As you’ve probably gathered, Dr. Jerkwad did not paralyze me. Thank you, Hippocratic oath. Or self-interest — my mother pointed out later that any misstep after I’d called him an asshole would have looked very bad in court. Also: I’m pretty sure you’re supposed to have the patient sign the consent before the procedure, not after.
For anyone reading this while considering options for her own delivery: getting the epidural was not a big deal. It did not hurt or even feel especially strange, and while the thought of a needle in the spine is a bit creepy, at that moment, the finer distinctions of human experience were not exactly at the forefront of my mind. There was no “creepy,” only “good” (a highly theoretical construct, belonging to the world that existed before the cab ride) and “bad” (everything I am feeling right now and for as long as I can remember). I, who am nervous about practically everything, felt no anxiety, only impatience. In terms of physical sensation, it was as I was told it would be: cold skin from the alcohol, very slight stinging from the local anesthetic, then a spreading coolness in my back. It hurt less than the IV. If you don’t want one, don’t get one, but if you think you might, don’t let fear of the procedure itself scare you off.
What can I say about epidurals that hasn’t already been said in a thousand love songs? Whoever invented those things should get the Nobel Prize for Medicine and no, I am not joking. I said some time ago that post-delivery, my anger at people (like that patronizing dick, Dr. Sears) who would try to scare women out of having epidurals had hardened to a murderous rage, and I meant it. (And again, this is not at all to say that those of you who didn’t or don’t want them shouldn’t have the choice, even if you do make me feel like a bit of a wimp.) I’ve had occasion recently to reflect on the unusual level of privilege I enjoy when it comes to medicine. Not only do I have access to good health care (insurance, good local doctors, all that), but I have a unusually (another rant for another day) good science education for someone who didn’t get a science degree, access to library databases and knowledge of how to use them, and an appropriately massive sense of entitlement regarding my medical care. So while I may have my own psychological demons about wanting/needing pain relief, at least I am more able than average to sort through the immense amount of crap out there about the supposed medical reasons to avoid epidurals. It pisses me off to no end that a whole parade of well-meaning nitwits and genuine jackasses would lie to women with fewer resources rather than risk letting women decide for themselves what ideologies to sign up with and what medicine to accept.
Back in the prenatal day, when I was confessing my epidural neuroses, wise Sara said:
The thing that nobody tells you about giving birth with an epidural (or, in my case, being denied an epidural, so giving birth without one after begging for one), is that in addition to dulling the pain, the epidural also totally erases any weird psychological hangups that one might have about epidurals. They actually rock, as it turns out. It’s just a well-kept secret.
And she’s right. I have a lot of strange feelings about how birth went, but not about the epidural. It just rocked, full stop.
Epidurals work very, very fast, but it does take a few contractions. The first contraction after it went in is as painful as the ones before, but somewhat more emotionally difficult for me, since I had been looking forward to being saved, and now I am not saved after all. I feel a sickening fear that it won’t work, but then it starts to. The next two contractions are maybe 85% of what I’ve been feeling, and after that they become manageable. I can sit up and turn around on the bed; I can listen to the nurses again. Kips Bay Mega Hospital uses low-dose, patient-controlled epidurals, which is part of why I wanted to come here: light epidurals compare favorably to traditional ones in studies of practically everything you can think of. Someone shows me the button I can use to boost the dose if I need to. The world begins to reassemble itself.
Despite my stabbing at the button, the low-dose epi is ultimately not enough, so after 45 minutes, a different anesthesiologist — who manages not to be an asshole, imagine that — comes in and gives me a bigger dose. After that, I can still feel the contractions, but they aren’t so bad. (I am glad I got to try the low-dose, though, and I think more hospitals should have that option.)
Unfortunately, what can’t feel my contractions is the contraction monitor. It picks up maybe one in three or four. The nurse keeps moving the sensor around, asking me to tell her when they come, and feeling all over my belly with her hands, but she can’t find them, either. At this point, I don’t think much of that. Who cares? I am having contractions — I can feel them — and it doesn’t seem surprising in the least that some contraption doesn’t register them. Contraptions! Of course they are prone to failure! Yes, I am the girl who thought for nearly 20 years that tampons didn’t work for me because they just don’t work all that well.
