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Birth

Rewrite: I become a six-year-old mom today

Six years ago today, this happened:

photo by our doula, Candace Palmerlee

The celebration of this day feels more significant than any other in my life. It lurched me awake at 5am this morning with memories of that exact time on this day in retrospect. It moved me to get out of my bed in my sleeping house and re-write this post I wrote 3 years ago today.

The anniversary of my birth of Jo is about returning. Every year, I circle back to the same day from farther away. Every year, I remember the same but different. Today, I remember 5am on 09/09/09. It’s not written down in the birth log that our doula wrote for us, and I can feel it more vividly than the moments we caught on video.

It was the hour we drove to the hospital. The hour that the momentum I had built over 19 hours of labor came crashing down into anger. I pissed off the triage nurse by declining a routine but optional vaginal exam. She shot me glances when I would moan with my contractions that said, “Jesus. This one is an entitled drama queen.” And so began my visit in triage–that bed in an open hallway–that lasted hours instead of minutes.

My blooming anger all but stopped my contractions, and just before we were finally admitted to a labor and delivery room, I literally peed on the floor in protest. Squatting down to the toilet was so painful that I chose to stand. The pee ran down my legs into a pool on the floor, and I barked at AJ not to clean it up. If the women who work in this place where mothers go to have babies were not going to respect me, then I wasn’t going to put myself through ripping pain to respect them.

This is the unsung triumph of my first birth: I pissed on their linoleum floor on purpose, without a lick of shame or regret.

As I set off into my 6th year as Jo’s mother, let me grow that mother stronger. The one who knew the moment when politeness and compliance weren’t useful tools anymore. The one who easily sank into her formidable, animal self.

My experience of labor and birth has expanded my emotional territory in all directions. There are sublime moments of rightness beyond knowing, and despair that can sweep me out to the furthest reaches of myself. I never knew I was so big until I started becoming a mother.

No wonder I wake when I could be sleeping to remember it.

5 things I wish every woman knew about birth

  1. There’s no right way to give birth. Throw moral superiority out the window. Women who have epidurals aren’t weak and women who have drug-free births aren’t strong. Every woman needs to do what feels best for her, deep down in that quiet place that knows what it wants if you get really still and listen.

    Here I am, getting still and listening during my labor with Jo. Or perhaps I’m just very stoned. Photo by Candace Palmerlee.
  2. How matters a lot more than what. There’s pretty much nothing I’d rather listen to than a birth story. So I’ve heard A LOT of them. And the consistent thread is this: The way a woman feels about her birth has lots to do with how things happened and much less to do with what happened. It’s easy to see birth as a binary with Drug Free Birth on the Winning side and C-Section on Losing. It’s that kind of black and white thinking that can leave women feeling less than open to options that might be helpful or necessary when the time comes. I’ve seen epidurals work wonders. I myself, hoping for a homebirth, said “I love Pitocin!!” during my labor with Cal.
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    Pitocin ain’t too shabby. Photo by Candace Palmerlee.

    I’ve witnessed rad homebirths and victorious C-sections. I’ve also listened to women talk about hospital and home births as traumatic. If you want to love your birth, focus on supporting yourself around the game-time decisions you’ll inevitably have to make during labor, and let go of the end game. Not surprisingly, you will be much more likely to feel good about your birth if you experience it as something you actively did and chose, rather than something that was chosen for and done to you. To that end, bring someone with you to your labor who will listen to you and help you understand the ins and outs. Which brings us to #3:

  3. It’s more about who you’re with than what you want.  I always figured that the largest factor contributing to a woman having the birth she wanted was her commitment to that kind of birth. After birthing twice and working as a doula, I know that idea is complete crap. What matters more than any commitment is having a care provider at your birth who has a depth of knowledge and experience about the kind of labor and birth you want. Labor without drugs–things like how to help a you relax through your contractions, how position changes and movement can hasten your labor and delivery, and when to use certain techniques and not others. Labor with drugs–things like how to dose pitocin so it doesn’t overwhelm you with contractions but so you’re not laboring forever and what types of pain relief are most useful when. Here’s the other kicker: if you’re having your baby in a hospital with an OB or midwife, it’s most likely that you won’t see them until you start pushing. Until then, the person who is going to help you is a labor and delivery nurse who is assigned to you (or nurses if you have a long labor that spans a shift change). I was really surprised to learn this, and I decided not to put all of my eggs in my OB’s basket, since she would, at most, be attending the last few hours of my first birth. Turns out, with Jo, I pushed for less than 15 minutes. They pulled an OB out of the hallway. I still don’t know her name. But I’ll never forget the calm, constant, trusting presence of my doula, Candace and the kick in the pants that was my labor and delivery nurse, Jackie.
    If not for my doula and L&D nurse, I would have never taken this walk outside after nearly 25 hours of labor. But I did. And while my face here looks pained as hell, I remember it as my most transcendent experience of labor.

