Reflecting on Merritt's Birth-Day

Merritt turned one year old on Saturday. We celebrated with a sweet and colorful afternoon party that fit perfectly with Merritt's low-key personality and my need for a quiet anniversary.

I recall the ache of my sinking heart when, at 32 weeks 6 days, my water broke and I understood that Merritt was on his way. The juxtaposition of the onset of labor for each of my two boys is stark. What I welcomed with warm confidence and joy with Roscoe, I summoned will to push away with Merritt. Whether or not I was ready to give birth to him, and for reasons that we'll never know, our little Merritt boy needed to be born early and by the time I had realized it, the process was in full motion.

When I first shared Merritt's birth story there was more that I wanted to write.  At the time, I wasn't sure how my sadness and anger, and feelings of powerlessness fit in with the story of how I met my second, and perfect, little boy. There wasn't room for the raw grief that I felt. But, there has always been more to say, and the feelings I felt then have only intensified with time.

Probably because life has been so very full and a little crazy since Merritt arrived, it's been hard to find time to process any of it. I've needed to grieve for what was lost, on both our accounts, and yet I haven't made time for it. And so, as the new year came and then February arrived, a sad disappointment lingered, which speaks nothing of the pride and sweet joy that Merritt brings to our family, or to the growing love that I feel for him.

We were very lucky that after a swift and uncomplicated labor, I gave birth to a small but utterly healthy baby. I know now that if any of the variables of Merritt's birth had been different--if labor hadn't progressed as quickly, if there had been earlier signs of the placental abruption, if Merritt’s heart tones had recovered even just a little bit slower--he would have been sectioned out. We were very close, in fact.

I’m so grateful that Merritt breathed well on his own, that he was a good size for his gestational age, and that his little system had the opportunity to experience the stress of labor and a vaginal birth.

The smug pride that I felt for beating the odds by giving birth to Merritt in a way that was as close to what I had hoped for us as I could have grasped at the time, was overshadowed shortly after by a quiet and serious panic that set in when first I was made to wait over two hours to see my baby and then, later, when I learned what a NICU stay of any length really implies.

That low-level heightened awareness stayed with me for the full 28 days, and I remained very guarded and vigilant. I held close to my determined heart the confidence I knew as a woman who had done most of this before--birth, breastfeeding, mothering. I clung tightly to the good and powerful feelings I kept from Merritt's birthday, and found enough strength to carry both of us in the foreign world of isolettes, feeding schedules, and separation. My role in there, as Merritt's Momma, made me feel for the first time in my life that I was a grown up. Truly. Merritt's tiny person needed me more than any other single thing and knowing that I was wholly responsible to him was humbling and intensely exhausting. (Posts about our adventures in the NICU begin here.)

I feel more deeply now, though I had always believed it to be true, that the way in which our children are born, our experience of birth, and the way that we process and retell our stories, is so vitally important to our health as women and to our role as mothers, with much, much, greater far-reaching importance and consequence than our society gives credit. I find it miserably inadequate when I hear of these powerful experiences of life and birth and loss whittled down to the healthy baby, healthy mother mantra.  Many will find it hard to understand, but while I am thankful that my baby was healthy and I am also thankful that I was left intact, some things (many things) were lost for me in that experience. I grieve for those things.  And I know many mothers who feel this way and who share the same sense of longing for what could have been.

Of course, I feel so sorry that Merritt was born into a circumstance where separation of mothers from their babies is not only normal but expected. Where painful procedures are frequent and, in our case, where I conceded (more than once) to stand at the nurses station while my baby had IV lines placed, a routine for which the nursing staff wouldn't allow me to be present.  I feel a lot of guilt for leaving Merritt so vulnerable and if ever our family has to endure another stay in the NICU, I will fight against any policy that elevates a protection for nursing staff above my right and responsibility to advocate for and emotionally support my own child.

While Merritt won't remember all that he went through before we brought him home from the hospital, he certainly experienced it, and I will never forget it.  I'll always wish that he had a more peaceful and deserving entry into the world.

Merritt's birth story

It's Mother's Day weekend and a good time to finally share the events that led up to meeting my second son.

His birth is emotionally complicated for me since we had planned to give birth at home. When my water broke at 32 weeks 6 days we headed to the nearest hospital for a preterm delivery.