What does need to be registering those contractions is at least one — ideally only one — cervix. (So far, there is no hint of my didelphic nature causing a problem: everyone who sticks a hand in my business agrees with Dr. Skinny that one has obviously taken over.) In the “natural” childbirth literature, there is a lot about how labor pain is not something women have justifiably dreaded for all of recorded history but is actually fantastic because unlike
kinds of pain men experience every other kind of pain, labor pain is “productive.” Allow me to add that to the list of things Dr. Sears can shove up his urethra. Frankly, so what? Passing a kidney stone is a thing that happens, too; does that make that pain “productive”and therefore worth having?
However, when the resident comes in and asks to do a cervix check, I am a little excited. If I was four centimeters five hours ago and spent most of those hours having strong, frequent contractions, surely things must be getting close. And my water broke, too. Maybe I really was in transition in the cab. Maybe the resident will look shocked and say, “No wonder you felt bad! It’s almost time!”
Instead, she feels around for a minute and says, “Great, you’re at four centimeters.”
WHAT? All that for NOTHING? Are you kidding me? I am ready to hit the ceiling. She looks like she knows she’s said the wrong thing. “Um, maybe four and a half?”
Oh, and my water hasn’t broken after all, so, um, sorry I peed in your car, cabbie.
While all this is going on, Sugar goes back downstairs to reclaim our luggage, which the man at the information desk let her leave there when it became obvious that she couldn’t carry it and push my wheelchair at the same time, formally checks me in, and gets a health care proxy. At some point, she calls the doulas — we have two, since neither is a full-time doula. It turns out the one we liked can’t come tonight, but the other one shows up a little while later and sits with me while Sugar gets dinner somewhere I don’t have to watch her eat and brings me back some cranberry juice. My main concern with this doula has been that I will find her happy but frantic energy upsetting in labor, but I manage to find the spine to tell her that I don’t want to talk, and to her credit, she listens.
This part, from when Sugar gets back in the room until it’s time to push, I look back on fondly, all thanks to the epidural. Sugar dozes on the fold-out chair/bed in the corner, the doula reads, and I just rest. I am freezing cold, but the nurse brings piles of warmed blankets and bundles me up. The lights are turned down low, and the fetal heart monitor fills the room with the Bean’s steady, reassuring heartbeat. I love the thought that we spent those last hours together that way, he listening to my heartbeat all around him while I heard his all around me. I feel safe and calm.
I’ve read quite a few stories that include praise for being at home or at a birth center; let me throw in some praise for being at the hospital. Because of my father’s devotion to his job, I spent quite a lot of night time at the hospital as a child, waiting for him to visit just one more set of patients on the way home from a piano concert; perhaps my experience is unrepeatably idiosyncratic. I remember the quiet of the wards at night as my father walked from room to room, silently watching his patients, stepping into the hall to ask a resident for details. Of course I like the epidural and feel reassured by the knowledge that there are pediatricians and a NICU right here if the Bean needs them, but I also like feeling that my room is a quiet part of an active hive. By now it is dark out, and my window is filled with a grid of windows from the wing of the hospital across the courtyard, some lit, some dark, some in between. I think I might have felt alone and isolated at home; here I feel watched but not bothered. Like I am in the right place, safe.
At some point, Dr. Russian turns up, seeming cheerful. She checks my cervix now and again, and there’s another thing to love about the epidural: now I am dilating smoothly and rapidly. I can’t remember exactly when I heard each number, but I remember thinking at one point it was two centimeters per hour. The Bean’s head is dropping nicely, too. Everything is fine, except that I am supposedly not contracting enough. At eight centimeters, Dr. Russian wants to break my water to speed things up, which I don’t mind and don’t even really feel. It certainly doesn’t hurt.
