Genius Toiling in Obscurity

Baby Has Arrived

Carl Scott Dierauer
2:54 p.m., March 22, 2004
6 pounds, 10 ounces

I have heard women talk in the most serious tones about the dreaded "back labor," in which the baby is facing the mother's front instead of the back. This means that when the uterus contracts, instead of being driven neatly into the opening of the cervix, assisting it in opening and dilating, the leading part of the baby's head is driven with great force into the mother's lower back, the base of her spine, and/or her rectum.

I have now had back labor, and soon I am going to start minting and distributing medals, the Medal of Honor of the Back-Laboring Mother, which all mothers who have endured back labor will receive and wear at all times on their lapels. All who come in contact with a Medal-Wearing mother will observe a brief period of silence in honor of her ordeal. A fairly elite sub-group, to which I belong, will also receive the Cluster of No Spinal Anaesthesia. Only two women in the last century have received the super-elite Ribbon of the Order of the Back-Laboring Mother Who Did Not So Much As Request Spinal Anaesthesia, though in both of those cases the mothers delivered unexpectedly far from home, in countries where no one understood the language they spoke, so the delivery room staff's signed affidavits affirming that they "did not hear the mother request spinal anaesthesia" have to be taken with a grain of salt. When there is a confirmed case of a woman delivering a back-labor baby without requesting spinal anaesthesia from delivery staff who speak her language, we Legionnaires will gather from all over the world and line her path to the induction ceremony by prostrating ourselves in her honor, foreheads to pavement. No, lining her path won't be enough. We will make her path of our prostrate bodies, for she will be our Queen.

After my labor with Eric, I could say things like "I loved pushing him out! It was glorious!" I could say, "I wouldn't exactly use the word 'pain' to describe my labor and delivery." I could use words like "discomfort," "sometimes very intense," and "challenging," without feeling I was doing violence to the reality of the experience. When I heard women describe labor as "agony," I thought--and sometimes said--"It doesn't have to be like that." And, clearly, my experience with Eric proves that it doesn't have to be.

But my experience with Carl proves that, sometimes, it is. Though I wouldn't exactly call the sensation "agony." Nor would I use "excruciating torment." Why not? Because words like these do not do justice to the searing...the searing what? "Pain" is too weak a word; we feel pain when we stub our toes. Back labor is some whole other category of sensation. "I wouldn't exactly use the word 'pain'..." I do not have words for it yet.

My friend Adrianne heroically applied continuous counter-pressure to my lower back throughout my labor, at great cost to herself. This counter-pressure was essential. With it, I was a dumb suffering animal. Without it--and I am not joking now, as far as I know, I am in earnest--without the measure of relief the counter-pressure brought me, I would have been traumatized by this birth. My brain would have done one of those tricks our brains do when confronted with an experience that is, on the one hand, unbearable, and on the other hand, inescapable, a trick that lets a person survive the moment but leaves her insane for the rest of her life. God bless Adrianne and her rower's arms.

The saving grace? The whole thing lasted only four hours. My water broke in the night, and about 10:00 the following morning, I started having contractions, assisted by a drug that ripens the cervix. I had a cervix-ripening drug with Eric, too (apparently this is how my body gets a baby out: ruptures its membranes and then sits around waiting for medical science to give it a kick), and I responded well both times, though the contractions that result are intense and close together from the very beginning. This time, I was prepared for that and was not overwhelmed by it, though even in the first two hours of my labor, when I was using my birth hypnosis to good effect and coping extremely well with the discomfort and intensity, I was having contractions that were much more painful than I had with Eric.

At the 2-hour mark, we moved from Special Obstetrics into our room in Labor and Delivery (the same room, by the way, where Eric was born) and an exam showed that I had dilated from "practically not at all" to 4 centimeters in just about two hours, a fast pace. I was glad to hear it, because I had been afraid my contractions were not productive; they remained localized in my lower uterus and back. I never felt them all over the way I did my contractions with Eric. I think now that the sensations from down low were so strong they overrode all other signals, but I had been coping heroically with great discomfort while fearing that nothing was getting done in there, so knowing that I had in fact dilated quite a bit cheered me up.

