a breech in several acts: act three

In part two I continued to have a baby that was breech.

ACT THREE: I JUST DROPPED IN TO SEE WHAT CONDITION MY CONDITION WAS IN

Monday, December 1st, came and with it my next doctor’s appointment. I woke up pretty sure that the baby hadn’t moved one centimeter and resigned myself to the fact that we were going to have to schedule the dread ECV — that is, the doctor was going to have to try to manually turn her around from the outside. I was so sure this was happening, in fact, that I was already drafting the heads-up email to my boss that I’d be spending the next day in the hospital for the procedure.

So, you know. You can already see where this is going, etc.

Just like last time the doctor shook her head the moment the ultrasound wand touched my abdomen. Nope, baby was still breech, we’d all already guessed that. But as she moved the wand she grew quiet. Lots of clicking came from the computer interface she was operating. “Your amniotic fluid is really low,” she finally said after several minutes. “In fact, it’s low enough to deliver now.”

Deliver now? It didn’t register. What, like a pizza?

She handed me a wad of paper, which was my cue to clean the ultrasound gel off of my stomach. The ECV was definitely off the table, she said, because of my low fluid and the position of my placenta. And then: “I think we should schedule a c-section for later this week. Probably Friday.”

The beau and I shot each other panicked looks. “This Friday?” I asked in disbelief. “This Friday,” the doctor repeated.

But that was two and a half weeks early!

We moved into her office to talk, which ended up being us asking WHAT? and WHY? over and over in slightly different ways. The problem with low amniotic fluid, she patiently explained, was the risk of umbilical cord compression, which was bad for the baby. The whole situation wasn’t technically an emergency but it wasn’t something we should wait on very long. And since low fluid was an issue of a malfunctioning placenta, there was nothing I could really do to help the matter.

“I don’t know what to say,” I said, because I didn’t. The doctor looked at me sympathetically for a beat before opening a desk drawer and pulling out a box of tissues. Unlike my placenta, apparently I wasn’t having any problems generating fluid from my eyes!

“Let’s schedule another appointment on Wednesday to check your levels again,” she said, escorting us to the front desk. “But I do think we’re going to have to do the c-section soon.”

Back outside, we may as well have landed on an alien planet. “What the fuck,” we repeated to each other the whole car ride home. “What the fuck.” We opened the front door to morning light pouring through the living room windows just like any other day; like the world didn’t even know we were suddenly having a baby soon. I sat down on the coffee table and dialed our doula. Over speakerphone, we recounted what we’d just learned. “What the fuck,” she said. Then she suggested we go see a specialist. “He is the premier breech birth doctor in Denver,” she told us. “Maybe he could at least give you a second opinion.”

I called as soon as I hung up with the doula. Surprisingly, the specialist took our insurance, but even more surprisingly, the receptionist was actually able to get us an appointment with him first thing on Wednesday morning, just before my next appointment with my OB. It was perfect timing. All we had to do for the next two days was wait.

Why wait when you can panic, though, huh?

not-even-sure

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“Cochrane review found that when AFI is used to measure fluid women are 2.4 times more likely to be diagnosed with oligohydramnios, 1.9 times more likely to be induced, and 1.5 times more likely to have a c-section without any corresponding improvement in fetal outcomes.”
– Nabhan and Abdelmoula 2009

“High and low levels of AFV have yet to be established in the literature and are difficult to directly link to adverse pregnancy outcomes.”
– Meagann et al 2011

On Tuesday, the night before my back-to-back doctors’ appointments, I collected ammunition. My doula had emailed over two research-based medical articles on low amniotic fluid, and I read them slowly, laboriously typing quotes into my phone’s notepad with my two fat thumbs.

I was sure the specialist would have something positive and encouraging to say about our situation, and that his advice would be to “wait and see.” Just as I was sure that afterward I’d have to go back to my regular OB and do some serious work to convince her of the same. I wanted to use this evidence to help back up my argument that, in an overall low-risk pregnancy such as mine, low amniotic fluid was not the end of the world and maybe all I needed was continued monitoring.

I was basically trying to buy time. Any amount.

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Wednesday, December 3, 7:30 am. The breech specialist’s office was located at the south end of the city, on a 1960s medical campus with a maze of interconnecting glass and concrete walkways that once looked sharply futuristic but now just looked downright moribund. The parking garage was very dark and I couldn’t zip my coat up all the way up against the cold. Inside, a series of narrow linoleum corridors of closed doors stretched out into infinity. We found the correct closed door and opened it onto a cluster of naugahyde chairs, and I sat down in one to fill out my intake paperwork. In the due date box, just as I had all my pregnancy, I dutifully wrote December 23.

