Sao Paulo, Brazil
10:30pm
Isabella was asleep in her bed. Rosemary was in the US. Roberto had just walked out the door to go for a jog. I was cooking dinner for myself -- penne w/chicken in a creamy tomato/red wine sauce. I ate one bowl-full. Went back to make some adjustments to the sauce and eat some more. I had the serving spoon still in my hand when suddenly a trickle of water ran down my leg. I looked down at the clear liquid on our white tile floor, confused.
I was 31 weeks and 4 days pregnant; the baby wasn't due until mid-February (I was hoping for Feb 14, as Rosemary is Apr 14 and Isabella is June 14 -- and all natural births, no inductions/cesareans).
I stared at the water continuing to trickle and puddle on the floor. I put the serving spoon down, and started whispering to myself, "Okay, what do I do? ...What do I do? ...What do I do?" I trickled down the hallway to the bathroom to check that my Kegel muscles were still working. And they were. It wasn't urine. I could make urine stop; I couldn't make the water stop. And it smelled sweet, and it was clear. Definitely amniotic fluid. I went back to the kitchen. I cleaned the floor. I got a towel to sit on. I looked at the clock. I called the midwife, for possibly the first time ever; usually I email her.
We talked. She wanted to make sure it was amniotic fluid. She told me I could go to the hospital to check, which is what I thought she would say. I was hoping there was some trick I had forgotten that would remedy the situation. There wasn't. When I hung up the phone and sat up, water that had pooled from not being allowed to trickle gushed out.
Roberto wasn't home yet, and he didn't have his cell phone with him. I called my mother-in-law. Then had to decide between laying still on the couch to avoid making the situation any worse, or cleaning up my husband and toddler's gigantic household mess--since my mother-in-law owns the apartment and hadn't seen the inside in a year...
I chose to clean up the mess.
And then I packed a bag for the hospital with my wallet, camera, and an extra pair of socks. I like clean socks.
My in-laws and a very sweaty Roberto all walked in the front door simultaneously. The dog started barking, and we all forgot to tell her to shut up, so Isabella woke -- thrilled to find her grandparents there. Roberto took a quick shower, and my in-laws packed-up Isabella to take to their house. Bella gave me an excited kiss and ran out the door. We let them take the first elevator so Isabella wouldn't get suspicious.
In the hospital, the nurse wanted to do a vaginal exam "to see if you are in labor and need a cesarean". Which, by the way, is total fucking bullshit. Luckily I knew that. I also knew that I shouldn't consent to a vaginal exam with my water broken (every exam after water is broken increases risk of infection, even with a sterile glove), but, honestly, hospitals are SO intimidating, and the nurse with her gloved hand wasn't willing to walk away without a fight, and my husband was looking at me like I was crazy for not doing what the nurse said, and I was afraid to cause trouble and start getting rough treatment that really would lead to a cesarean...
I wasn't dilated. And no contractions. And the baby's heartbeat was great, as always. Later, test results showed us there were no signs of an infection that may have caused my water to break; the cause was unknown, as is fairly common with premature rupture of membranes (or in my case, preterm premature rupture of membranes -- "PPROM").
When the nurse had her back turned, I made an unladylike gesture and mouthed to my husband "No fucking way am I getting a cesarean". I needed him to know that I had snapped out of my fear and expected to have control of this situation--that we were not going to blindly follow anybody's orders, and that he needed to prepare to deal with that.
So, I was checked into my room and at 3am was given the first steroid shot to ripen baby's lungs in case he/she was going to come within the next two weeks; the second shot would come 24 hours later, and the drugs would have the greatest effect if baby stayed put until at least 48 hours after the first shot.
We were still hoping to hold the baby in for at least two more weeks, if not the full eight. They told us that if baby was born then, at just under 32 weeks, he/she would probably be in the NICU for over a month. If we could hold the baby in until 34 weeks, he/she might stay in the NICU for half that. My husband asked our midwife if we'd still be able to have a (2nd) homebirth if we still managed to go past 36 weeks. She responded, "Forget about it," and predicted we had 10 more days at the very, very most.
