Labor, part 2

Now come the endless morning hours, when a white, cold light eked through the blinds and our sense of time collapsed to ninety second intervals: that’s how long the contractions lasted, and that’s approximately how far apart they were. S was in transition: the short, intense period before the pushing. Her screams increased in volume and frequency, and she dug into my hand when the contractions crested. The pain cut short S’s breath, so before the midwife handed off the baton to her colleague she taught S to exhale in short, strong bursts of “hee, hee, hooo.” At times things became so intense even this simple rhythm was difficult for S to keep up without gasping, nearly hyperventilating.

For a while this went on, much longer than the fifteen minutes considered typical for transition. A wonderful nurse stayed by our side, relieving me when I needed to use the bathroom, making sure S had enough water. Then the new midwife came on, the matriarch of the practice, who’s been delivering babies for as long as S and I have been alive. She examined S again, and found that though a couple of hours had passed, her cervix hadn’t changed—she was still at eight centimeters. The midwife tried changing S’s position to facilitate the dilation and move the labor along. She propped S up with a wedge of foam on the bed so that S could lean forward on all fours. She had her balance on a birth ball. She walked her to the bathroom and then back to the bed. She rubbed her back and said, “Think ‘out, out, out, baby!’ Tell that baby, ‘it’s time to come out!’ That’s it love, that’s it.”

Clear liquid leaked out during some of the contractions—traces of amniotic fluid.

Through all of this I held S’s hands. If I walked away when the pain hit she would cry out for me in a panic. She needed me close, and to hear me saying the same things I had been saying hours before, “You’re doing great! Keep at it, breathe it out.”

After a long period of varying positions, the midwife examined S again. The baby’s head was visible, she said, right beyond the cervix, which still hadn’t dilated fully. It formed a ring like a stopper, preventing the baby from moving into the vagina, which was when the pushing would begin.

The midwife inserted her hands and tried to manually move the cervix, prying it back during the contractions so the baby’s head could break through. This was incredibly painful for S, and her voice was now ragged and somewhat hoarse from screaming. But it didn’t help. The cervix remained in the way. Hours after it began, S was still technically in transition, though in a normal birth the baby would’ve been born by now.

“You’re just going to have to push him through and out,” the midwife said.

The nurse draped a white pad on the floor, and leaned a small mirror against the bed, and brought in a light on the end of a crooked pole, the kind you might see in an operating room. S crouched in front of the mirror, and the midwife sat on the birthing ball behind her, hands under S’s arms, legs supporting her back. The light was moved so that we could see her bottom clearly. During the contractions the midwife had S hold her elbows away from her body (“like airplane wings”), and taught her to exhale down through her uterus, pushing the baby out. In between contractions, S leaned over the bed, and the midwife rubbed her back, while I ferried her water or a wet washcloth. When S pushed her face scrunched up and became flushed and sweaty with the exertion. It was at this point that the first bits of blood began to spray out of her vagina, at first pink and then a deeper red, stippling the pad beneath her.

S switches back to the bed, to try pushing on her back. The nurse becomes fastidious about checking the baby’s heartbeat between contractions, listening for “one-twenties.” After—how long? An hour? Over an hour? Though these events all happened, I’m not even sure if this is the exact chronology, my memory is so blurred by exhaustion and adrenalin—I help the nurse set up an oxygen lead. There’s hope that the oxygen will give her a boost of energy and also keep the baby stable, since he’s still getting blood through the placenta. The hose doesn’t reach her face, so we take a longer tube and fashion a makeshift mask by shoving it through a plastic cup. Now a new routine begins: pushing with the contraction followed by a whiff of oxygen, a sip of water, and a wipe of the forehead with a cold compress. A push, a whiff, a sip, a wipe. Again and again, for another hour.

Blood beads on her labia, and the room smells tangy and astringent with it. S’s eyes are wide and glassy, and in between efforts she’s white as a ghost, and she doesn’t talk so much as moan for things when she needs them. I can tell she’s deep in herself. Fear begins to grab my chest, and it squeezes tighter when the midwife, who had left for a bit, comes in and says, “The doctor wants to know why we have a woman down here who’s been pushing for over two hours.”

“What should we do?” the nurse responds.

“I told him to give it more time, we have a few other things we can try. But then he’s going to have to come down.”

Another exam. The gloves come in a folded paper packet. Pull one side off and remove a glove, then a little baggie of lubricant. Spread the lubricant out with your ungloved hand. Then remove the other glove. The room smells of these things too—rubber and petroleum gel. I’m trying not to freak out.

The baby’s head is visible. She’s pushed it past the cervix, though—and I may be misremembering this—the nurse spots some of it hanging on to him, a bit that’s come along with him. Or maybe it’s just a clot. They move her labia aside and I look, though it’s hard for me to figure out what I’m seeing. The baby has seemed so abstract, and now I’m supposed to recognize that this dark purply mass deep inside my wife is my son?

More pushing. More whiffs, sips, and wipes. We lie to S. “He’s almost there, you can do it, just one good push, bring him closer.” Her weariness is visible in her eyes. She’s clammy. We increase our efforts to keep her hydrated. Ice chips are given along with the sips.