At my last birth hypnosis class, I learned a partner-assisted hands-on relaxation technique that I expected to find very helpful. I found it so helpful that David did it with me for every single contraction; it helped me focus my attention, stay relaxed, and regulate my breathing. During the "first half," I found that the intense phase of each contraction lasted for twelve deep breaths, and I counted them. I got into a good groove, and felt I could keep handing those contractions, one breath at a time, for as long as I needed to.

Not long after we moved to L&D, a contraction began. I started breathing and counting breaths. I got to 12 and prepared to relax. But the intensity remained. I counted to 14...17...22...28. "Shit," I thought.

It never stopped after that. I went from 4 cm to holding the baby in my arms in just under two additional hours. The labor itself was more intense (I keep using that word) and much more painful than anything I had with Eric, not excluding the very challenging, fast transition stage I had in Eric's labor, in which I contracted that last 3-4 cm in something like 35 minutes. At some point in this second labor the pain stopped going away between contractions; it just phased back to "merely excruciating" before popping back up to that as-yet-unnamed level during contractions. And when I hit transition contractions were coming so fast and hard it was total chaos in my head. Things were moving so fast I didn't understand them. When they nurses told me I was fully dilated and would be able to start pushing soon, I didn't understand what they were talking about. I couldn't take it in.

By the fourth hour, I began each contraction by crying out, "It's starting, it's starting. Help me! Help me!" Adrianne would step up the counter-pressure, David would dash to my side to help me relax (he also had sponging duty, since I was uncomfortably hot all over), and Candy, one of our nurses, would come stand by my head and talk to me, helping me steady my breathing and bringing me down when the pain started making me squeak in unproductively high ranges. When contractions ended, she would also help me slow my breathing back to normal and relax all over so I could get whatever meager rest I could.

And then Penny, our other nurse, said it was time to get ready to push, and once I took that in we talked about our strategy. I was interested in trying the squat bar, but Penny said, "If we put you on the bar, this baby will be out in two pushes, and that's too fast." So I did it on my back again, with David holding my left hand, Adrianne helping support my left leg (one of the many small thoughtful things Adrianne did during and after my labor and delivery: she asked for towels to put under my legs in the big vinyl stirrups, so I wouldn't get sweaty and sticky). I had a whole circle of people around me: David, then Adrianne, then Penny, Dr. Shah the resident, Dr. MoyerBrailean our o.b., Candy, and, holding my right hand, in what still feels like the miracle of miracles: our beloved friend Scott, who lived with us for many years and was with us when Eric was born. He moved to Boston last fall, and I have been grieving his absence at this second birth, but just as we were getting me ready to push, someone said, "Scott is here." We couldn't take it in. "Scott from Boston, he says to say?" the voice said, and we said, "Send him in, send him in!" and he came into the room and took hold of my right hand and didn't let go of it until the baby was born. He had decided to catch a plane after I called in the night to tell him my water had broken and the baby would be born that day, and he got to the hospital in the nick of time.

When Eric was born, Adrianne and her family were living in Montana and couldn't be with us. Now they're back, and I was so glad she could be there, but sorry Scott couldn't be. But even though it was impossible for Scott to be there, he was. Everyone I wanted with me was there, except Adrianne's partner Carla, who arrived shortly after the birth because she had been caught up in arranging care for their son so she could come. But Carla, an experienced nursing mom, stood by me and Carl after the birth--while David sagged into a chair and ate some much-needed food and Adrianne rested and hoped she would someday regain sensation in her hands and wrists--and supported and coached us nursing for the first time, and that is really precious to me.

I pushed for about half an hour. It was, I am sorry to say, not glorious. It was painful, painful, painful. Also, I think because all my nerves were so hyper-stimulated by then, I couldn't feel just where the baby was. With Eric, I felt him coming down with every push. Carl was also coming down, but I had to rely on the reports of the Gallery of Spectators to tell me it was happening. Once his head was engaged in my vagina, I could sort of tell he was there. But not really.

Here is something I am proud of: around the three-hour mark, I started saying during contractions, "I feel it pushing! I feel it pushing!" I don't know exactly what "it" was; I suppose the baby, coming down so fast it felt very much like when Eric was actually being born. Except that it hurt about a million times more. My instinct was to clench up against the pain in the world's greatest Kegel maneuver--and every single time, I relaxed all the muscles down there instead to let it happen. This was an act of will, and so was pushing. I steeled myself to do it because it was the fastest way to be done, and I pushed like a champion every time, with my whole body. I had excellent coaching, and I did what they told me to do, and the baby was born. Almost face-up, but born. His shoulders came out easily, he started crying and breathing on his own, the nurse put him, slimy and naked, right on my own slimy and naked chest, and we were done.

