When a Birth is Almost a Death
We have this perception, in the U.S., that motherhood and birth and everything associated with it is beautiful. And it’s such a funny perception, because lying just underneath the surface is the knowledge and the certainty that motherhood is frightening and perilous from the moment of conception until…There is no end. There’s no expiration date on a child; even when they’re adults, you’ll still worry (or so I’m told).
An ambivalence exists, then. And it’s especially strong around the birthing process itself. It is absolute fact that the U.S. has a staggering number of maternal deaths; we are only just beginning to face this problem. What we haven’t yet begun to face, really, is the even larger number of women who almost die.
Allow me to tell you about Little Jedi’s birth.
In 2008, I was a 24 year old graduate student. I’d just returned from a summer-long study abroad program, and I dove right into an intensive Spanish-language translation course, tutor training in our university writing center, and an on-again-off-again relationship with my college boyfriend.
A few weeks later, I just knew I was pregnant. Blood tests confirmed what I suspected, and I began the long road of Deciding What to Do. Abortion was something I considered, of course–I was a poor graduate student whose life was being subsidized by her parents; I was in the middle of writing a lengthy master’s thesis; and with I had a not-entirely-solid relationship. But ultimately, abortion was not a decision I could make. I also knew that adoption would not be an option–my parents or my boyfriend’s parents would likely have adopted the child, and I’m not sure I could have psychologically dealt with that scenario. So my family loomed large in my decision. I knew that my parents would be angry and disappointed (I was right), but that they would come around to accepting things as they were (I was partly right, but that’s a tale for another post) if I decided to have the child.
And so, I decided to have the child. Lucky for me, the insurance provided through my graduate assistantship position went into effect 2 weeks before (!!!) that blood test, and the insurance did cover pregnancy and childbirth, so I was not faced with the tough decision of being uninsured and pregnant. My GYN was also an OB, so I did not even face the onerous task of finding a new doctor. We began prenatal vitamins and regular check-ups immediately; I dutifully didn’t eat cold cuts or drink anymore; I quit smoking; I tried to keep to a regular sleep schedule. I was given a due date close to the end of May, and everything proceeded fairly normally.
And then it didn’t. Cut to March 7, 2009: I was 28 weeks pregnant. I’d been experiencing swelling for quite some time, though I was assured that this was fairly normal and might not indicate a problem. But an ultrasound at that check-up showed us that he was measuring much smaller than was normal for his gestational age, indicating a problem. I don’t remember much of what was explained to me at the time–just that I needed to have consult with a doctor who could perform a higher-level ultrasound that could predict problems. We made an appointment, which had to be 20 days later (almost 3 weeks, which is a long time in making-a-baby-land) because there was only 1 clinic anywhere nearby that did this level of testing. And then we waited.
On the 26th, we drove to 90 miles to the clinic that performed this test and saw a doctor and sonographer who spent about an hour looking at the kiddo. That doctor told us that aside from being small, our baby was looking fine. This suggested a problem with me–for some reason, I was getting enough nutrients to the kiddo, so he’d need to be delivered a bit earlier than normal, maybe at 37 weeks. For the time being, I needed to count kicks during the day, have more frequent ultrasounds, and go to appointments twice a week.
All of this–and yet, on April 2, I rushed myself to the hospital and to admissions. I’d just had an appointment with my OB, and my blood pressure was alarmingly high–there was also an alarming amount of protein in my urine. I called Little Jedi’s father, who was a few hours away finishing the last class for his degree; I called my parents, who were an hour away at their home; and then I sat in an observation room with a blood pressure cuff taking my pressure every 15 minutes, nurses making concerned noises when they saw the readouts, my head buzzing buzzing buzzing with the word “preeclamspia.” (There is no cure but delivery)
I’d read about it, this word. I knew it could kill him; I knew it could kill me. I knew that even though I felt fine, just fine, was tutoring students just the day before, that blood pressure in the 200 range was Not Good, Not Good at All. I would be fine, though, I reasoned. High blood pressure was dangerous but manageable. (There is no cure but delivery)
Naturally, the doctors decided very quickly that they would need to admit me. I needed observation and, perhaps, intervention. (There is no cure but delivery) I think this is the point that I became afraid for the first time, really afraid and not just numb. Because at this point there was family there, and there were doctors coming to talk about potential scenarios if my baby was delivered that weekend, and I had no crib yet no diapers no bags not even a decent bathrobe and it was soon, so soon, too soon. It was 32 weeks. They shot steroids into my system to help develop my baby’s lungs; they talked to me about trying to keep him in as long as possible, hoping that they could keep my pressure down and keep me in the hospital bed for a few weeks (!!! oh god, I thought; confinement) while he had more time (but yes, he needed more time, so bed is the best scenario here there is no cure but delivery there is no cure but delivery).
But they couldn’t. My pressure kept rising, kept rising would not come down. The night of April 3, the doctors made the decision to perform the C-section the next day, giving the steroid shots the full 48 hours to work but delivering the kiddo quickly. They pumped magnesium sulfate into my body, inserted a catheter and put compression socks on my legs to prevent blood clots. I was in the bed to stay there, and delivery was happening. There is no cure there is no cure there is no cure but delivery. The doctors offered to induce labor, but they explained that labor often makes blood pressure rise, which would lead to a C-section anyway–so we opted for the safer route. The magnesium sulfate had awful effects: I was delirious, vomiting, miserable. At one point just before my C-section on the evening of April 4, I remember my room being full of people as I vomited into a bag held by the nurse. I was afraid and agitated, wanted to make everyone leave but without the strength or the know-how to make that happen.
I was wheeled into the surgery room and given a spinal block. The most terrifying moments were those when that sheet was up, a veil between my body and my baby and myself, I couldn’t move more than my head and I panicked and there was pressure and then and then and then.
A small cry. The smallest cry I ever heard, the loudest cry I ever heard. A moment to see his small face, to kiss his tiny tiny perfect wrinkled face his not-quite-three-pound body before he was whisked away.
After is a blur of people, a blur of emotions. Still delirious, magnesium drunk for another 24 hours as doctors said things like NICU and PICC line and sucking reflexes and genetic tests and warmer and incubator and something called “liquid gold” breastmilk. And all I could think was that I still needed a crib still needed this thing that thing a baby to hold.
I didn’t see him again until April 6, because I couldn’t get out of my bed until then, and he could not be out of his incubator. He was so frail so tiny so perfect so terrifying. I cried; I didn’t want to hold him yet. I thought I would break him. I thought, really, that I’d already broken him. I wasn’t sure about him in the beginning, you see, and so I thought maybe I’d made him sick, made myself sick.
Recovery, for both of us is still a blur in my head. I left the hospital on April 7 without him. I cried and I pumped breastmilk every 3 hours and I bled and I ached and I laughed and I loved and I tried not to smoke and I have no idea what I was doing, what I did for weeks, for 5 weeks, while he was in the hospital.
And yet. And yet and yet and yet.
We were lucky. We were privileged. We were in an enviable position from a socioeconomic standpoint if not from a physical standpoint. I did have good prenatal, perinatal, and postnatal care. We’re alive because of that care. Neither of us has long-lasting effects (that’s only partially true–I have a band of scar tissue along my abdominal wall with no feeling but a lot of residual emotional feeling). We had insurance to help cover the hundreds of thousands of dollars of medical care required to get us healthy. We had all of that and still–I almost died.
It’s far, far past time that we address the prenatal and postnatal care as well as perinatal care. We have to address all three. Because too many women die, too many women almost die, too many children die almost die have died are dead. It’s inexcusable horrifying terrifying.