Happy Birth Day

I like to think the baby heard all the discussion about induction and decided to get labor moving on her own.

And just like that, there we were, four days past my due date, water broken, contractions coming strong, checking into the bougie hospital. My husband and I were escorted to the maternal assessment area (that drab, claustrophobic, and windowless room) on the labor and delivery floor, where I changed into a gown.

A fetal monitor showed my contractions were coming every two minutes and an internal exam revealed that I was 2 1/2 to 3 centimeters dilated. That didn’t sound like much to me. My heart sunk. I thought I was going to get sent home. But then the nurse said, “You're not going anywhere." 

Soon, I started to believe her. The longer I was confined to the bed, the more painful the contractions became. I really wanted to get up and move around and be in the water.

“You're handling these so much better than I could,” the nurse said, studying the fetal monitor readout. “You're so calm.”

I thought, “I'm Norwegian. We don't show anyone our pain.”

Just as I was starting to wonder if I'd made a mistake in choosing the hospital over the birth center, I was transferred to a big delivery suite with natural light – but no birthing tub. At that point, I didn't care. I just wanted water, from any source.

“What is your pain management strategy?” my labor and delivery nurse asked.

“I want to try to do this naturally, but I want you to warn me when my last chance for an epidural is,” I said.

“Have you had an epidural before?”

“No.” 

She said if I wasn’t sure about the epidural, there was an acronym-ed injection (I can’t remember the name of it now) that could be administered at 7 centimeters and that lasted about 90 minutes. That sounded good in theory, but I wasn't sure I was going to make it to 7 centimeters without pain relief.

As soon as I got the OK, I headed to the shower, where I stripped and sat on a plastic bench. My husband held the shower head on my lower back and when the contractions came, I wrapped my arms around his waist and squeezed as hard as I could until the pain subsided. That worked for a while, but eventually I got tired of sitting down. I tried standing up, and when the contractions came, I gripped the handrails and pulled back like I was trying to pull the shower wall down. My moans echoed against the tiles. After an hour of this, the steam in the bathroom was so thick I could barely see my husband. I soon became overheated and woozy, so he flapped air at me with a towel, like palm fronds on Cleopatra.

The nurse stopped in once with a Doppler to check the baby’s heart rate. Since the baby was doing fine, I was given the green light to continue in the shower. But after around 90 minutes of pelvis-shattering contractions and too-brief periods of relief, I said, “I don't know how much longer I can do this.”

The next time the nurse returned, I asked to get checked. I was only 4 centimeters. Not even halfway! The nurse said I couldn't have the acronym-ed drug yet.

“What about the epidural?” I asked.

“Four to 5 centimeters is the ideal time to do that.”

“Let’s do it.”

I guess I surprised her and my husband, too, because both of them looked at me, like, “Are you sure?”

“I'm tired,” I said. (As if I had to justify asking for pain relief in labor!)

“That’s a perfectly good reason to get an epidural,” the nurse responded. She paged the anesthesiologist and inserted an IV line.

Realizing that I was about to do the one thing I swore I wouldn’t do during birth, I started crying. I felt a little disappointed in myself. Was I underestimating my own strength?

But by the time the anesthesiologist arrived, the contractions were so intense I felt like I was being tortured on the rack. With each one, I shook uncontrollably, as if I were having a seizure. I didn’t remember that being part of labor, but the nurses said it wasn't abnormal. My moans grew louder.

“Breathe through it!” the nurse said, which was annoying because I was breathing, just with sound.

I was told to sit on the edge of the bed and grip a pillow. The anesthesiologist cleaned my back, put what felt like a plastic shield over me, then numbed the area. I felt a sharp poke but it was nothing compared to the contractions. The epidural went in. About 10 minutes later, I felt the intensity of the contractions fade. Within 20 minutes, I couldn't feel anything at all.

It. Was. Heaven.

“Why are women so anti-epidural?” I asked aloud. “This is the best thing ever!”

Why did I force myself to suffer through unmedicated birth before when I could have been blissed out, eating grape popsicles, and texting my family updates? If I could have an epidural like this every time, I would birth 100 babies.

An hour or two later (time flies when you’re on drugs), I was at 8 centimeters. A nurse gave me "the peanut," a birth ball-like contraption that I put between my legs while lying on the side. The peanut helped me get almost to 10, but the nurse said I still had “a little cervix left on one side,” so I switched sides and within an hour I felt a strong urge to push. I was pleasantly surprised that I could still feel my body’s signals even though I was otherwise numb.

I had been told a doctor I’d never met from Dr. Baby-Maker’s clinic was on call and going to deliver me, but at the last minute, that doctor got stuck at another birth, so Dr. Baby-Maker was called in. I had never been so happy to see her smiling face before. She was as enthusiastic as ever, despite it being 10 p.m. and long after her regular workday should have ended.