    You might luck out and be assigned to a labor and delivery nurse whose skills match with what you want. And you might not. My advice? (As if you had to ask…) Do your research about the skills that the labor and delivery nurses at your hospital have. You and your partner can beef up your skills at a birth class geared towards your goals. And you can invite a doula who has the skills you want to your birth. You should also really like your doula and feel safe around her. Which is the perfect segue way to #4:

  4. The safer and more relaxed you feel during birth the better. Trust your instincts. Go with your gut. Cause in the end, you birth with your instincts and your gut. It’s good practise, cause that’s often where you mother from too.

    Blissful, transcendent photo by Candace Palmerlee
  5. There is no plan. While I’m a fan of “the birth plan,” I’m not a fan of calling it a plan. (“Birth hopes” maybe?) If my births and every single birth story I’ve ever heard is any indication, birth follows anything but a plan. I know it’s a bit of a downer, but I’m going to call a spade a spade: no matter how many books you read or classes you take or visualizations you do, unexpected things will happen during your labor and delivery. Things that you don’t like will happen. And while that might sound terrifying, getting comfy cozy with the practice of planning for (ha!) and adapting to uncertainty is one of the most helpful things any woman can do to prepare for her birth. How the heck do you do that? Control the things you can: read the books, take the classes, and invite the people to your labor and delivery who you trust in times of uncertainty. Then throw your hands to the sky and let go.

How the NICU saved and tormented our brand new family

My most recent doula client, Maude, had an incredible birth. She hoped to have her baby at home and labored there with grace and vigor for a day.

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When she was deep into active labor, this woman thudded up and down her stairs stairs with the consistent purpose of a metronome. (And that expert on-the-stairs-back-rubber, is Anna Mahony, dream-doula, who I sometimes work with.)

Three hours into pushing, she made the decision to transfer to the hospital. Within an hour after getting there, she pushed her baby out to discover, much to her surprise, that it was a girl. We all sighed with relief that we wound up at the hospital, since her daughter needed some help with her breathing at the NICU. She later developed some other complications that resulted in her transfer to a NICU at a nearby children’s hospital. When I met with Maude 2 weeks after the birth, her baby girl was healthy and happy and at home. As we watched Baby Girl nap peacefully in her swing, Maude launched into a passionate recounting of her experience at the NICU. It was so moving and real that I invited her to write a guest post here. I know that her experience is not an isolated one. I also know that her story and candor will be eye-opening at the very least and validating and inspiring to those of you who have spent time in NICU-land.

***

I feel obligated to start by saying this: I am grateful beyond words that my daughter is alive and well. She may not have been, had the skills of the NICU staffs of two hospitals not been so competent. And I shudder to think of what might have happened to our family had we given birth in a country or part of the United States where medical care is not so advanced or covered by health insurance (kind of) or accessible to nearly anyone. I am grateful that she will likely not experience any long-term disability or complications from what happened at her birth. I am GRATEFUL for her stay in the NICU.

AND

I am flabbergasted, horrified, and raging mad.

I say “her stay” in the NICU on purpose… For it was made clear to me early on that this was HER stay in the NICU, not ours. The person who was INSIDE OF ME 24 hours ago was now considered a separate being, whom I was supposed to turn over to strangers to care for while I tried to mentally comprehend her medical issues, communicate these to our loved ones, and take care of my throbbing body that had just experienced the most exhilarating, intense experience of my life.

Upon admittance to the NICU, my husband and I were told our daughter was allowed two visitors at a time, and we counted as visitors.

I wanted to shout, “I am her MOTHER (even though this concept was only a few hours old to me). Her MOTHER!!! She lived inside me a few days ago. No me. No her. Get it? I am NOT A VISITOR. I am an integral part of her care and well-being. I am like the ventilator to which she is attached. I am like the bed on which she is lying. I am (literally) like the feeding tube that is trailing down her throat. I am an indispensable part of her medical care!”

The system in which we found ourselves did not see it this way.

The system saw me as a visitor, at best. At worst, I was an intruder, a distraction, an obstacle to my daughter’s healing. The NICU was a large, open, fluorescently lit room lined with cribs and bassinets on all four walls. There was  no privacy for our family to talk, to cry, to sleep, to figure out what the hell just happened to us. There wasn’t even a place for us to sit down at her bedside.

