from the blog.

Lauren’s Birth Story – Part One

My birth story neither begins nor ends on the day my daughter was born. It’s rather long, but the six-word version is this:

Planned caesarean.
Postpartum haemmorrhage.
We survived.

At the anatomy scan, almost 19 weeks into my pregnancy, I learned that I would most likely need a caesarean. I’d long had my heart set on a midwife-led delivery in my hospital’s birth centre, so this news was the last in a series of blows.

Miscarriage. Infertility. A devastating genetic diagnosis. Egg donation. And now I don’t even get to give birth the way I wanted? What the fuck!

I went home and cried for an hour, cradling my little bump. I’m sorry, I’m sorry, I whispered to my unborn child, confirmed that afternoon as being a girl.

And then I took a deep breath and began to research surgical birth, determined to make it the most positive experience I could. I read a wonderful book, Choosing Cesarean, written by a journalist and a doctor. I learned that there were distinct advantages to having a caesarean: the main one being my pelvic floor would remain intact, making it less likely that I would suffer from any sort of incontinence. Best of all, my baby would be born in a controlled environment and I knew ahead of time that my wonderful OB, Dr. D, would be the person to deliver her.

I dutifully made a birth plan, but it really boiled down to four things:

1. That Violet be delivered safely;
2. That she be healthy enough not to need extra care;
3. That I not need an emergency hysterectomy;
4. That I be able to breastfeed her.

♥ ♥ ♥

On the eve of my daughter’s birth, I prepared for surgery. At 10.55pm, I drank a last glass of the milk I’d craved throughout my pregnancy before lumbering into the shower to scrub my body with the industrial strength antibacterial soap I’d been prescribed.

As instructed, I slept in freshly laundered pyjamas and bed sheets. After a few hours of sleep, I showered again. By 5.30am, I was on the sofa, crunching ice cubes, and texting my family in Europe. My caesarean was scheduled for 8.00am, the first of the day, and it was wild to know I would be meeting my little disco mermaid in three hours’ time.

At 5.45am, my husband and I left for the hospital. It was dark outside, and the streets were clear of traffic. I made a point of inhaling the cool, damp early morning air, noting these would be my last outside breaths before meeting our baby. My husband went to park the car and I headed inside the hospital, smiling to think the next time I saw daylight I’d have our daughter in my arms.

I checked in at the nurses’ station. “Good morning! I’m Lauren ____ and I have a caesarean scheduled for 8.00am with Dr. D.” Some paperwork was printed, a couple of wristbands produced, and I was led to a curtained cubicle where I changed into a gown. A junior nurse strapped two monitors to my belly: there was some uterine activity, but no contractions, and the baby’s heart rate was right on track. I listened to the little galloping hooves noise and put my hands over my belly. Soon there’ll be a bright light, baby girl—remember to scream your head off when you see it, okay? I willed her. The nurse then set about clipping my pubic hair and was halfway done when my husband appeared, wide-eyed and breathless. He set down my little suitcase and his backpack and hovered next to me.

Our assigned OR nurse, Gena, introduced herself and started prepping the IV. It was already 7.40am. I didn’t care that placing the IV made my vein ache—I was focused on the fact that this long-awaited baby would soon be born. I reckoned within the hour (I would be right) and I got quite emotional. I imagined crying tears of joy at the first sound of our baby’s cry.

My doctors stopped by for the pre-op checks. First, Dr. D, who reminded my husband that the 20-30 minutes we’d be separated as the spinal block was placed would feel like a long time. Next, the anaesthesiology team: Dr. A, a tall, bearded man in his 50s, and Dr. J, a resident. They looked in my mouth, got my consent for the spinal block, and showed me how they’d like me to hunch over my belly in preparation for the spinal block. To their surprise, I declined their offer of a mild sedative, explaining I wanted to be able to remember my daughter’s birth.

At 8.00am, Gena wheeled me to the OR. I looked around me, expecting the room to be a similar size to the one where I had my D&C, but it was a lot smaller. I felt a surge in my chest when I saw the isolette—she’s really going to be here!—but there wasn’t much time to indulge the feeling. I was instructed to sit on the edge of the operating table, and Gena stood opposite me with her hands on my knees as I slumped over my giant belly, feeling the baby’s kicks for absolutely the last time. Remember, scream your head off, baby girl… With the spinal ultrasound performed, a local anaesthetic was administered. It stung, and Gena talked to me in a soothing voice. Right then I noticed that beautiful song, Somewhere Over the Rainbow/What a Wonderful World was playing and I welled up. It was like my grandparents (who’d bequeathed me enough money to pay for DEIVF), my darling great-grandmother, and Bean were winking at us. In went the spinal block, like a bee sting that ended quickly, and I must have gasped because Gena squeezed my knees and stroked my legs.