We had to choose a doctor and a hospital. We chose the doctor who works as back-up for my midwife, and, after viewing the NICU, we chose to remain at our current hospital, which was closest to our home (a 7-minute walk). It's a very expensive, private hospital with a 90% cesarean rate, but the care is reportedly good, and the NICU nurse answered all my questions with the "right" answers.
As long as I worked to control my emotions, I had almost no contractions the two days in the hospital after my water broke, but I continued to lose lots of clear, sweet-smelling amniotic fluid. The NSTs continued to show that baby was doing very well -- good heartbeat, active, happy. I kept drinking as much water as I could to continue to replenish the fluid... Eventually I realized the only time the fluid stopped leaking was when baby's head was acting as the plug--when I was sitting or standing. So, although no one else said it, it seemed to me and Google that the hole in the amniotic sac must be down low, near my cervix. Meaning pretty much no chance for self-repair. A tear at the top of the amniotic sac might have been able to repair itself, under just the right conditions. Bad luck.
We had an ultrasound to see how things were -- the first ultrasound of the pregnancy. And they respected our request not to find out the baby's sex. (Whew!) And everything looked really good. But I had already lost a lot of fluid. A lot. My belly literally looked smaller when I looked in the mirror. I looked five or six months pregnant instead of seven. So I kept chugging water. And going to the bathroom.
We were sent home the evening of the 2nd day with instructions to be super-careful to avoid and prevent any infection (take propolis, echinacea, vitamin C; sit on sterile towels...). And we would need to come in for ultrasounds once a week to check on things. I could feel Roberto's tension growing, knowing he was thinking about the time and money he was going to be losing.
We were home only an hour or two before contractions started -- about 44 hours after the first steroid shot. I drank tons of water, took some magnesium, then tried beer. The second Heineken worked; it stopped the contractions enough that I could sleep for three hours, anyway. (Thank you, Heineken; as far as pale beers go, you're a'ight.)
Saturday, Dec 19th, 2010
I woke at 6:30am, and contractions were light and infrequent. But they started returning by 8am. They were exactly 8 minutes apart, except more often with movement. I tried a bath at the doctor's instruction, but, while it helped me to cope, it did not slow the contractions at all; this was real labor, and it was happening fast. I talked to my midwife over the phone (midwife trick: See how the client sounds over the phone; if she's talking through contractions, she's still got some time to go). At the end of the conversation, she told me she would bring her birthing stool to the hospital, which I had requested when I interviewed her earlier in the pregnancy. At this moment, another contraction came on, and I realized I was really going to birth an 8-weeks-premature baby in a hospital today, and I almost started to cry as I told my midwife, "I'm not sure if I care right now..."
I had to get out of the bath and head for the hospital. I felt overwhelmed. The contractions H*U*R*T. (I can now say that faster DOES hurt more.) I couldn't shake my fear of what would happen with a premature baby. (Fear ALSO makes labor harder.) I was already moaning loudly with each contraction. This was serious.
Roberto was rushing me out the door as I tried to pull together the things I wanted for the birth. I tried to tell him he didn't need to be in a bigger hurry than *I* was, but he was too nervous to listen. And MAN is he a bossy pain in the neck when he gets nervous. But so am I. He was pulling me into the elevator when I started crying because "NOOOO, I won't go if you don't bring your guitar!" If my labor slowed down in the hospital, I wanted to be able to continue with elements of my original birth plan--which included Roberto with his guitar, giving me some rhythm to focus on during contractions.
I reminded him that he needed to just do what I said, because his tension and bossiness would increase my tension, which would increase my PAIN. And aside from that, I've been studying birth for some years now in addition to previously birthing two children, so there's really no contest on which of us is more qualified to be in charge of this situation! He didn't see it that way, but he did get the guitar so that I would shut up. Although when we arrived at the hospital, he left it in the car.