Contrary to what you may have read about epidurals, mine in no way leaves me paralyzed or numb-feeling. I can and do move my legs, and when the nurse starts talking about catheters, it’s not because she won’t let me try walking to the bathroom. However, even though she says my bladder is very full, I do not feel any urge to pee, so after a few minutes of focusing on finding that sensation, I agree that the catheter is a good idea. I had really wanted to avoid that, but it isn’t a big deal. Getting cleaned for it hurts in a “clitoral exfoliation” kind of way, but the catheter itself doesn’t. She takes it out as soon as it’s done its job.
The only negative side-effect I have from the epidural is that my belly itches. A lot. And all that moving around the monitor in search of my contractions isn’t helping. Of all the things we threw in the hospital bag, the only one I really want is the washcloth we’ve forgotten. Sugar gets paper towels wet to distract me with cold. It only sort of works, but boy howdy, I will take itching like this any day of the week over the pain I was having.
The nurse who is mostly taking care of me is sweet and young. She thinks the baby will be a girl because it is being so good; Dr. Russian says that surely means boy. The nurse asks about names. We had wanted to give the baby a name from each family, and while the girl names were easy to choose (we have 3 names we like, in four possible combinations), finding a male name from Sugar’s family has not been not easy. There are plenty of men on her dad’s side, but not many names at all. My pick is Sugar’s father’s middle name, which lots of the men have, but she is having none of it.
No one ever says I’m completely dilated, but I gather that I must be at about 10 o’clock, when Dr. Russian tells me I have an hour to develop an urge to push before she wants to turn off the epidural. How about down rather than off, I ask, terrified. She agrees and leaves me with the nurse again.
So for an hour, I try to push. The nurse tries to find my contractions; Sugar and the doula try to help me. I can feel the muscles just fine. I know what to do and I feel a slightly constipated feeling, but never anything more. I roll over a few times, which I don’t like and doesn’t help. The nurse coaches me through pushing anyway, but the resident says I’m not doing it right. I convince the nurse to let me breathe out as through a straw while pushing, because holding my breath makes me feel terrible. I do three 10-count pushes per contraction.
After 45 minutes, Dr. Russian returns, and I agree that it’s time to turn down the epidural. I’m not too worried, since I figure the pain will just return to where it was before the extra dose. And they say epidurals do slow down pushing, so maybe this won’t even last long. Maybe I’ll have a February baby, just like BFF predicted back in October! The anesthesiologist (another one) comes in and lowers the dose; Dr. Russian says, “Don’t you DARE touch that button,” and leaves again.
And here, Gentle Internets, is where the horror movie starts. I can’t tell this part of the story neatly, because I wasn’t in my right mind for it. I often wish I didn’t remember it at all.
Without the epidural, the pain rapidly goes past what I can stand. Now my bones are being broken again, but only after being set on fire. There’s still nothing in my belly at all, just back and hips and especially my thighs. God, my thighs. I feel sick now just thinking about it. Between contractions, I can hear that I’m making those terrible dry sobbing sounds again. At some point, Dr. Russian speaks with scorn about my crying, but I’m not crying in any normal sense. My face is dry. This noise is coming from some dying animal part of me, utterly beyond my control.
I’m on my back still — I know, I KNOW; I “should” be in some other position. I didn’t even want to tell you all this now, because I am afraid someone will come tearing in to lecture me on Best Practices for Back Labor and tell me it’s all my fault. But I can’t stand the thought of any other position. I know I’ll fall apart if anyone tries to move me, and I mean fall apart physically.
At each contraction, Sugar and the doula hold my legs up while I push. At various points, I try holding the bar or my own legs; eventually I settle on holding a sheet-rope tied to the bar. I push for a count of ten, three times per contraction, while someone — usually the resident, sometimes Dr. Russian — tells me I’m not doing it right. I am doing exactly what they describe. A few times, I am told that I have finally done the right thing, that I should keep doing that. I am always doing exactly the same thing, every time. The scolding and praise come at arbitrary intervals, heavy with emotional freight. It’s very like a nightmare.
Dr. Russian is horrified that the nurse has let me hiss breath out during pushing, so it’s back to holding my breath. Which is stupid, by the way. And, as far as I can remember, not supported in the literature. Up until this point in our relationship, Dr. Russian has been so medically rational that I blithely ignored the advice to talk to my OB about her views on coached pushing, a grave mistake.