We tried to retreat to the “waiting room” where we often encountered unfortunate families who spoke loudly, using profanity, about who they were preparing to “fight” upon return to their home communities.

We tried to retreat to the cafeteria, but it was loud and cluttered, and sometimes it was difficult to find a clean table. Plus, it was on a completely different floor from my daughter. I didn’t like being so far away.

We even tried to retreat to the chapel, but the chaplain (!!) told us that sleeping in there was inappropriate. Sleep was all we needed. I can pray anywhere.

Most of the nine days we were there, I had to fight to remain by her bedside and not feel like a distraction to the medical professionals attending her. On the first night of her stay, five doctors came in for “rounds” where they discuss the patient. One of the doctors asked me if I had questions for the main doctor. I asked her about seven or eight questions. The other doctors started fidgeting, annoyed at having to stand and wait through my questions. Finally the nurse jumped in, “You’ll have a chance to talk to the doctors again in the morning.” I guess I asked too many questions.

One reason I was treated as such an anomaly in this particular hospital occurred to me slowly, over the nine days of her stay. This particular hospital tends to serve many “Medicaid” (read: poor) patients. Why they are funneled to this hospital is a mystery to me. Why their children need intensive care is not. In the NICU there are mainly premature babies, many of whom likely did not receive adequate prenatal care or nourishment. This NICU is used to poor parents. Poor parents tend not to ask questions. They may be intimidated by medical professionals. Poor parents rarely have the luxury to stay at their child’s bedside all day. They have to go to work. So the NICU has developed policies, facilities, and protocols accordingly. And naturally, the staff there were ill-prepared for my borage of questions and constant attempts to stay at the center of what was happening to my daughter.

This makes me RAGING MAD. Poor parents and their children deserve the same kind of care as any other family. They deserve everything I want and am about to ask for.

1) Deliberate coaching on pumping breast milk.

It was 2:00 am on the first morning of her stay in the NICU. (I elected to spend the night, even though there was not an adequate place for me to sleep in any restorative way. Leaving my daughter in the hands of strangers while she was 36 hours old while I went home to my bed empty-handed just didn’t seem doable to me.) I said to the nurse that I wanted to learn how to pump breast milk. This fabulous nurse called her friend from another unit to come over and help me in the “mother’s room” (a hideous, windowless closet with one, overhead fluorescent light and a breast pump with no instructions). The friend came and showed me how to operate the machine and set up the plastic flanges on my breasts. She gave instructions to pump every two hours. As a result, the nurses were eventually able to administer my milk to her via a feeding tube instead of formula, and I had an established milk supply several days later when my daughter was allowed and able to nurse.

Every new mother should be offered pumping instruction in her first visit to the NICU. She shouldn’t have to remember to ask.

2) A clean, private place to use the bathroom.

After a woman has given birth, going to the bathroom is a new experience. New moms often have stitches, either in their abdomens or in their vaginas. A filthy, windowless hospital bathroom is not a place to care for open wounds. New moms have supplies they need while in the bathroom. Placing my bag of said supplies on the filthy floor of the bathroom stall (upon which I KNOW someone vomited less than 24 hours ago) is not hygienic. So I balanced the heavy bag on my shoulder while tending to myself.

New moms need sanitary napkins, ice packs, garbage cans within reach of the toilet, spray bottles, glasses of water with which to take their prescriptions, and toilets that are higher than normal so we don’t have to squat so low. In short, we need private bathrooms.

3) A clean, private place to eat.

I was told upon arrival to the hospital that it is critical that I eat a lot and eat well to establish and maintain milk supply. In the next breath, I was told I was only allowed to eat in two places: the waiting room (aforementioned disaster) and the cafeteria (on another floor from my kid). I was also told that I was afforded one meal per day from the hospital. They would deliver this meal to the NICU, but I had to transport it to an “eating area” to consume it.

4) Have a doctor say to me, “You are an integral part of your daughter’s wellness and healing.” (And have said-doctor believe these words.)

I fear the neonatologists and other doctors were not trained (or forgot) that the presence of a neonate’s mother is CRUCIAL to her surviving and thriving, especially when in critical condition. Doctors certainly did not express this verbally, and the facility in which they work does not express this non-verbally. I was given small squares of fabric that I was to wear close to my body and then place in her bassinet so she could “smell me.” Guess what? If I STAY IN THE ROOM with her, she can smell me too. I found these fabric squares to be insulting. If I were provided a CHAIR to sit in, I might feel more welcome to stay.

5) NICU spaces should be designed to encourage family participation.

