened fast after that. I was prepared to be pushing for hours; but all that time that I'd spent having to be coerced into pushing by the nurses seemed to have paid off. Dr. Bushrod gave good directions with each contraction: push just a tiny bit, push as hard as you can; push at 50%. I remember seeing Dan's face next to me and the wooshing of the oxygen mask they slipped over my face; I also remember my mother turning vaguely purple every time I pushed; she was pushing too.

Suddenly, I felt the baby slither free. It was a huge relief: seconds before I'd been pregnant, now I was most decidedly not. The difference was night and day and I remember heaving a huge sigh of relief. Dr. Bushrod held Max up for me to see him for a split second before passing him off to the NICU nurse who was waiting with a towel spread over her arms to receive him. He had fuzzy tufts of blondish hair that was full of bits of blood and other gore; he and I exchanged what I can only imagine was an astonished look of holy fuck! and he was whisked off to the other side of the room. I could hear him bleating noisily in protest at whatever was happening over there but I didn't mind; the activity on that side of the room was efficient, but not frantic; if he was crying he was breathing and I'd seen him; he'd been squirming and clearly a healthy newborn, even if he looked a lot like Dan's older brother in squashed-old-man form.

The doctor sewed up the episiotomy with a few quick stitches and positioned a basin under my butt to catch the placenta. I had to push more for the placenta than I had for Max. The heartburn I'd been suffering from for months finally paid off; I'd had a cough caused by reflux for weeks and finally by coughing in conjunction with the enormous pitocin contractions I was still having, the placenta dropped into the basin with a graphic-sounding squish. I never looked at it; I'm not squeamish per se, but there's some stuff I can live a long time without seeing.

They brought Max back to me, tightly swaddled in one of those ugly flannel receiving blankets with a hat squished down over his face. The first thing I did was strip all of that off of him so I could see him. He was totally normal looking: he looked just like a baby. He had giant hands and cute little feet and I thought he looked a lot like Dan. He did need to be monitored more closely in the NICU, though; low blood sugar is a major concern for babies of diabetics because they get excess insulin from the injections. He did have a couple of episodes of low blood sugar that first night, but I was, to be honest, a whole lot more concerned with what was happening to me at that point.

To be Continued...