In for a penny in for a pound: how Mallory was born

My daughter’s birth is very far from my mind right now but it occurs to me that there’s a few details missing from the last week that I really should fill in.

Here goes.

In the nine months of anticipating Mallory, Irene and I had read a fair bit about birthing and how to plan it. Some authors argued that you should have a very specific plan detailing everything from big picture stuff right down to the colour of the walls and what’s on the CD player.

Others argued that there’s no point because events conspire against you, life is flux, you have to go with the flow, etc etc however you want to put it, insert your cliché here.

Our midwife told us that having a baby was like deciding to go on a journey only you didn’t know whether you’d end up in Spain or France.

Indeed. If we’d had a birth plan – we didn’t write anything out – it would have gone like this: natural as possible. No interventions, no medication. Bring some soothing music, some essential oils, a few homeopathic remedies, burn a candle. Hope for the best. But have the baby in the hospital in case of something else.

If that was Spain then we ended up in Uzbekistan.

At first we were excited when Irene’s waters broke in the first minutes of the new year. Irene was due on the fourth and eager to have the baby, so we looked forward to getting on with it.

But the ruptured membrane was the only sign the baby was coming. A couple of hours later, Irene started to experience some mild contractions.

She got no sleep that night.

The next morning we met our midwife at the hospital. Wendy monitored the baby’s heartbeat for 20 minutes and found it was healthy. She then examined Irene using a sterile speculum, confirming that her waters had indeed broken.

We went home and tried to stay distracted and to do other labour-inducing home remedies. The night of the first was also sleepless as Irene’s prelabour contractions were keeping her awake. Our friend and doula Moe came over in the evening and stayed with us until after the birth. We helped Irene through the night, to cope with the increasingly intense contractions. Still, the contractions hadn’t established a pattern and ferocity that suggested labour.

By the middle of the next morning we were back at the Civic. Wendy again monitored the baby’s heart rate. She then did an internal exam, finding that Irene’s cervix was effaced and that the baby’s head was far descended. However, the cervix was only two centimetres dilated. Wendy discovered by the exam that the waters hadn’t completely broken. The membranes had ruptured higher up in the uterus. She poked a hole with what looked like a large plastic crochet needle, and the waters broke with a gush.

By this point, 37 hours had passed since the membranes first ruptured.

One ought not wait much longer than that, we’re told, due to the increased risk of infection. In-utero infections can cause permanent damage, like loss of vision, hearing or cerebral palsy in newborns. In fact if we were with an obstetrician, we’d have been induced after 24 hours.

We settled into the birthing room at the Civic. We’d planned to be in the hospital. That much was on target.

We were told we couldn’t burn our candle. Hmmm. Ah well. We totally forgot about the homeopathic remedies, played only one of 13 custom mix CDs we brought, and the essential oils, essentially, went unused.

Why? Because Pitocin arrived. Women produce oxytocin naturally. It’s what causes the uterus to contract, and the cervix to dilate. But bless modern medicine if they haven’t synthesized the chemical and found a way to dose women with it to cause contractions where before there were none, or not enough.

And at about 3 pm, that’s what we did, seeing that the contractions, while intense, had not established a regular pattern. The downside to ‘Pit’, as the nurses call it, is that it’s only one part of the chemical cocktail women produce to birth a baby. In “natural” labour, the body has time to produce endorphins and other painkillers to soften the pain of contractions.

When they ‘Pit’ you, your body doesn’t get enough time to adjust and self-medicate; so, the contractions hit like a truck.

And that’s what happened. Suddenly from one 30 second contraction every four to seven minutes, Irene was getting minute long contractions of ferocious intensity, often with less than a minute between them. Sometimes one came on top of another without a break.

She handled this for six hours, sitting on the edge of the bed, and then when she felt them coming, she would stand up (or I’d pull her up) and she’d hang on to me and moan until it subsided. Then she’d sit down.

We tried a bunch of other positions – kneeling on the bed and in the shower, sitting, squatting – but only this one worked. By 6pm or so, Irene was getting delerious, slurring her words and lolling in exhaustion between contractions.