Part 1 of our story can be found here.

Part 2:

Earlier that day

By morning, the regularity of the middle of the night contractions had dissipated but because I was uncertain of when true labor might begin, I requested to meet with the Neonatalogist and also the on-call OB/GYN. I had every intention to take a nap that afternoon and catch up from lack of sleep from the previous day and night but, both physicians decided to stop by before I had the chance.

1:10 pm

Mid conversation with the obstetrician, as we discussed my "ideal" birth and reframed some of my expectations to reflect the current circumstances, the contractions returned and this time they were uncomfortable. I had five contractions over 45 minutes, and at the end of our talk I knew that this was the official start of my labor.

Still on the antepartum/postpartum floor, assuming that I wouldn't be allowed any food during labor, I ordered the lunch that I hadn't eaten earlier in the day. Then I called Andy and my doula to let them know that it was a good time for them to make their way to the hospital.

2:10 pm

Nursing staff came in to hook me up to the external fetal monitor (EFM) and within a few minutes I was wheeled off the floor to Labor and Delivery. The power of the contractions was familiar and continued to increase. I was in labor, but the nurses insisted that I remain in bed on my back while they monitored the contractions so that they could confirm it.

One nurse turned on the tv and handed me the remote before she left. (ha!)

2:30 pm

Andy arrived shortly after I was settled in L&D, and because I had left my room before lunch arrived, and because I was so hungry already, we plotted how to get food and water (I had been told not to eat or drink anything). He bought some chapstick, and retrieved some water bottles and GUs from my room on postpartum.

The intensity of the contractions required my total concentration, and because I was confined to the bed, I couldn't rely on position changes. Instead, I dug deep into my arsenal of Bradley techniques--stuff that I had never used or needed for Roscoe's labor.

Centered at my cervix, each contraction radiated tight and hot to my hips and lower back. Andy applied counterpressure on my lower back for a few contractions, but lying on my side required that I "push back" to avoid being pushed over, and it became less helpful and more irritating so we stopped.

What worked best for the duration of my labor was total relaxation--I never really understood how this technique could work during labor, but it is the cornerstone of the Bradley method and given the constraints of the situation, I was willing to give it a try. Nestled in a bed of pillows and fully supported, I invested my energy in relaxing every part of my body, and then used visualizations to help me focus in on the work of my cervix. I visualized my body making way for my baby.

My Ipod was incredibly helpful--while I hadn't had time to load a birthing playlist (or even make one, for that matter!), for the duration of each contraction I turned on my music and went to other places. I think I listened to the same three or four songs on repeat: Roscoe by Midlake, Dog Days Are Over by Florence and the Machine, Clocks by Coldplay, and I Like It by Enrique Iglesias (don't ask! It was on there, and it worked.).

Music always gives me energy to physically push myself, but in this birth, it also served to drown out the myriad distractions in my room: nurses coming in and out to check the monitors, lights flipping on and off, NICU team staff preparing and organizing in their corner for Merritt's arrival.

4:30 pm

My doctor stopped by for an update and after we talked for a few minutes she checked me and confirmed that I was 4 cm dilated, and 100% effaced. Active Labor! Honestly, I would rather have not known of this "progress" because the contractions were already so powerful. I didn't want to be discouraged, but knowing that I had 6 cm to go was discouraging. I gave myself a moment, and with the pain of the next contraction I forgot all about numbers and welcomed a return to work.

I asked for water and freedom to move and labor as I felt most comfortable. One point not up for negotiation was the EFM--because this was a preterm birth I had to have continuous monitoring, which was ok because the leads were plenty long and gave me enough space next to my bed to move around. The nurse gave me a hard time about wanting to labor out of the bed, but conceded "as long as the monitors could be read." I was given permission to eat ice chips, which I was so grateful for.

5:00 pm

I was relieved by the thought alone of maybe finding a more comfortable position. As you might expect, the external monitors were so sensitive that they lost signal anytime I wasn't lying still and, like clockwork, an exasperated nurse would run in to check the leads.

5:30 pm

My doula arrived, which emotionally relieved a lot of my stress. I really wanted her to be there to help us through the later stages of labor, and I felt much safer once she was with us. We tried some new positions (squatting with the head of the bed raised at a 90 angle, squatting on the floor, sitting on a ball, leaning over the side of the raised bed) and with minimal luck Lori manually kept the monitors in place.