Having nowhere for a mother to sleep, breastfeed, eat, or even sit sent me the message, “Go home. We’ll call you when we’ve healed your child.” Having this exclusion constantly rained down upon me made me want to strangle the medical professionals who designed this standard of care. I absolutely could not go home, at least not for the first 48 hours. After that, I felt so defeated that I started to force myself to go home each night. There was literally nowhere for me to be at my daughter’s side.

A nurse said, “You should go home to rest and be ready when your baby does come home.”

I smiled and nodded at the time, but that comment has gnawed away at me. Some of my friends would mention that at least there was the silver lining of me having some extra time to rest. I adore these friends. And I know they were just trying to say something kind. And I feel compelled now to share why the concept of resting at this particular time is a complete crock.

If you think you don’t sleep well when your first-born daughter is cooing or crying in the bassinet by your bed, try sleeping with her 15 miles away in the care of a stranger.  That, my friend, is the definition of NOT sleeping well.

Coming home was not restful. My husband and I followed the same, breathless routine upon arrival home each night. After crying and shaking and heaving in the car the whole way home, I would peel myself out of the passenger’s seat, walk in the house, strip off all of my clothes (which were filthy, thanks to the condition of the hospital) and proceed upstairs to start pumping. My husband would throw all of our clothes into the washing machine, and provided the hot compresses, cold compresses and all supplies necessary to kick-start a milk supply with a breast pump in the absence of an infant. I would call the hospital to check in with the night nurse about how my daughter was doing, remind them that we didn’t want her to be given a bottle or pacifier or formula, and thank her for taking care of my girl. After pumping for 45 minutes, my husband would take the expressed milk and my plastic pumping supplies down to the freezer. I would set the timer on my phone for two hours, and my husband and I would wake up to repeat the process. Somewhere in there he would bring up the newly cleaned clothes for us to wear again.

I want to see a standard of care that acknowledges the neonate and mother as one unit. When a father or partner is in the picture, this person should also be included in the unit. These two adults are not visitors. They are pieces of the child’s care plan that are indispensable.

I want to see individual rooms for neonates and their parents. Period. With bathrooms, eating trays, and windows, just like other patients in the hospital. If neonates could talk, I’m sure they would request the same.

I must finish where I started.  I am grateful. I realize that my girl’s stay in the NICU was very short by most standards. She was born at full-term and therefore was able, eventually, to breastfeed well. All things considered, she recovered quickly. I’d like to think at least part of this is due to my fierce wrangling to be there, to advocate, to do everything I could to keep her healthy in the ways that felt right to me. And I feel deep gratitude to the to the skillful nurses, doctors, and researchers who contributed to her wellness, the manufacturers of products and drugs she used, and the millions of babies who went before her to pave the way with knowledge and skills to help heal her particular illnesses.

And

I want better. I want better for families of means and families without. I want better for moms who don’t know how or what they should ask, and I want better for moms who are pains in the neck and ask “too much.” I want better for all babies.

What I want is out there.

Waxing poetic about time, treasure and sisters

There are moments of sweetness I can hardly describe. The kind of sweetness that aches, that wraps its tiny fingers around your heart and squeezes a little bit too hard. It’s the sweetness of endings and beginnings. Of beginnings as endings.

My sister had a baby this week, and I was there. She rested her head on my shoulder as she slumped her back forward to receive an epidural. I rubbed her feet and laughed with her while we waited. I was there, and I looked into her face while she collected her energy and courage between pushes. Her face calm, fierce, focused.

Today is Jo’s last day of preschool before summer. I lingered with Cal at circle time and listened while Jo’s teacher told him and his class about the treasure hunt. All those smooth, soft, warm 3 and 4 year olds sitting cross legged on the carpet, listening.

“There might be times when you’re hunting that you just want everything. When you see a big pile of treasure and you want it and all the treasure in the world for yourself. When you feel that way, you can put your hand on your heart like this and say, ‘I have gold fever.’ When you have gold fever, it’s a good idea to slow down, and come in to the snack table and have a little bit of water, and maybe a snack. And then you can put your hand on your chest again and say, ‘There’s enough treasure for everybody.'”

As I sit here, writing this, Jo is probably surveying his gold, nestled in his treasure bag, or digging deeper into the sandbox for more booty, or treating his gold fever with some celery and hummus. And my sister is probably looking down at that new girl of hers, cupping her tiny head in her palm, smoothing her black hair down with the rhythmic stroke of a thumb.

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Time is passing, just flowing right through. It brings babies, it takes childhoods, it grows chickens and firmly closes doors behind us. No more preschool. No more pregnancy. But this now. Treasure hunting. Newborn nieces. Tree limbs arcing up to sun and wind.