I shook for a good two hours after the birth. Longer than that; I was still shaky when we got to our post-partum room in the Mother/Baby Center. Carl was steady as a rock, and he apparently saw the same video we saw in our breast feeding class that showed how babies instinctively seek out the nipple, because within minutes of being born and placed on my chest, he was rooting around and looking for a nipple. I was too shaky to help place him; Carla connected us to each other, and I think he nursed for the first time within five minutes of being born, and he nursed off and on for much of the first two hours. He clearly came with Nursing Infant 1.0 pre-installed and ready to run, because he has a great latch, he sucks and swallows well, and he lets me know when he's hungry. After everything we went through with Eric, this is a huge relief. I find I am buoyed up simply knowing that, whatever we face in these first week, the rigors of pumping milk and finger-feeding it to a reluctant baby, followed by the eventual failure of our efforts to nurse, aren't among them.

When my water broke on Sunday night, I worried about Carl being so early: only about 36 weeks, 4 days gestation. But he looks and acts like a 38-week baby. I'm relieved.

There is no need to commiserate about the painful labor. Three days later, I find that I am not disappointed or let down by my labor experience at all. I suppose it's partly because memory draws a gauzy veil over painful experiences, but I think more importantly, it was a good labor in every way that counted. It progressed well (better than well--faster than fast), and we were never worried about either me or the baby, or about the outcome of the labor. Nobody doubted that I was going to keep progressing to the point of delivering a healthy baby vaginally. Even in the worst of the pain, I didn't think anything was wrong; I just wondered whether I could really endure until it was over.

Also, as with Eric, almost as soon as the baby was born I felt more like myself than I had in weeks. I'm definitely tired from not enough sleep, but the crushing fatigue is gone, and so is my sour mood. Physically, I'm very comfortable, more comfortable in my body than I was in the last few months. And there's this wonderful baby, who so far is about as good and easy to care for as any mother could wish.

I can't help but feel good about how I handled my labor. As with my first labor, I feel entirely good about the decisions we made, about the medical interventions we accepted and the ones we didn't. I complained a lot, but during the contractions I focused, relaxed, controlled my breathing, and generally managed not to interfere with the breakneck progress of the freight train my uterus had become. And, as I told David, I'm not exactly sorry it was as hard as it was. "When you've had an experience like that," I said, "you know you've had an experience."

Finally, a couple of awards to be presented:

Most Disappointing Moment in Delivery Room 1:

The nurses--our wonderful nurses, about whom I cannot say enough good--suggested that I would be more comfortable if we "got gravity on my side," and they arranged the bed to support me on all fours and flipped my gravid ass over. Gravity pulled the baby away from my back, and for about ten seconds I experienced a near-complete cessation of pain. "Oh," I sighed. "I love this. I am staying like this!"

"I'm so sorry," nurse Penny said, looking at the fetal monitor, "but you can't. The baby won't tolerate it."

"He's probably lying on his cord in that position," Candy added. "You are going to have to turn back over."

"The baby needs me to turn back over?" I said.

"Yes," they said.

So I turned back over. But that ten seconds of relief shines in my mind with bright lucidity.

Su's Finest Moment

There are few circumstances under which I can resist making a smart-alecky comment. Here's proof: it's, say, about 2:45 p.m. I've been pushing for about twenty minutes or so, give or take. A contraction ends and I fall back to rest. The support crew give me the usual update: "You're doing great! When you push, we can see the baby's head peek out!"

I said, "Did he see his shadow?"

Nobody got it, because, as Adrianne said later, nobody expected me to be making a joke right then. Except David, who knows and loves me, who laughed and said, "Oh, no, not six more weeks of winter!"

Three days later, we're home and doing well. Eric likes the baby very much and has been treating him with tender care, I'm a bit tired but not as much as I expected to be since Carl sleeps at night so far. Scott is staying with us until Sunday, which is like having all the help of a mother and mother-in-law without any of the unpleasantness. All is well.

Posted by Su Penn at March 25, 2004 04:18 PM | TrackBack