My nurse stormed in to announce that I could have ten more minutes, but then it was "back to bed." The different positions were not very helpful at that point anyway, so I took what I could get and we kept at it. Ten minutes later we had found a squatting position that was more helpful than others and when we asked for more time the nurse said, "well I have the solution, I'll just put in an internal fetal monitor!" (The kind that screw into the baby's head). I had heard enough and jumped back into my pillows.

With the monitors registering properly, Merritt's heart rate was decelling with each contraction. Although this is normal, and he was recovering ok as far as we could tell, the nurse continued to come in and out of our room every few contractions, drowning us in fluorescent overhead lights upon her every arrival. Andy and Lori encouraged me with each contraction to take big deep breaths in order to get the most oxygen to the baby. Lori's mantra was "breathe for your baby". I felt lightheaded and the pain was making me feel nauseated. The nurse warned that if I was going to throw up, that I couldn't have any more ice chips. My doula said it was a response to the pain and I confirmed that I wasn't actually going to get sick. Lori gave me some physical support with counterpressure, and both Andy and Lori cheered me on and continued to work with me through each contraction.

5:45 pm

I silently talked myself through each contraction. I can do anything for 90 seconds. I focused on each contraction independent from the rest, and took full advantage of those quiet moments in between where comfort still reigned. Labor is such a beautiful and mysterious process, and those breaks are built in for a reason. Releasing long, relaxed, exhalations also helped me to manage my pain.

I remember being so thirsty during this labor, probably because I wasn't allowed to drink anything, and I couldn't get enough of those ice chips. At some point I snuck two GUs, which were just the thing at the time. (I highly recommend them for running, and other marathons, like birth!)

6:00 pm

By the nature of the contractions, I knew I was close to the end and began searching hard for that feeling to bear down and push, because then I knew relief would come. When Lori and Andy pulled the covers back to help reposition my pillows they found blood and Lori said, "uh, I think she's complete" and went to alert the nurses. In no more than a minute or two, my doctor had arrived, along with several nurses, and an entire NICU team. The room was suddenly bright again and filled with people.

I still had no urge to push, although I could feel him moving down. My doctor checked me one last time, noted that I was 10cm dilated and declared it was time to push. I also remember mention of a suspected cord around the neck and placental abruption.

I wanted to push on my own terms, but I still didn't feel the urge and while I had been told that I would be allowed to give birth in whichever position felt most comfortable, my doctor insisted then that she wanted me on my back in the traditional birthing position. She insisted too, on directive pushing which is totally unnecessary in a natural birth especially, and another common practice not at all supported by the literature.

After a few minutes I could feel the transition from labor contractions to pushing contractions, but my urge to push was still ramping up. My doctor relied on the monitor to estimate when a contraction was about to happen and then she would begin to count to ten, but by her third count my urge to push was over, and I wasn't going to push any more. She began talking about the baby's safety, and how I needed to get him out, like, NOW. Pushing was forced and more painful than necessary. I will always remember the sterile drapes and her stern and serious face.

By the third or fourth contraction I finally felt a real urge to push, and when Andy leaned into me to share his concern that we'd be headed for a c-section if the baby wasn't born soon, I followed her instructions to push, with way more force than I would have chosen if left on my own. As Merritt was crowning, I started to resist and told my doctor that I wanted to breathe through a contraction or two to ease him out, but everyone in the room was insisting that he was right there, and so close to being born. My doctor maintained that I should continue to push, push, push.

One of my most vivid memories of this birth is the feeling of shooting a baby out like cannon ball.

6:20 pm

Merritt was born with the cord wrapped around his neck (she just unwrapped it, no biggie) and a robust cry. His cord was cut after 30 seconds, (not the full sixty that is recommended for delayed cord cutting, but we were thankful for any delay). They let me give him a kiss, and then he was handed over to the NICU staff. He weighed 4 pounds 1.6 ounces, and was 17 inches long. His Apgar scores were 7 and 8.

6:30 pm

I delivered the placenta uneventfully and without the use of pitocin. A partial placental abruption was later confirmed.

6:35 pm

Andy was invited to join the NICU staff to observe and take pictures. I remember looking over to the blur of people revolving around Merritt. Andy was tearfully trying to capture the moments that I couldn't be a part of.