The nurse (at the Civic, if you have to be induced, your midwife must transfer care to the hospital staff) did an internal exam. Her four hour stint with Pit had netted her only one more centimetre of dilation.

Irene had reached her limit. With one hour of sleep in three days and the contractions coming fierce and fast, with little progress to show, her energy was draining. Some time around 9pm, Irene issued the secret code word and asked for an epidural.

It wasn’t at all what I had wanted. But after seeing Irene go through all that and not see her any closer to giving birth, I must admit, it did seem like a reasonable option.

And so in came the battalion of medical professionals. An anaesthesiologist, a couple more nurses, the on-duty obstetrician, all paraded in. The nurse had reduced the pitocin drip to give Irene time to prepare for the epidural. Irene bravely sat still in a most uncomfortable position through a contraction as the needle went in, and it was done.

They gave her the “walking epidural” (although the term “walking” is more than a little misleading). She could still feel contractions, though they were more like a tug than body-rending agony.

At least, we figured, she might be able to rest.

About ten minutes after the epidural took effect, Tanya, our OB-nurse came in and started fussing with the fetal heart monitor. She got in another nurse and they turned Irene over. “We’re a little concerned about the baby’s heart rate,” she added gently but clearly.

We were just settling down to get a little rest. Suddenly more staff came in. A flurry of conferrals, and the obstetric resident (Dr. Edith Valcourt, herself very pregnant) announced quietly, “this is a c-section”.

And then a whirlwind. A steady procession of scrub-clad women and men trooped into the room, each cheerily asking “do you need an extra pair of hands?” And each pair of hands grabbed a cord, a cart, a tray, part of Irene, and pretty much everything else and whisked Irene off down the hall.

Wendy, wide-eyed, grabbed me and brought me to a room and told me to put on a set of surgical scrubs. I did and within a few seconds, another engowned staff member ushered me into the operating room.

It was quite disorienting, but after a few seconds I did manage to locate Irene’s face, streaming with tears, looking up at me. The rest of her was under surgical linen and there was some form of screen blocking her view of the surgeon who was gearing up to make an incision.

“Do you have a camera?” a gown-clad woman asked me, as if she were asking for the Defibrilator paddles. I told her it was in the birthing room. She sped off. I was desperately trying to comfort Irene when she brought it back to me.

I looked up to see two gloved hands hauling the then-unnamed baby out of Irene’s belly. A second later, I heard her cry.

“It’s a… a…”

“A girl,” one of the nurses offered helpfully.

“A girl,” I told Irene, who by then was crying for a whole other reason. I cried too.

From the moment the decision was made to do the cesarian section, the whole procedure took 12 minutes.

Her heart rate had dropped to 40 beats per minute (normal is 120 to 160). Irene was doing some bleeding, which is not normal, and may suggest that the placenta is being pulled away from the wall of the uterus (placenta abrubtia) and when they hauled the baby out, they found the umbilical cord wrapped around her neck.

Was the crisis actually instigated by the interventions? Possibly. One thing does lead to another. Pitocin makes contractions difficult to endure, inspiring epidurals, which are known to lower heart rates both of the baby and the mother. Falling heart rates are a major reason for doing c-sections.

Or did Irene’s cervix not dilate because the baby would have been at risk if it descended, given the cord and the placenta?

All the steps were “medically indicated” by the fact that Irene’s membranes ruptured prior to going into labour. Or rather the first one was, the rest followed like water down a river.

I still am a bit sad that we had Mallory by c-section. But I do think it was the best option. Living the experience of natural childbirth just didn’t seem worth the risk to me.

And now I’ve got Mallory asleep in her snuggly on my chest.

Life is good.

Cudos to the staff at the Civic. They’re brilliant. Cudos to Wendy Huculak, our midwife. There should be legions of midwives. It blows my mind that they only handle a tiny fraction of the births in Ottawa. Cudos to the public health care system. It really works. And a big big thank you to Moe, who helped bring Mallory into this world and who continues to be an enormous support to us.