The specialist was an old cowboy dressed, from top to bottom, in yellowed hair, bolo tie, salmon button-down shirt, jeans, and boots. He opened the session by delivering a brief monologue about how many years he had been in obstetrics (many dozens of them) before launching into a longer monologue about how totally fucked up our medical system is about childbirth. “Americans do too many c-sections,” he complained.

Which is why I was surprised, to say the least, when after almost a 30 minutes of careful examination via ultrasound, he looked us straight in the eyes and told us to go get a c-section. He’d seen some strange pockets near the baby’s face, which had flashed on the screen in red and blue, that he’d interpreted as the cord being wrapped several times around her neck. Maybe this was why she hadn’t yet turned, he hypothesized. And to him, waiting it out wasn’t worth the risk. “If you were my wife,” he said, “I’d want you to go in tomorrow.”

I was accustomed to getting handed an ultrasound photo door prize when I left my regular doctor’s office, but the specialist instead took the whole ream with him when he left the room, pulling the door closed behind him with a loud click. The beau and I turned and looked at each other. Well, I guess that was that. It was totally crazy, but it looked like we were going to have to have a baby on Friday. I just needed the room to stop spinning first.

At our next appointment I kept my phone in my bag. I didn’t need research notes to convince my OB to wait because we were all mostly on the same page. We were at least in the same book. Me, her, the beau, and the quirky old cowboy. A loosely united front of imminent surgical delivery.

But then!

My OB measured my amniotic fluid and cheerfully informed us that the measurements had improved. With continued monitoring, she said, we could probably “wait and see” until next week sometime.

Here is where I might have had a small mental break with reality, because I literally did not know what reality was anymore. We had, with the help of a lot of exclamations of fuck! on the car ride over, juuuust begun to rally behind the idea of having a baby in just two quick blinks of days. I mean, two doctors had said we should! And now one doctor had sort of… changed her mind?

She flipped through her schedule. “We can do Wednesday or maybe Friday of next week?” She did some more flipping. No, wait, the hospital wasn’t taking any more scheduled cesareans after Wednesday, because they were moving to a totally new building. So, Monday or Tuesday, then?

With the sense of urgency gone, doubt rushed back in. Was it better to just keep waiting? Maybe until the week after the next week? (Admittedly, that question was driven by the fact that I really wanted to have a baby in the slick new hospital instead of the sad old one.) My OB seemed to believe we could wait, but not for that long. It had to be next week. And with the old hospital closing, we were looking pretty much at waiting only until Monday or Tuesday of next week.

The beau and I stared at each other. Pick one, Monday or Tuesday! What if we chose the wrong day? How were were supposed to know what the right day even was? What if we were doing the wrong thing? How were we supposed to know what the right thing even was?

With the instructions to let the doctor know what we’d decided later, we excused ourselves to the lobby to talk everything over. I still didn’t understand how it could be such a rush and then be not such a rush anymore. I still didn’t understand how one doctor could be focused on one complication (cord placement) that the other doctor didn’t even seem to see. Did I ask about all this during our appointments? I think I did. I hope I did. I do remember placing a followup call to drill her about it, to help me fill in the gaps in my understanding. But at this moment in time, sitting at a little round table between the elevators and the pharmacy, we were reeling. We were adrift on an unknown sea. We had crudely assembled a tiny craft out of whatever bits and pieces of knowledge we could grab, and we were trying to figure out which way to steer it the damn thing.

Our logic process kept looping us around the same stupid circle. Prompt delivery had been so important with one doctor and then not so important with another doctor, so ??? What did that mean? Did we need to back up further, go find more doctors, get more opinions? Did we even have the time for that? What was real and what wasn’t? What were the risks and benefits of having the baby Friday versus Monday or Tuesday?

We didn’t know for sure. We couldn’t know.

One thing we came to agree on was this: two very different doctors had said I should have a cesarean. For different reasons, yeah, but they agreed on the end result. That had to count for something. So I was going to do the cesarean, and the only question left was when. One doctor had said sooner, and the other had said later. We liked later, because it gave us more time. We really wanted more time, because we weren’t at all ready. At all.

So we were back to picking between Monday or Tuesday.

A pretty surreal experience is trying to figure out what day your baby should be born. No big deal, I mean, it would just be her birthday for the rest of time, a date she would write over and over again on forms, applications, and registrations. Numbers aside, it felt in that moment like the kind of heavy decision that could forever seal her fate. What if a Monday birthday made her a pauper? What if Tuesday made her a prince?