The passage of time is not lost on us. But we get lost inside it sometimes. The monotony can be a real trickster. Today is the same as yesterday. Time for the Wednesday routine again. Wake, run around, sleep, repeat.

Thank goodness for endings. And beginnings. The bookends of time. They hold us upright and keep us honest. They remind, with their firmness, that things can change. Sisters can become mothers. Boys can become treasure hunters. Life can be unbearably good.

Saying goodbye to birth: a love letter

Since I’m a total birth junkie, I can’t let any moment with obsess-about-birth potential go by without properly obsessing.

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So I made this little altar in the corner of our back patio where I meditated for 3 interrupted minutes on birthing Cal.

I’m diving in today because it was almost exactly a year ago to the minute that Cal was born. Even as I write them, the words “Cal was born” are a passive and withered description of what actually happened. No single human in the history of the world “was born.” Someone birthed them while they simultaneously birthed themselves. In reality, Cal and I and pitocin and AJ and my midwife and doula and nurses did a magical, timeless birthing together. Cal navigated out of the most cramped but yielding passage. I faced all of my yeses and my nos and a deep, dark, holy abyss. I stood on the very pin prick point where the breathless height of awe tips over into terror.

I’ve been marinating all day in the birth log my doula kept, announcing to a friend at a 5 year old birthday party today,

Right now a year ago I was puking. Yep. 12:15. Puke time.

After I got Cal down for his nap this afternoon, I positively skipped down the stairs to my laptop where I flicked through all our Cal birth photos. I gushed over little snippets of video too. I forgot how lucid I was between contractions. And how quiet I was in the beginning. How loud at the end.

Now I’m feeling high. Just the thoughts and scenes and sounds of our birthing a year ago have left my body feeling like a slightly jostled bottle of sparkling water. I’m actually fizzing.

Birth is unequivocaly the peak experience of my life. Both of my births. Celebrating Jo’s and now Cal’s birth feels so much deeper and more real than celebrating my own. And it’s not because of my unending love for each of them. It’s because I remember being there. Because I had no choice but to go straight into the depths of my body with each of them. And the only way out was straight through the pain and intensity and I-can’t-do-this of it all. There has never been anything like it for me.

I’ve been skirting around the edges of my grief about the decision that AJ and I have made to stop making babies. I’m firmly rooted in our choice–I do not want to raise any more children. About that I am crystal clear. Oh, but birth. I would do you again in a heartbeat. Even after having just listened to this.

 

Nay, BECAUSE I just listened to that.

There will never be another thing in my life that will take me to that place. The small, smooth stone of that truth drops down and leaves an ache. There is an emptiness. I’m on the other end of my births, and I can never go back again.

It is this minute. This very minute a year ago that I felt that shockingly insanely huge hard round head coming out. Between contractions, it just lodged there, expanding me, and there was nothing but that smooth, molded skull and my voice and the vast shock of awe.

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Photo by Best Doula on Earth, Candace Palmerlee.

And then, it was over.

***

If you’d like to read more about Cal’s birth, help yourself to Part 1 and Part 2. And here’s my sappy nod to Jo’s.

What to say to any pregnant woman on earth who is close to her due date

For some bonkers reason, pregnant women are given a due date of 40 weeks after the first day of their last period, even though the average day of arrival for first and second babies hovers around to week 41 . So, odds are that if you know a pregnant lady, it’s likely she’ll go past her due date. And odds are, if her due date is looming, and you happen to like her, you’re going to wonder what’s going on. You’ll want to text or call her to see how things are going.

It’s quite likely that without meaning to, you’ll say something that makes her feel like this:

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Photo by istolethetv

Never fear, dear readers. Now you can be spared from making this easy mistake. I have two friends who just had their first baby (2 weeks past their due date, surprise!) and they came up with this easy way to determine if your comment to the very pregnant woman is worth putting out there.

It is very simple.

This is it:

Your comment should end in a period, not a question mark.

YES: “We’re thinking about you so much and are here if you need us.”

NO: “Do you need anything?”

YES: “I’m so excited to meet the baby.”

NO: (And this is quite possibly the biggest no of all.) “Baby yet?” or “Any baby?” or any question remotely like this.

Quite simply, waiting to go into labor can be ridiculously unnerving, and while it’s lovely to know that the people you love are thinking about you, it sucks to feel required to talk to them or to answer stupid questions. If you convey your support and curiosity in a statement, then your pregnant lady has the choice of whether or not to get back to you.

So keep those comments confined with periods, people. That way, you can rest easy knowing that you didn’t annoy the crap out of her and that she knows you’re one of the supportive and thoughtful ones.