Birth Plans and Lost Ideals

Birth Plans and Lost Ideals
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A birth plan is a nice idea, but I knew better than to make up a schedule of what I wanted to happen in something as unpredictable as bringing twins into the world.  The birth of my first child had taught me to expect the unexpected and sometimes to expect nothing at all.  The mix of factors that made up the labor and delivery of my twins topped the birth of my first, throwing in possibilities I never even dreamed of.  The birth I was hoping for vanished well before I laid my first kiss on their brows and they were whisked away from me.

After much discussion between my doctor, Christine Lee, and then with my doula, Rachel Shaw, we decided to go in for an induction at 37 ½ weeks gestation, not for medical reasons or scheduling conflicts, but because the nurses at Berkeley’s Alta Bates Summit Medical Center were going on strike the following week, and my doctor was apprehensive about the level of care I might receive in the chaos of out-of-town substitute nurses who, while well-intentioned, would not be used to the environment and volume of maternity patients at the busy Berkeley hospital.

My husband and I went in on June 29th to have our twin girls, arriving at the hospital at 6am at the doctor’s request.  I had not originally wanted to be induced, hoping to follow my body’s wishes and nature’s plan as closely as possible.  But I was bloated and miserable at this point, and so ready to move on.  Induction included being started on a very low drip Pitocin to start labor contractions—a completely unnatural cocktail mixer of a drug that I had hoped to avoid.  At my doctor’s request, we had already decided that I would get an epidural at 8 cm dilation, and deliver in the operating room—again, two more ingredients I would not normally have chosen to have a mostly natural birth.  But twins is more complicated than simply laboring and then delivering, and I was grateful that both babies were in head-down presentation, and that my doctor was willing to let me try to deliver them vaginally and avoid invasive abdominal surgery and a long recovery period from a caesarian.

At one o’clock, the doctor broke the bag of waters on my first twin.  By two, pain rocketed through my body and I gave in to the ‘unnatural’ and received the epidural at 5 cm dilation.  Less than an hour later, I was 8 cm dilated and wheeled into the operating room in my gauzy blue shower cap.  As part of the ‘natural plan’ (notice the word plan is becoming a vaguer and vaguer idea) I delivered Billie Marianne at 7:52 that evening, tired but mustering the energy to do it all over again in a few minutes to deliver Twin B.

The doctors and specialists—eight people including my husband, the expert hand-holder—took my vital signs, they checked the ultrasound monitor and then they began talking in lower voices.  Even the cheerleader of an aesthetician (a strange but wonderful combination of personality traits) sounded like she was getting down to business rather than rallying me to push.

From the captain’s seat between my knees, my doctor informed me that I was running a fever of 103—quite suddenly.  For whatever reason, infection was setting in.  In addition to this latest, uninvited element, my cervix had gone from 10cm to 6 cm and the second baby’s head was not in the best position to help dilate my cervix.  I was pushing with a tired uterus on a baby that had not, as we had hoped, lined up properly, and now infection was setting in—a danger to both me and my two girls.

The discussion that followed was brief.  I could see that factors mounted against a second ‘natural’ and vaginal delivery.  I wanted to keep trying, but it was obvious that it wasn’t really up to me any more.  The anesthesiologist topped up the drugs, I lost all sensation from my neck down, though still trying to squeeze me husband’s hand as the tears dribbled out of the corners of my eyes.

At 9:40pm, Emily Faith was delivered by caesarian section.  Then—the most severe blow to my ‘plan’ of an even mostly ‘natural’ delivery of twins— was dealt to me tenderly by a fellow mom and friend who worked in the Neonatal Intensive Care Unit upstairs. Due to the infection, all three of us (mom and both babies) would have to be on antibiotics for the next 48 hours, and for the duration my two little girls would not be with me in the hospital.  I saw each of them for a minute apiece, and then they were gone—no natural skin-to-skin contact, no ability to try breastfeeding right after birth, no joyous and tearful snuggling moments… no babies.

In recovery, I listened to other parents and their new babies.  I cried every time I heard one of them coo.  The picture above was a result of a smartphone exchange between the NICU nurse and the recovery nurse—just so I could see my girls.  Hours before, I had sent my husband upstairs for a much-needed nap, figuring I’d be able to join him shortly to get some sleep—the silver lining in the dark cloud of being separated from my twins.  Rachel went home to her family, leaving me in the capable hands of the recovery nurse, Leah.  As it turned out, she was more than just capable—she helped keep me this side of the living.  Typically, a woman spends a couple of hours in recovery, her vital signs checked regularly, and her abdomen palpitated at intervals to insure that the taxed uterus is coping well and that the expected blood loss is within normal levels.

Mine was not normal.

First Leah gave me oxygen, then she gave me a shot to help my blood clot and then she had to give me a blood transfusion.  Without her intuition, I would have likely been whisked away to another operating room and someone would have had to frantically track down my husband.  Six hours later, exhausted and circulating the precious gift of someone else’s blood, I arrived in my room upstairs.

I had my ideals, sure, but I tried not to have a ‘birth plan’.  I should have checked my ideals at the triage room door, too.  None of them came to pass.  Now at home, two weeks later, I have two healthy girls and a body that’s recoverig well.  I’m done with having children, so I won’t be going through this again.

In this pregnancy and birth, I did it all—and I’m done.

Many thanks to Monica, the nurse who received this picture, and to the unknown nurse in the NICU who took it.

To the rest of the Alta Bates Labor and Delivery, Recovery, NICU and Family Care staff– you were all so helpful and wonderfully compassionate to both me and my girls.  I am eternally grateful to all of you for my health and care.