The spinal block quickly took effect. Dr. A held up a purple glove filled with ice and explained that he was going to touch it against various parts of my body and I was to tell him if it felt Cold or Touch. My shoulder was Cold and my thigh was Touch. Somewhere around my lower ribs Touch became Cold. Satisfied that I was completely numb from the waist down on both sides, I was catheterized. A blue curtain was draped high above my head. With that, Dr. D and the obstetric and paediatric/NICU teams entered the OR. And finally, just before 8.30am, my husband was summoned.

He appeared wearing a white zip-up bunny suit, cap, and mask, and was shown where to sit by my head. We clasped hands and he cradled my head and stroked my hair with his free hand. We had eyes only for each other and talked quietly about how we couldn’t believe we were about to meet our daughter. Our daughter! I didn’t notice the surgery had begun until I heard suctioning of amniotic fluid. I was transfixed by my husband’s beautiful round blue eyes, his only visible features, and the enormity of what was happening.

I felt some tugging and pulling. I pictured Dr. D’s hands cradling the baby’s head to manoeuvre her out of my pelvis. I grinned and said to DH, It really does feel like someone doing the washing up in your belly! There was more tugging, this time it felt like a pushing down above my belly button, and someone said the baby would be born soon. Was it a minute that went by, or five? The next thing I heard was a collective gasp from the obstetric team, Dr. D saying Here she is!, and the most beautiful and reassuring wail. At 8.37am, Baby Violet made good on her mama’s request and was screaming her head off!

I’d been imagining this moment since I was a little kid, and from then up until a few minutes before I’d been so sure I would be in floods of tears…but those first moments of our daughter’s cries were so profound, I was too shocked to cry. I’d done it. I’d really done it! I listened, wide-eyed and clutching my husband’s hand. I longed to see her, but the curtain wasn’t lowered. Where is she? I wondered impatiently. Finally, a glimpse as she was carried past us, and I craned my neck to watch as a small group of people huddled around her, rubbing her vigorously. A chubby pink thigh. The smooth grey rubber of the umbilical cord. A blue hand. Overall, she was a swirl of light purple. A much bigger baby than I expected, her features were swollen from the fluids administered to me via the IV. Go look! I said to my husband. Take a picture, because I can’t see what’s going on.

Finally, she was brought to me. It was a magical and weird moment to meet the creature whom I’d only known from the inside. My husband held her face next to mine, and she and I lay cheek-to-cheek. I reached around my arm to cradle her and kiss her chubby cheek. “Hi… hi…” I murmured. She seemed calmed by my presence and my voice. It wasn’t so much a rush of blind, unconditional love that I felt, but a surge of fascination and tenderness. I took in her tiny swollen features, and recognised her pouty lips, pointed chin, full cheeks, and my husband’s brow from our many ultrasounds. Someone took our first family photos together. No wonder the obstetric team gasped: even though Violet was three weeks early, she was 20.5″ ( 52 cm) long and weighed 7 lbs 11 oz (3.5 kg). But I was only able to relax when I heard her Apgar scores were 8 and 9. My beautiful girl was healthy and strong—and, dammit, against the odds she was here!

But then the shit hit the fan. Silently and, despite half a dozen ultrasounds, without warning.

I knew something was wrong when someone announced, ‘Here’s the placenta,’ and, as per my original birth plan, I asked to see it but no one responded. Unbeknownst to us at the time, my uterus wasn’t contracting which meant it was filling with blood. I was haemmorrhaging.

I heard Dr. D quietly ask, “How much have we lost?” and my ears pricked up. Someone replied, “800,” and I deduced they must be talking about blood loss and milliliters. I was trying to calculate if losing the equivalent of a bottle of wine of blood was normal (it isn’t) when I started feeling faint. I heard “1,483,” as my eyes began to involuntarily roll in the back of my head. A single thought, Keep your eyes open. Don’t fall asleep, that would be bad. Fight! rang in my head like a white alarm bell. My eyelids felt like they had weights attached, but I forced my eyes open. I wanted to tell my husband that I didn’t feel so good, but it was too much effort to stay awake. Besides, I knew he would notice. I heard him say, “Dr. A? Lauren’s having a hard time keeping her eyes open.” Dr. A evenly responded with, “We’ve already given her something for that.” Whatever it was, I swam back into consciousness.