And now it is too late. For two hours, this goes on. I try to push, despite the fact that I am now in so much pain that some primitive part of my brain simply won’t let my legs spread enough, won’t let my back muscles let go at all. My body is trying to save itself, and I can’t override it. I can’t open more, I can’t relax, I can’t push harder; wanting to doesn’t enter into it, and neither does any conscious idea of fear. I am trying my best with every part of myself still under the control of my brain, but it’s not enough.
Complicating matters, no one can find my contractions on the monitor or by feeling my belly, so they often don’t believe I’m having contractions, just that I’m carrying on, I guess. I have to tell them when one is starting or stopping, which pleases no one. I have since learned (thanks, HFF) that this happens to bionic folks like us reasonably often; I didn’t make the connection until recently, but I was told early on that no matter the normal size and shape of my uterus, there would likely be differences in the muscle tissue at a microscopic level, which is why they wouldn’t have attempted an external version in case of breech presentation. I can only assume that no one at the hospital ever put those ideas together at all.
And then there was Dr. Russian. It’s Dr. Russian who has kept me from writing this down for all these months. It was two months before I could begin to be honest with myself that she was not, in fact, consciously using “tough love” in a misguided attempt to motivate me but is, in fact, the kind of smart, funny, emotionally unstable maniac that I Always Fucking Fall For. (That I have managed to marry someone smart, funny, and also compassionate and gentle is a miracle of the first order.) Four months out, I can confidently say that her behavior was assholic and frankly cruel, but it’s taken some time to get here.
Dr. Russian, as far as I can remember, spends the remainder of labor yelling at me for pushing wrong, for making noise, for holding my face wrong, for not wanting to push the baby out, for not trying.
That last one, that’s the one I can’t shut out, then or now. It cuts to the bone of my childhood insecurities. Recently, a friend whose pregnancy overlapped mine asked why I had liked being pregnant. From her perspective, pregnancy had been a somewhat uncomfortable, often inconvenient means to an end, not something she enjoyed for its own sake. But I did love it, and talking to her made me realize that a big part of why is that for the first time, after a lifetime of being told I was failing at gym and the like because I wasn’t trying (not, say, because I had untreated asthma), I felt physically competent at something important. I was doing it right, and until the last day, no one said otherwise.
Over the course of two hours, everyone in the room realizes that however typically helpful it is to turn down the epidural at this stage, in my case it is a rank disaster. When Dr. Russian leaves the room, the nurse starts asking if maybe, really I do want to push that button. I refuse. Things are bad enough; I am terrified of what Dr. Russian will say if I do that.
Dr. Russian comes and goes. At some point she threatens me with a c-section if I don’t start trying, which, despite the high rate of sections at this hospital, is curiously the only thing she says that doesn’t frighten me. I know I’ve dilated smoothly, I know The Bean is very far down, I know my water hasn’t been broken for long. The Bean’s heartbeat is steady and strong, no distress there. For the first time since I googled “double vagina,” I know I’m not having a c-section. I am sure of that, and the threat doesn’t touch me.
Eventually, the mood in the room changes enough that I can say, yes, I give up, I need the epidural back. Sugar tells me later that the resident and a collection of nurses bundled Dr. Russian off to the hallway to convince her it was not working. The anesthesiologist who had turned it down comes and turns it back up, without comment. I rest a little while. It starts to work, and while I’m never out of pain again, I stop sobbing.
Dr. Russian spends the rest of labor sulking. At some point, when I say how much better I think things are going with the epidural back on, she rolls her eyes at the ceiling.
Pushing continues. I’m exhausted and shaking all over. In between contractions, when my legs are released to the bed, I have to tell myself, out loud, over and over, that the bed will hold me up. Again and again, I’m told I’m not pushing hard enough or long enough or right. They say I’m not having enough contractions. I am. I’m tempted to lie sometimes, to not mention one is starting, just so I can get a break, but I don’t. They give me pitocin — or maybe that was before the epidural was turned down; I can’t remember now because I didn’t care at the time.