6:40 pm

Merritt was shown to me one last time, and then taken to the NICU. Andy followed to know the location, but wasn't allowed to stay.

6:50 pm

The doctor came in with a dinner menu, but we quickly realized that the cafeteria was closed. Andy was instructed by staff to leave the hospital to find food (so horrible!), but a girlfriend of mine arrived shortly after with homemade enchiladas and strawberry shortcake.

We had to spend over an hour on the L&D floor, with promises to see Merritt on the way to Postpartum. Instead, we were taken directly to Postpartum where we were made to wait more.

Around 9:00 pm

Two and a half hours after his birth, we finally got to see Met and hold him for the first time.

Surprise, it's preterm labor

My water broke yesterday around 12:30pm. I wrapped up a conference call, put Roscoe down for his nap and then settled in for a snack and some email catchup. A few small gushes and a double check in the bathroom didn't convince me, but as I walked back to my computer more water trickled out and I was back to the toilet where I sat for 30 minutes with water intermittently dripping and gushing as I called my midwife, Andy, my mom, and my doula, in that order.

36 weeks is the cutoff for home birth. I'm 33 weeks today. After much debate, and because we thought the baby might come quickly, we went to our nearest hospital, instead of my primary choice located in the heart of DC. I wasn't experiencing much in the way of contractions so we took our time at the house--I showered, we packed my bag, and gathered all the necessities including extra pillows. We left around 2:45; Roscoe was sawing logs in his bed, and my mom was elbow deep folding a huge pile of laundry.

When we first arrived I tried my best to resist any internal exams because they significantly increase risk of infection once the amniotic sac has ruptured. When the doctor couldn't visually see my cervix with the speculum she convinced me to do an internal, my first FAIL.

My cervix was soft, thick, and 1 centimeter dilated. We were told the baby might come tonight, or in a week.

The sonographer paid us a visit and Little Sears was well engaged in my pelvis, head down, and butted up snuggly to my cervix. I thought we might get a glimpse of his sweet little face but it was buried. He's measuring right on track (estimated weight: 3 pounds 13 oz. plus or minus 11oz.) and he hasn't shown any signs of distress so far.

We spent over an hour with the neonatal intensive care nurse practitioner to get a better understanding of the NICU's policies and procedures. At this stage in the pregnancy we're guaranteed a minimum two week stay, and of course the realities that go along with that break my heart, but we're trying to stay positive and advocate for the things that are important to us.

I can't imagine leaving him in the NICU alone. ever. We've been told that we can stay with him 24 hours a day, practice kangaroo care whenever possible, and I've expressed my very strong preference that he receive only breast milk. I was a horrible pumper last time so the learning curve will be interesting. Once he is born we will initiate the process to request donor milk in case he needs to be supplemented.

I was transferred to the ante/postpartum ward and ordered for strict bed rest with trips to the bathroom as needed. I've been able to change back into my own clothes and I have a "room service" menu to order from at all hours so, for the moment, I'm pretty content. Overall we've been pleasantly surprised, staff have been really wonderful and we're bummed that they'll be switching shifts in four hours. Of course, I couldn't escape confinement to the bed and continuous monitoring, didn't get to eat for almost 12 hours, or use the bathroom for the first 6, but comfort measures are hard to come by here. Even pillows are a hot commodity and I'm glad we brought three. 'Tis the nature of the hospital I suppose.

I finally fell asleep around 1:30am but woke around 2:00am with contractions that are now 5-8 minutes apart--they're not painful, but I would definitely categorize them as contractions vs. the cramping I've been experiencing off and on over the last two weeks. I'm torn between wanting to keep the baby in as long as possible (I received the first of a series of steroid injections around 6 this evening), and wanting to avoid infection and the higher risk for a c-section. When my body goes into labor they will not try to stop it. My doula is on call, and my hope is that I will still have a natural, vaginal birth. The current estimate is that he'll be born within the next three or four days.

For now everyone is exercising the wait and see approach, which is just fine with me. I'm still processing everything and I'm grateful for this little lull in activity which not only bides us time to emotionally and mentally prepare in the context of the current situation, but to gather our thoughts around our priorities and to adequately communicate them to everyone on staff.

Keep Little Sears in your thoughts, outcomes are typically great for babies at 33 weeks.