I sat there at that table and, no shit, started googling stuff. I googled that dumb fortune-telling nursery rhyme based on day of birth. Would it be better to be fair of face or full of grace? I googled “December 8” and “December 9” and compared historical significance. December 9 would give us that vital extra day to prepare, but December 8 was the Feast of the Immaculate Conception, which my grandmother would certainly appreciate. I tend to like odd numbers better but hey, look, 8 was the infinity symbol on its side!

In the end — and this is ridiculous, but no less ridiculous than relying on the internet to make your decisions in the first place — I was swayed to December 8 because it was Nicki Minaj’s birthday. My baby and Nicki Minaj, forever connected by the loosest of contrived threads.

Once we had finally made our decision, we walked back to the office to get the cesarean officially the books for December 8. But when we got there the door was locked, the window dark. Everyone had gone to lunch.

Okay universe, I see yr cosmic irony and raise you… nothing. I got nothing.

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Up until this point of my pregnancy, I knew the right things to do. I knew not to get caught up in the particulars of delivery, because anything could change at any minute. I knew to be rational, to carefully assess data and risks, and to make informed decisions. Most importantly, I knew not to make plans because I knew they could change at any moment.

The problem is that all the knowing in the world doesn’t stop the planning from actually happening.

For months I’d scroll my calendar forward to December and play out the final weeks of my pregnancy in my head. December 19th was to be my last day of work; maybe I’d schedule a labor-inducing massage for the 20th. What would I feel like when I woke up on the 22nd, my first day of temporary unemployment? What day would I actually go into labor? A spiritual friend had given me a “birthday” reading and the pendulum had predicted the baby would come on Christmas Eve. I was skeptical, to say the least, but I admit I couldn’t shake the date from my head. If the baby did come on Christmas Eve, and everything went well, maybe we could even go home on Christmas Day. Maybe it would even be snowy! I mean, what a story that would be.

More than the birth story, I’d come to plan what the birth would be like, and it wasn’t at all like this. I’d wanted to have the baby in the shiny new hospital; instead I was having her in the creepy old one. I’d wanted minimal interventions; this was the triple-double Intervention Special. I’d wanted the baby to “pick” her birthday; we had chosen it for her. Everything about her birth now felt unnatural, rushed, and uncertain.

I thought I wasn’t attached to any plans until I lost them. It’s like my plans were the girlfriend I always took for granted until she finally broke up with me and suddenly I’m banging on the door hollering for her to take me back. All I wanted was to have my old plans back.

It didn’t make any sense, but there it was.

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After Wednesday’s chaos, the next few days were a numb blur. Everyone says you can never fully be ready for a baby, but we were just desperately trying to knock out the basics. Much of it was administrative, to be honest. Both of us had to wrap up and hand off work projects. We had to call and cancel upcoming appointments, including our scheduled tour of the new hospital (ha!). I had to coordinate new travel dates for my mom, who’d been planning on flying to visit in the new year and now couldn’t cope with waiting that long to meet the baby. I had to go to Target and get clothes and gear for nursing and recovery. We had to make spare house keys and arrange for someone to pick up our packages. We had to install the carseat bases. We had to batch-cook burritos to freeze. We had to get a new bed because our old one wouldn’t accommodate co-sleeping with an infant.

We had to basically condense 2.5 weeks into four days.

All along I kept getting calls from friends who’d had c-sections. It’s really not that bad, they told me. It’s actually great! You just get to lay there and they do all the work. I appreciated their reaching out, I really did, but at the same time their assurances made me feel a bit ridiculous, like maybe I was just choosing to be nervous and upset when I could just as easily choose not to be. Couldn’t I just relax?

I’d never had surgery and getting cut open, under any circumstance, felt like a really big deal. In the context of having a baby, it felt like a gaping black hole of a big deal. Mix in my regret over missing out on the experience of labor and it became a weeping, gaping black hole of sorrow. People thought I was nuts — why would you want to experience labor? I dunno, because it’s been a rite of passage since the dawn of humans? Every birth story I had read described it as sort of threading yourself through the eye of your own needle and coming out the other side, transformed, and I was afraid of remaining untransformed. I was afraid I’d have trouble bonding with the baby, and I was afraid my postpartum depression could be worse without the benefit of those trusty ol’ labor hormones.

I was simply very afraid.

We were lucky to be able to have a few days to prepare, and I was lucky that I didn’t have to labor before going through surgery. I mean, I was really fucking lucky.

But I wasn’t feeling so lucky at the time.