Without warning, Drs. A and J began injecting my shoulders. Their movements were so swift, it was alarming. A blur coming toward my collarbone followed by a pause where I could see a syringe dumping its contents. They tried two different kinds of drugs to get my uterus to contract, but nothing was working. That’s when I noticed someone was on the OR phone talking about “more units of A-negative,” and Dr. A informed me that I needed a blood transfusion. I was quite shocked by that but didn’t have time to be scared. He tried to start a second IV in my left hand so I could get blood replaced more quickly. It hurt, but I didn’t flinch. It didn’t work. He tried another spot and, even though the OR was brightly lit, asked someone for a flashlight. My husband pulled out my iPhone and turned on its flashlight, but it didn’t help. Dr. A was still having trouble placing a second IV because my blood pressure was so low that my veins had collapsed. After several attempts to place a second IV line, my husband was asked to leave the OR, and that’s when we both knew things were bad.

At a prenatal appointment back in September, we made a point of asking Dr. D what would happen if something went wrong during the delivery. My cervix had always felt weird throughout my pregnancy, like the tugging of a drawstring. I could never shake the feeling that I had placenta accreta—even though my many ultrasounds had ruled it out—and was concerned about having an emergency hysterectomy on the day. I told Dr. D, “I know the ultrasounds have ruled out placenta accreta, but with my uncanny ability to fall headlong into tiny statistics, if anyone is going to have a surprise on the day, it’ll be me.” Dr. D always listened to my concerns and outlined the obstetrical measures taken before an emergency hysterectomy is performed. She reassured us that my husband would be allowed to remain in the OR with me unless things got very serious…

When my husband was asked to leave we were under no disillusion that things must be very serious. It seemed like one minute he was sitting at my head and the next he was gone. To my relief, he reappeared a minute later. In shock by what was happening, it didn’t occur to him until after he’d left the OR that he might never see me again. Dr. A let him back in, and as he made his way back to me, my husband said that all he could see were people’s shoes in huge pools of my blood. All I could see were his blue eyes, pink-rimmed and damp with worry. He told me he loved me again and again. I told him I loved him too, and, because I didn’t feel as scared as he looked, I told him I was going to be okay. Then, in my brightest voice, I told him to go to the waiting room and find his parents. I thought that if I were in his shoes, I’d appreciate being directed what to do. We kissed each other again and then he left.

My husband found his parents and told them what was happening. My MIL knew something was wrong because things were taking such a long time. Then he called my family and best friend to let them know the baby was born but that things weren’t going so well for me. After he changed out of the bunny suit and saw his parents, he came across two nurses wheeling V to the NICU. There, he sat holding her in his arms for a long time, wondering if he would be leaving the hospital with a baby but no wife…

Meanwhile, with my husband and daughter gone, I turned my attention towards what was happening. The very real question, Am I going to die? entered my head. I calmly considered this and decided that although things were probably serious, No, I’m not going to die today. I was very aware of my life force and it was strong. Plus, I had absolute confidence in the medical team working. Gena told me that evening that I had “everyone’s favourite doctors” working on me in the OR, a sentiment echoed by a resident who had been passing by and scrubbed in to help.

Dr. J placed an oxygen mask over my face as Dr. A finally managed to place a second IV. My blood pressure was so low it took him—a clinical professor at a top U.S. medical school—15 attempts to place the second IV (I counted the scabs the next day). I watched as each doctor hooked up one bag of blood and one of plasma to each arm – the first of the eight units I’d receive. I looked up and saw A-NEGATIVE printed on the bag, and my eyes followed the trail of other people’s blood as it snaked its way down the hose and into my arm.

I reflected on the half a dozen times I’d donated blood. It was something I didn’t enjoy but found rewarding in its own way. Giving blood hadn’t seemed like a big deal at the time, but lying there as a recipient, not a donor, I understood just how important it is to donate. I offered my most profuse silent thanks to the eight individuals whose donations played a crucial part in saving my life.