I don't think I had any contractions in the car; the vibrations felt GOOD--later I realized it was because they were helping the baby maneuver down. I had brought a pair of nail clippers with me, and while Roberto drove like his usual crazy self, I calmly chanted "It's okay, It's okay, It's okay..." while I clipped my nails. I knew I wouldn't want any germs under my nails later when I handled my premature baby. And I needed the chant to stay focused. My baby needed me to stay focused and make this easy on his/her tiny self.
When we arrived, my husband told me that our midwife and her back-up doctor (who managed to get special permission to attend our birth at this hospital) were both already in the hospital, somehow. We live three blocks away; they both live/work at least a 20-minute drive away with no traffic.
Contractions in the ER wheelchair upon arrival sucked, until the attendant started rolling the chair, and then those vibrations felt as GOOD as they had in the car. Then the attendant dropped me off in the exam room and made me sit on the bed-thing. Those contractions sucked, too. I instinctively felt that I needed to shake my legs, hard, with each contraction, which was hard to do with them dangling from the edge of the bed. I also dealt better with contractions if I was upright and staying still -- NOT laying down.
Suddenly, while still waiting in the exam room, I needed to throw up. The nurse left the room to go get a bag, but Roberto was smarter and just brought the trash can closer to me -- just in time. I threw up (orange juice)--twice. I reminded Roberto that in both Rosemary's and Isabella's births, I threw up (and twice in a row) almost exactly two hours before they were actually born. So when I threw up, I knew my body hadn't gone crazy -- it was doing its work; we were still on the same team. This was good news, because I really wanted a beer or some drugs or a cesarean so I wouldn't have to feel this panic at birthing prematurely. I think I did mention beer a few times, but I didn't ask for anything else. I really didn't want this possibly-already-compromised baby to come out drugged.
My midwife and doctor came in to the exam room, looking like angels. Even though they had never attended a birth at this super-cesarean-happy hospital, the regular staff stayed completely out of their way and let them take over. They looked confident. I was so proud of them.
My midwife checked me, and I was declared 4cm dilated, to which I replied, "That's bullshit!" But I knew that there is no standard timeframe for dilation (although some docs will insist on at least 1cm/hr and induce you if you can't make it happen). I knew I could dilate to 10 in just a few minutes if conditions were right. My midwife also mentioned that a premature baby could be born without my being completely dilated. I also knew that even full-term babies can be born without complete dilation, if the mother is really listening to her body. I wasn't worried, but the contractions HURT, and the only number you EVER want to hear during labor is "10" anyway.
My midwife gently rubbed circles into my lower back during contractions--which were coming in groups of three!--and it made them so much more bearable just to have that attention. I would feel almost panicked when she would walk away from me to talk to the doctor, because I needed her for each contraction. Baby's heartrate was checked and was excellent.
Before I knew it, they were sending me to another room, where I assumed I would stay. I was checked again -- 6cm. I went to the bathroom and sat on the toilet with the door open for a few contractions (this is a good, often-comfortable position for labor, and it's good to have an empty bladder for baby to move past). Suddenly, my FATHER-IN-LAW walked into the room! I started yelling, "NO! NO! NO! NO! NO!!" I don't know if he saw me sitting on the toilet, half-naked, contracting, simultaneously pissed-off and bewildered, but he did leave immediately. I couldn't believe they'd allowed him into the room, but now I realize they were not used to natural births at that hospital; normally, their birthing mothers are drugged and quiet and social, I guess.
With each contraction, I was stomping my feet on the floor; I could feel the rhythm and vibration bringing the baby down. I was checked again -- 8cm, and feeling pushy, which sent them into a panic. I knew the baby wasn't coming just yet, but I didn't know I wasn't supposed to birth in that room. They had me lay down on a wheeled bed and rolled me to yet another room -- turned out to be their delivery room. Contractions laying down were horrible, but the vibrating movement of the bed down the hallways still felt GOOD. The car ride, the wheel chair, the rolling beds...all felt SO good.
When we got to the delivery room, I was surrounded by a number of unfamiliar people in scrubs. My midwife later told me that while she was scrubbing up, some nurse commented to her, "It will be a cesarean, of course?"
