by Mosa Maxwell-Smith
Monday
On Monday I became a patient. As my husband and I walked through the automatic doors into UCSF, I realized that something had shifted. I wasn’t visiting the hospital; for the first time in my life, I was a patient at the hospital.
We were in pretty good spirits. I was there for a simple procedure: external cephalic version. After weeks of swimming and moxibustion and acupuncture and chiropractic treatments and sadistic yoga classes, the little girl growing in my belly was still head-up. This procedure, we were told, had about a 50% chance of turning her. We were optimistic.
Our midwife, with whom we’d been planning a home birth, showed up after a while, and the three of us laughed and joked as we watched my baby’s heart rate tick away steady and strong on the fetal monitor. Doctors and nurses assembled to give me a mild muscle relaxant and attempt to flip my breech baby.
Another mother had told me the drug would make me feel jittery – it didn’t. I practiced my deep relaxation breathing as three doctors worked together pushing and shoving my belly and my baby inside of it. It was not comfortable, and a couple of times I thought I might throw up.
Despite their efforts, the doctors could not get a grip on my little girl’s head. Based on the ultrasounds I’d seen, she seemed to be wearing a placenta beret. I could just imagine it drooping down seductively over one eye. Oooo la la! Nonetheless, her nascent sense of style prevented the doctors from getting a good grip on her head to flip her around.
We were disappointed, but knew that it was not uncommon to schedule a second attempt at external version. We were offered a second try, this time with spinal anesthesia, and I gladly accepted.
I spent the next few days trying everything under the sun to help my baby turn. I even spent two restless nights tossing and turning with headphones blaring a heartbeat strapped to my upper thigh – the thought being that my little one might poke her head down to investigate.
I also put some effort into coming to acceptance. I was basking in sunshine again, content that no matter how my daughter chose to enter the world, I was going to get to meet her soon. I was feeling happy, safe, and ready to enjoy the last few weeks ever of having this particular being in my body. What a joy! How lucky I am!
Friday
Despite my fear of needles, we drove to the hospital again on Friday for our version with spinal anesthesia. My stomach rumbling with anxiety and lack of food (I’d been told not to eat before the procedure), we made camp in the busting waiting room for several hours. After choppy discussions with numerous nurses and a doctor or two, we were told the staff was too busy to perform the procedure that day after all.
It was strange to leave the hospital this time. Both my husband and I had felt like something was going to happen – something was going to be decided. We left with our infant car seat and overnight bags untouched and neatly tucked away in the trunk of our car and a promise that someone from the hospital would give us a call on Saturday morning to reschedule.
Saturday
I didn’t eat at all on Saturday morning, imagining (hoping) that we might get a call on the early side. After several calls back and forth, we arrived at the hospital right around noon. We bypassed the now quiet waiting room and were led straight to a private room – already a good sign that things might actually happen this time.
I changed into the gown of immodesty and was quickly hooked up to the fetal heart rate monitor. I laughed and joked with the nurses and even did a pretty good job coming to terms with the IV they stuck in my right hand – I hadn’t been expecting that. Despite not being so into the IV, I was soon glad for the intravenous fluids that began to drip, refreshingly into my arm. I was thirsty, and I got a kick out of the cool sensation that cascaded into my veins though the needle in my hand.
Everyone that came into our room commented on how strong and steady our little girl’s heart was. I was feeling good and ready. I had renewed hope that I might actually get to precede with the homebirth my husband and I had so consciously planned. We talked to my belly girl and told her again what the plan was for the day, explaining that the doctors were going to try and help her turn.
After introducing themselves to me separately over the course of a few hours, the hospital staff managed to assemble, and I walked, wrapped in the ill-fitting hospital gown and the blanket from my hospital bed, to the operating room. One of the anesthesiologists told me that nobody around there had any modesty, and that I didn’t need the blanket. “Really, no modesty? Then why don’t they make your scrubs with a gapping hole down the back?” He had to admit I had a point.
I was still feeling confident and full of smiles when I entered the OR. I calmly held on to my husband’s shoulders as they prepped my back and gave me spinal anesthesia. The anesthesiologist was adept at explaining to me precisely what sensations I would feel next – first stinging with the shot, then pressure as he pressed the needle between my vertebrae, then warmth, then the inability to move my legs. As they lay me back on the skinny operating table, I marveled at the new feelings (or lack thereof) in my body and how quickly they had taken effect.
I was given the muscle relaxant again, and I remember laughing at how funny it felt to not really have any feeling in my belly but to feel it jiggling with laughter just the same. This only made me laugh harder which made the fetal heart rate monitor bounce and jiggle, too. Everyone was laughing. I was feeling ready and optimistic. I was glad to have my husband – my partner – smiling down on me and holding my hand.
I closed my eyes as the doctors began to manipulate my belly. Despite the lack of pain, I could feel my baby moving inside of me. I felt my uterus stretch as her head moved from the apex of my ribs down, to the right – almost horizontal! I kept urging her on, “Come on, you can do it, good girl, good girl, good girl! So close!” Suddenly, there was what seemed almost like the snapping of a rubber band, and I felt her head bounce back into its usual spot. They tried again. Same result.