I felt the colour return to my face and then I saw that my blood pressure was back up to 83/51. I still wonder how low it must have gone for my eyes to roll in their sockets.

I heard Dr. D say she was starting a “B-lynch”—a double suture that goes around the uterus, kind of like braces (suspenders) that hold up trousers. I entered a strange head space where time simultaneously slowed down and seemed to go by quickly. Every time I looked at the clock, another 15 minutes had passed. I was aware of tugging and pressure. It seemed different than in the seconds before Violet’s birth, more intense. I surmised the spinal block was wearing off. No! Come on, that’s not possible! I looked at the clock. Spinal blocks last for a couple of hours, and the clock read 10.15am, about two hours after mine was first administered. I checked myself, using my experience of the Cold/Touch test. I swallowed. I determined that although what I was feeling couldn’t be described as pain, it was definitely a lot more than Touch. The sensations felt not thick and generalized, but more precise. There was a tugging, similar to when Violet was being lifted out, which I’m guessing was my uterus being lifted out of my abdominal cavity so Dr. D could work on it. I was pretty sure that if I said something to Dr. A, he’d give me a general anaesthetic, and I was also pretty sure that if I was put under, I’d wake up without a uterus.

I considered my options. I certainly didn’t want to feel the pain of major abdominal surgery. But neither did I want to lose my womb. I thought about the first two of my four hopes that transcended anything on my birth plan…

That Violet be delivered safely.
That she be healthy enough not to need the NICU.

… and concluded I was at peace with a hysterectomy. I wouldn’t learn until that afternoon that I’d lost 3.6 L (a smidge less than a gallon) of blood and would probably have died if I’d delivered in a more rural setting. Although it’s the closest I’ve ever come to dying, I knew I was in good hands with Dr. D—I first met her during my miscarriage when she performed my D&C and she knew then about my fear of losing my uterus—so if she needed to perform an emergency hysterectomy to save my life, I absolutely trusted her judgment. My only thoughts were: Violet is here and she is healthy. I want to be a mama to this little girl. I want to raise her with my beautiful husband. I just want to live.

I looked at the clock again. I wasn’t imagining things—the two-hour window of anaesthesia was rapidly drawing to a close. And with that, I took a deep breath and timidly told Dr. A, I think the spinal block is beginning to wear off. He looked at me very seriously and said, “I think we need to put you under.” I nodded. He called over to Dr. D, “We need to give her a general,” but she replied sharply, “One minute!” It wasn’t a barking order so much as a request to buy more time. I waited, drifting along for those sixty-odd seconds, vaguely aware that this important minute was going to mean the difference between keeping my womb or losing it.

Then, finally, “It worked.” I was passively awash with relief. I lay with my arms slightly outstretched at my sides, like some ghastly Jesus art project, quietly taking in everything that had just happened. I could feel more tugging. I dared look up to see my open abdomen reflected in the giant overhead OR lamp. A blurry, red gash shaped like an eye. I studied my reaction. How interesting… At the time I was surprised I wasn’t freaked out, but Dr. A probably gave me some narcotics to take off the edge of the fading spinal block. But right then, looking at the red reflection of my open belly and noticing the vibe in the room was less urgent, I’ve never had more respect and admiration for the entire medical profession.

All sutured up, they were getting ready to wheel me out to recovery. The head of the gurney was raised, the curtain removed. I remember two vivid things: one, someone holding up a large absorbent pad that was saturated with blood; and two, the time…

Early in my pregnancy, I had a dream that my late grandmother spoke to me. She said “The baby will be born between seven and quarter to eleven.”

…As I left the OR, the clock read 10.45am.

Read Part 2 on Thursday.

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2 Comments

  1. Even though I know the outcome, I was still worried for you while reading this. I’m amazed at all of the details you were able to remember, from the exact times, to the feelings you had. I’m so glad you were in such good hands and that your team was able to save your life. What an amazing dream to have, and to have come true!

    1. I’ll confess something: *I* still get worried for myself when I re-read this! 😉 I suspect I remember a lot of things because there was nothing to distract me, and I am interested in medicine. My OB/gyn is one of the best doctors I’ve ever had the privilege of being treated by (and I’ve seen quite a few in my time) and heartily recommend her to anyone in San Diego. The dream is weird, isn’t it? Especially when you consider that the 7am part is when Dr. D came by to do her pre-op check!

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