At some point, Dr. Russian asks whether the heart rate on the monitor is mine or the baby’s. “The baby’s, I think,” says the resident.
“No. About this I am very particular. Find out for sure.” I am grateful for Dr. Russian in that moment, glad she is watching out for The Bean.
There is a small flurry of activity as the resident and nurse try to figure out what to do, how to move the monitor, how to be sure, but then Nurse Ringer, an older Latina says calmly, “Why not take mom’s pulse and see if it matches?” They do and it doesn’t. Thanks, Nurse Ringer, for saving me from internal monitoring with the power of logic.
The Bean’s heart keeps steady on, steady on through all of this. At one point, I hear Dr. Russian remark to a nurse that he has an “enviable trace.” I glow with pride and silently thank the Bean for being so strong, for causing no worry.
Eventually, it is Nurse RInger who saves the contraction-monitoring day, too, as she finds a magic spot, very low on my belly, where she can feel them. Everyone is gathered around the bed at this point. The doula reminds me at every contraction to keep my face relaxed and my chin down; I am grateful that she can say that gently, since it saves me from being yelled at by Dr. Russian. They keep saying I’m pushing wrong. Someone gets a mirror, tells me I can see the head, but I never do, just my swollen lady bits and blood. (They had tried to clean the blood away before bringing the mirror, for fear of upsetting me, but I’m not bothered.) I carry on. Nurse Ringer is yelling that she wants to meet this baby; she reminds me of the baby-crazy secretary at Sugar’s office, and I don’t mind her yelling.
And here is what happens, after four hours of pushing three times per contraction, exactly the same way every time: I have another contraction, just like the others. I push twice, and am told I’m not doing it right. I push one more time — exactly the same way I’ve done it before, except maybe for two seconds longer — and out comes the Bean, all at once. Dr. Russian is across the room. The resident catches him, and “catch” is no metaphor here: he was flying.
* * *
And everything is happening at once again, only now it’s in a good way. Someone says he’s a boy. Someone puts him on my chest. The placenta comes out, and he’s passed back down so Sugar can cut the cord. Someone asks if we have a name. We have a first name…. Everyone else has to wear gloves to touch him, but we don’t, because we belong to each other. We talk gently to him and are awed.
His initial Apgar is 9, with a point off for not crying much. (A very polite way to lose a point, in my opinion.) After a few minutes, Nurse Ringer takes him to the bassinet and warming station in the corner to suction him and clean him up a bit. Sugar goes with him, and I’m so glad she can. Holding him was one kind of amazing, but watching her with him is another kind altogether. I hope she’ll tell you about it herself.
Meanwhile, I am getting stitched up. Dr. Russian is giddy now, and she and the resident are working together, stitching and pulling and filling me up with gauze and pulling it back out again. I ask to see the placenta, and the resident shows me, after asking if I want to go skin to skin with it. It’s smaller than I had expected. They can’t get the bleeding to stop. The epidural is turned up higher and they’re using lidocaine, but it hurts. This indicates to me that I had plenty of sensation in my vagina all along and that the woman who told me tearing wouldn’t really hurt in the moment was right, because I certainly didn’t notice it happening.
Mr. Hyde Dr. Russian had said when the epidural was tuned back up that it wouldn’t stop me feeling pain as he came through my vagina and that I had to not “freak out,” but really, it was nothing compared to everything else.
The Bean was born at 3:06 am, after four and a half hours of pushing. I hear Dr. Russian declare to the resident that it was really only two hours, since I apparently wasn’t trying the rest of the time. She has very sharp things in my crotch. I don’t kick her.
Meanwhile, Sugar is still with the Bean. Suddenly she looks up at me, teary-eyed, and cries out, “I want to give him my dad’s middle name!” I agree, and he has a name.
Eventually, the stitching and gauze-stuffing stops, my legs are released to the bed, and Sugar brings The Bean back to nurse. And he does, or at least makes a good effort. The doula swoops in to give me confusing advice, but mostly we just lie there together.
(What ever did happen to my vagina, anyway? Stay tuned for the Recovery Epilogue.)