The pattern changes again. Contractions come in double spikes. There’s a big one, then thirty seconds of peace, then a little one, then almost a minute of rest, and then repeat. It’s monotonous, exhausting, awful.

S is hooked back up to the monitoring belt. As the contractions begin, the numbers slowly rise from zero. Around thirty S gets that look that means she feels it coming. When the contractions peak the monitor tops out at 199 and an upward pointing arrow blinks. The baby’s heartbeat fibrillates with each push, sky rocketing up into the 180s, then dropping down into the sixties and seventies. I understand why the nurse regularly checks his pulse. With each contraction the baby’s having a heart attack.

The doctor comes in, a handsome man with a gentle voice—do they train everyone in this profession to speak softly?—and he teaches S a new way to push. “Look at this chart,” the midwife says, showing him the monitor readout. “You’d think she was on pitocin with contractions like these.” He examines her and agrees with the midwife. S’s body is working hard to get the baby out, but he’s coming slowly. S says she can keep going, and the baby’s heartbeat is regular and strong, so they decide to give her more time.

She gets on all fours, and the nurse and midwife press their fists into her ass as S bears back pushing. The new technique gives her a burst of energy. “You’re so strong, sweetie, stronger than anyone could ever ask you to be,” the midwife says. My eyes are tearing with terror and admiration, and sometimes when I talk to her I choke up.

For a while this goes on, and the baby’s head slides forward until it’s just visible beyond the folds of her labia. It looks like a meatball, with strange flecks of red and white. I can’t picture a baby beyond it.

In between contractions the nurse hooks S up to an IV, attaching it with a wad of tape so she won’t yank it out when she struggles. There’s concern she’s dehydrating. We move S closer to the oxygen, replacing the rig we MacGyvered for her to breathe through with a mask that straps over her nose and mouth. She’s told to keep it on throughout the contractions.

There’s talk of the doctor returning. This is used almost like a threat, like you have to push this baby out or else the doctor’s coming back and who knows what’s going to happen. The midwife tells the nurse to prepare The Table.

I figure this means a stretcher, and that soon we’re going to have to go upstairs to the traditional delivery room, but I’m wrong. The nurse wheels in a table hidden under a blue sheet, like the blue of a tarp, but a bit darker. I’m chilled, anticipating something awful. Under the sheet is a variety of scalpels, scissors, and forceps. The midwife pulls out a huge needle and dispenses an arc of clear fluid. This is the local for her episiotomy.

I start to totally lose it. My chest is gripped with panic, and I run off to the bathroom to try and pull myself together. I tell myself to get a grip, for S. She needs me to be strong and confident.

I go back to the bedside but can’t stop tears from leaking out. I’m breathing deep with her, trying to keep hysterics off. S dreaded having to get an episiotomy, and I worried she was going to bleed out on the table, an irrational fear sparked by my own rough delivery, when my mom hemorrhaged after a misplaced cut.

The midwife places a blue sheet under S and goes toward her with the needle and I stare into S’s eyes because I can’t stand to look anywhere else. When I finally peek there’s a dark crimson blotch, so deep it’s almost black, leaking onto the blue field. The midwife inserts her hands and tries to help S bring the baby down. The head is right there, but he’s stuck. He won’t pass beyond, he won’t crown.

The midwife stays low on the bed, coaching S, and during the contractions I hold one leg while the nurse holds the other. The oxygen and IV tubes get in the way, and if we don’t hold her tight her limbs flail about. In between every push the nurse listens to the baby’s heart with growing concern over his health, but it remains strong. S on the other hand is getting tired. At this point everyone knows something’s wrong, but no one’s sure what. The going theory is that the baby’s turned around, coming out with his nose facing up instead of down, as normal. But S didn’t have back pains, which you’d have in ‘back labor’ when the baby is facing up.

The doctor comes back and S gives it one last try. He also uses her hands to help pry the baby out. When he removes his gloves they’re slick with blood and black goobery clots. S’s hair’s wet with sweat, and the bags under her eyes hang heavy with weariness. The doctor and the midwife explain that it’s been too long, almost twenty three hours, over four of them spent pushing, and that we need an intervention. He explains that he can use a vacuum to help S bring the baby out—she’ll still need to push, so her work isn’t done yet, but the doctor can pull while she does it.

S agrees. The doctor disappears, and the nurse wheels in a stretcher to take her upstairs to Labor and Delivery. It’s a little before two o’clock in the afternoon.

Note: During our six week postpartum visit to the midwives, we found out that S received just one incision, and it was made in the labor and delivery room, not the birthing center. (This explains why S only found one deep scar down there after the fact.) The table with the equipment was wheeled in, but the blood must have come from S tearing, and not being cut. Strangely, we both remember the midwife holding the needle. Maybe that happened in the labor and delivery room too? Like I said when I started writing this account, the exact chronology is all screwed up.


2 Responses to “Labor, part 2”

  1. 1 Erika June 10, 2009 at 8:42 am

    Oh my goodness, I’m so glad I already know that this ends with S and Felix being OK…it’s a cliffhanger!

    What an amazing thing to experience together. Wow.

  2. 2 Rachael June 11, 2009 at 11:17 am

    My jaw is wide open and cannot close. Holy fuck. Baby in my uterus started flailing the minute I started reading this and didn’t calm down until I stopped. Thank you both for this.

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