I noticed the lights in the room had been dimmed, which was very nice. But I looked around and didn't see my husband, midwife, or doctor, and I started to feel a twinge of panic. Nurses were trying to take off my shirt, but I was in the middle of a contraction and wouldn't let them.
Soon, my midwife and doctor came in -- everyone in the room, except me, had to don scrubs!! (Preparing for a cesarean, or was this a normal birthing preparation??)
Again, my midwife later told me that the anesthesiologist had come up behind me and said, "I'm going to do the epidural now." And my midwife had answered for me, since everything was in Portuguese and I wasn't listening, "No, we're not doing that!"
My midwife helped me move off the bed and onto the birthing stool, with lots of clean sheets covering it and the floor. I took off my shirt but did not put on a gown. I think probably none of the hospital staff had ever seen anyone give birth that way before, but it felt good to sit there. This would be my last birth, and I still wanted to feel free and do it my way. Plus there may have been cat fur or other germs on the shirt, but my chest was clean.
I opened my eyes after another contraction had ended and asked, "Where is Roberto?!", and he raised his hand from across the room, "I'm here, baby!" -- I hadn't recognized him fully decked-out in scrubs! My midwife called him over to our side of the room, and he sat in a chair behind me where he could rub my shoulders a little bit. Normally he's not great at shoulder rubs, but, in this moment, I just desperately needed to feel his presence. He stopped rubbing at one point when a contraction was beginning, and I thought I would die. "No, no!" "You want him to stop?" "No, DON'T! STOP! Roberto! NO, I mean, DON'T STOP!"
I saw a drop of blood fall onto the white sheet, and I thought, "Is that supposed to happen?" When my midwife pointed it out to me, I figured not. Time to start pushing. I don't know how long I pushed, but I think it was through a couple of contractions. There was a cervical lip that the doctor moved out of the way; I'd thought that would hurt, but it felt good--necessary. But after that was the 'ring of fire', and I could feel my skin stretching TOO MUCH. It felt as though my clitoris would tear, and I did NOT want to be touched while this was happening.
I asked if I could touch, because I had been too timid to do so during my previous two births. I felt my baby's scalp, and I kept my hand there for a while.
Then it's almost a blank for me now. I don't know how long anything took. I know I felt the baby's scalp. I know I pushed hard while Roberto rubbed my shoulders. I know the head arrived, and then the body.
And then, in this dark little room, with what seemed like a crowd of people lined against the walls behind me, I was suddenly holding the tiniest little baby I had ever seen. An amazing, tiny, black-haired replica of my middle daughter--and she was crying! She was breathing, alive, well, complete! I was in awe. I don't remember if I said hello. I just remember looking down at this miniature baby in my arms in the dark, and it felt surreal. It felt exactly like a dream. My midwife asked, "Did you see??" And I snapped awake and looked -- I said, "A girl! Roberto, it's a GIRL!" And I whispered, "It's Julianna!"
I was allowed to hold her in my arms for some time, then they took her away to do their checks. I asked my midwife if she was okay, and she said, "Yes! Did you hear her crying?" Roberto left the room to go for a walk and cry-out his overwhelm and relief. (Or sadness that she wasn't a boy--I can't be sure!)
Julianna, born at 11:45am, was 1.9 kg or 4.3 lbs--a perfect size for her age. She was 16.5 inches long. Her APGARS were 7 & 10. She really was perfect. They gave her a tiny bit of oxygen, then wrapped her in a blanket and hat and brought her back to me. I held her again. She was warm, she was breathing on her own, she was amazing.
After that, she was taken to the NICU for further evaluations, where they later said, "She is perfect--just small!". She ended up staying in the NICU/SICU for two LONG LONG LONG weeks--although really this was very short, as the pre-birth prediction had been at least a month's stay. I spent most of that time in the hospital with her, holding her or pumping milk for her or snacking and surfing the internet. On her 16th day of life, she came home with me. That was the happiest day of my life, I think.
Today, Julianna is almost 5 months old. She has the most deliciously chubby thighs; she is cheerful and alert and beautiful; she is almost wearing size 6-mos clothing.
We are very, very lucky.
Julianna -- May 8, 2010