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On Sunday I took a long walk with my dad, who very coincidentally happened to be in town on a business trip. After we got back home he helped the beau assemble our new IKEA bed frame while I packed my hospital bags. Before he left to go to his hotel we Skyped my mom, but I couldn’t find much to say between all the tears. It was a lot of my mom asking Are you anxious? Are you scared? Why? and me going Yes, mmhmm, I dunno while trying to nonchalantly hide my face in my hands. Crying in front of the ‘rents didn’t feel great at 14 but it felt even worse at 34!

For my “last meal,” as I kept jokingly-but-seriously calling it, I requested boxed macaroni and cheese. We had dinner late, around 10:00 pm, which worked out for the best because I wasn’t allowed to eat after midnight anyway. I finished clearing off my phone, shutting down my computer, and double checking my bags. Around 11:30 we brushed our teeth and gingerly climbed into our brand new bed. I chugged the last of my water, reluctantly set my alarm for 4:23 am, and settled back into my carefully arranged mound of pillows. I’d been sleeping practically sitting up since about week 23, and this was the last night I’d have to do that.

The beau and I chatted in subdued tones for a little while, my head a good two feet above his. “I can’t believe we have to go have a baby in a few hours,” I said.

“Me either,” he said.

“Are you scared?” I asked.

“Yeah.”

I knew that, because I was too.

I guess most people would be excited for a new beginning, but this very much felt like the end.

The beau rolled over to try to get some sleep but I sat there against my wall of pillows, awake, watching the darker corners of the room. We had managed to buy a little time, and the time had run out.

NEXT, SOMEHOW I’M NOT DONE TALKING ABOUT THIS? THE FINAL ACT.

5 Responses to “a breech in several acts: act three”

  1. I love reading your blog, Lyn. I love your honesty and your wit. I know I say that all the time, but it’s true.

    And I’m really glad you’re documenting all this here, because this way you have a record of the experience, and I think you’ll be glad you have that.

  2. Yep. The knowing it’s coming and then it comes faster than it was supposed to is extremely difficult. We were all set to be induced on one day and then I ended up in the hospital 15 hours earlier than the scheduled induction and I could barely deal with it. We weren’t supposed to be here yet – I had 15 more hours to accept that my life was changing. I think I’m glad I didn’t have to face a C-section directly. By the time the c-section became a necessity I had been on drugs for induction for 20 hours and had pushed for 4 hours, there was nothing left of me. I didn’t care what happened to me anymore I just wanted to close my friggin’ eyes for a second – which everyone knows is the very best mental state to meet your baby. Also with throw up all over you, I threw up on myself and Collin as they were wheeling me to the OR.

    • Jeez…see what I did there? I co-opted your whole story and made it about me. Cool jerk-face. Can you tell I’m still trying to figure out a way to “process” how my baby got here. That is all to say I love your writing and sharing and it makes me feel better. The horribleness and confusion of deciding what date to pick is palpable; it’s tough to make decisions for a baby that is still mostly theoretical. And I do understand wanting to see what labor feels like.
      There is so much stuff floating around about how medical intervention is BAD – unless medically necessary; getting the baby out early is BAD – unless medically necessary; and these interventions are supposedly being shoved down everyone’s throats so when you are told you need to get that baby out early you’re skeptical and confused and then doubting everyone. It’s a pit of confusion.

      • No no no! You aren’t co-opting anything. And I can’t believe you had to go through 20 hours of induction and then FOUR HOURS of pushing! Woooooof. You are insanely strong.

        I had it easy and I still regularly had a hard time with it until about 8 or 9 months later. I had a lot of anger and grief, for some reason, and it felt unexplainable and unjustifiable. Anyway, all of this is to say to take the time you need to process, there is no deadline.

        I never thought of it that way, re: medical interventions, but now that I’m thinking about it I think that did play into a lot of my guilt and doubt. I had been coached that hospitals/doctors didn’t really have my best interests at heart and maybe in some cases that’s true. But it really ends up putting a lot of the burden of proof on YOU to verify what’s “necessary” and what’s not. It kind of pits you against your health care providers from the start, when ideally you should just be able to trust them. I get where the distrust came in, but it’s almost gone too far the other direction. Ugh, I don’t know. You’ve given me a lot to think about.

  3. I know exactly what you mean about your plans being upset and the apparent theft of time. I was so sure my kiddo was going to be late; when I found out I was in labor I was shocked and indignant that I was having to cancel work things and probably wasn’t going to have a haircut on Saturday after all. And now he’s over two weeks old and we’re still using a cardboard box as a laundry hamper (THANKS FEDEX).

    Two and half weeks snatched out of your hands is no joke.

    I love reading this series, btw.

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