Since they had tried turning my little one to the right on Monday without success, and they had just tried it again twice, we asked that they try to turn her to the left. As they began to do this, I started to feel light-headed and woozy. I thought it would pass, but when I was unable to open my eyes, I said something. “I think I might pass out.”
“No you won’t. You’re fine. Totally normal,” from the senior anesthesiologist.
“Her blood pressure is low,” from a doctor.
“I just gave her something,” from the senior anesthesiologist.
“To raise her blood pressure?” from my husband.
“No, to help relax her uterus,” from the senior anesthesiologist.
“Something is wrong,” from me.
Usually before I throw-up, I feel like I have a choice. I have time to make it to the bathroom or at least a sink. Before I knew it, and before I had a choice, I was throwing up. In one of his more endearing gestures, my husband held out his cupped hands to catch my puke. I tried really hard to stop vomiting because I remember thinking it would be hard for the doctors to manipulate the baby and help her turn if I was contracting my stomach muscles. Everything was blurry. I remember feeling very thankful for the pulsing and squeezing of the blood pressure band on my arm. It was something familiar that I could count on, and the steady pressure at regular intervals felt good amidst the chaos that was fast enveloping me.
Just as quickly as I had started to feel like I was losing consciousness, I started to feel better because something else was injected into my IV that stabilized my blood pressure. The vomiting stopped, and I was able to open my eyes. What I saw did not reassure me. The bright operating lights had been turned on. Suddenly, the room was full of people. I was confused because as I was starting to feel better, everything around me was getting more intense – something was clearly wrong. My baby’s father kept stroking my hand and saying, “It’s alright. She’s gonna be fine.” Of course, she’s gonna be fine, I thought. I mean, I’m feeling better, so she’s got to be feeling better. I only learned later that my baby’s heart rate had dropped from a healthy 140 or so to somewhere around 70 beats per minute. It was hanging out there.
There was lots of movement all over the room. Then it hit me. Oh, no! They are getting ready to do a C-section. A woman with smiling eyes looked down at me and introduced herself as the pediatrician who would be taking care of my baby. “Not today!” I said. “Not today!” I thought for sure I was doomed to the hospital birth I had worked so hard to avoid. My first glimmer of hope came when the head doctor had them hold off on painting my belly with antiseptic. “Give it one more minute,” she said.
Despite the hustle-bustle everywhere, all I could focus on was my husband – the father of my child. He looked so worried, so pained. I felt sad for him that I had caused him so much worry. I felt bad that for the first time in our eight-year relationship, I had puked not only in front of him but on him. I didn’t know he was still transfixed by our daughter’s sluggish heart rate pumping away on the monitor. Tension permeated the room. Everyone stood poised and at the ready. Seconds seemed like hours. The head doctor said something like, “It’s my call, and I am not going to call it yet.” It was reminiscent of a doctor on one of those medical dramas calling time of death – the death of my birth plan.
Eventually the tension began to ease. The doctors sheepishly apologized and left the room. Before the head anesthesiologist left, I managed to ask him what he had given me that made my blood pressure drop. “Nitroglycerine,” he said, “It was to help relax your uterus, but it lowered your blood pressure. We knew that might happen. You showed classic symptoms of a pregnant woman with low blood pressure; you threw up.”
After hoisting me onto a gurney with the help of my husband, the nurse wheeled me back to our room. She monitored us as my legs came back to life and my appetite began to stir – it was after 4pm now. I ate popsicles and crackers and enjoyed increased sensation as my husband squeezed my toes. Before the drugs wore off completely, we convinced the nurse to remove the catheter they had inserted in preparation for my almost surgery. After I got up and peed on my own, she agreed to remove my IV. As pieces of medical technology were removed from my body, I began to regain pieces of myself.
One of the doctors gave us the “OK” to leave, and told me about the doctor at UCSF who decides whether or not women are candidates for vaginal breech delivery. I said I would talk to him, but I was tired. I was done with hospitals, yet I knew I couldn’t be. At this point it seemed like a hospital would be part of my birth plan no matter how I looked at it. I still planned on playing in the pool and doing moxibustion, and trying to reason with my heads-up daughter, but I was also trying to come to terms with my options.
My husband and I left the hospital to celebrate our daughter’s “very merry unbirthday.” We reminded ourselves that we were going out to dinner as a twosome without having to pay a babysitter. We drank a toast to that and to our daughter’s healthy heart.
Sunday
Today we are celebrating Heads Up Day. We are not urging movement. We are not doing moxibustion. I will not strap the headphones to my inner thigh and blare a foreign pulse. Today is the day to just be with what is. We are taking a break from forcing and changing and manipulating. My daughter’s kicks to my ribs tell me she’s glad.
~~~
My beautiful baby girl entered the world via planned Cesarean at Saint Luke’s Hospital on June 3, 2009.