Dr. Baby-Maker and the nurses got me into position: on my back, legs in stirrups parallel to the bed (which, I’ll admit, seemed counterproductive to pushing, but whatever). Apparently, I still had some “forebag” left, which Dr. Baby-Maker ruptured with a long hook. Then it was time to push. When I felt a contraction coming, I alerted everyone, then had to hold my breath and push down and out while pulling my legs back toward my head (a lot harder than it sounds). I couldn’t tell if I was being effective or not.

In between pushes, everyone was small-talking like this wasn’t the biggest event of my life in a long time. Dr. Baby-Maker asked about the marathon tattoos on my ankles. Then my husband started talking about his job. It was so surreal. I kept thinking, “Hello! I’m having a baby here!”

Finally, Dr. Baby-Maker and the nurses gave me some feedback: “That was the best push so far!” or “Every time you push, the baby’s head comes down further!” or “I can see hair!”

After 20 minutes of pushing, I felt that all-too-familiar “ring of fire” sensation...but without the fire. It was pressure, in a very localized, circular form. One more push and relief washed over me. The baby’s head was out. Another push and her body slipped out, too. I breathed in big gulps.

Dr. Baby-Maker put the baby right on my chest. I started crying and my husband followed suit. As soon as we talked to her, she lifted her head. Her huge blue eyes were open and she was very alert. She had a defined chin, a cute piggy nose, and lots of feather-soft brown hair.

It was love at first sight.

All the waiting? Worth it. The pain? Worth it. The money? Worth it.

Worth it. Worth it. Worth it. Our baby was here and she was perfect.

“Do you want to see the placenta?” Dr. Baby-Maker asked. I hadn’t even felt it come out.

“No,” I said. I only had eyes for my baby.

Dr. Baby-Maker told me I had a second-degree tear; she repaired it while my husband and I just gazed and gazed at the baby. Thanks again to the epidural, I felt no pain. When she was done, she prepared to leave.

“You did so well,“ she said. “I can’t wait to hear how much the baby weighs!”

We waited until the golden hour was over before weighing and measuring the baby. She was 8 pounds, 12 ounces (my biggest baby so far) and 22 inches long (very long by any baby’s standards).

While the birth wasn’t “natural” by midwifery standards, there was nothing unnatural about it to me. I was surrounded by supportive, professional women, from Dr. Baby-Maker to the nurses to the anesthesiologist. I felt respected and empowered throughout the birth. And because of the epidural, and subsequent pain relief, I was able to be fully present during that glorious golden hour in a way I wasn’t with my previous daughters. I didn’t even feel the need to take any photos (which I kind of regret now); I was just there, fully and completely in the moment. And what a glorious moment it was! Among the best of my life.

Of course, I couldn’t stay on cloud nine indefinitely. The crash was coming, and it was killer…

Pop Goes The Preggo

One of the things this pregnancy taught me was that every time I thought I had an absolute, such as “I am never going to be induced,” I soon realized that life was determined to prove me wrong. 

Two days before my due date of May 15, I returned to Dr. Baby-Maker’s clinic. I hadn’t been back there since late January, well before the coronavirus outbreak, and it was all very eerie now. The parking lot was near empty. Signs warned that visitors were not allowed. There was even a checkpoint where you had to stop and get quizzed about where you were going and if you’d been exposed to, or had symptoms of, coronavirus.

A sole receptionist manned the clinic desk behind a massive Plexiglas shield. The waiting room looked like it had been robbed; there were only a few chairs, substantially spaced out throughout the room. All the newspapers and magazines were gone. Every day since coronavirus arrived in Minnesota felt more and more like a sci-fi movie.

First on the appointment agenda was an ultrasound. The sonographer confirmed that I had the minimum amount of amniotic fluid necessary for “this far along” in the pregnancy. The baby was way too big for any glamour shots, so the sonographer focused on gathering measurements of the head, femur bone, and abdomen. According to the machine’s magic math, my due date would be May 18, which was odd, since the baby had been measuring ahead of the due date for most of the pregnancy.

Then it was time for the baby's weight estimate. I was worried that with each passing day, the baby was getting too big to birth vaginally. The sonographer did not assuage this fear.

“Nine pounds, 10 ounces!” she announced.

“Oh, no,” I said.

“But these estimates can be off by 15 percent in either direction,” she added. If the numbers skewed lower, that would still put the baby at 8 pounds, 1 ounce, which wasn’t the biggest baby I’d ever delivered (my first was 8 pounds, 4 ounces), but it was pretty big for a girl.

While waiting for Dr. Baby-Maker in an exam room, I texted my family about the baby’s weight.

“OOF!” my younger daughter replied.

“Can we get an F in the chat,” my older daughter said.

At this rate, all the newborn clothes I’d purchased for the baby would be too small by the time she arrived.

Dr. Baby-Maker entered the treatment room, donning a face mask and shield. It made her appear slightly more serious than usual. I explained that I’d transferred to the birth center in the hopes of having a natural birth but that now I just wanted to deliver the baby by any means necessary. 

“I can imagine,” she said. “This is the longest you've ever been pregnant!”

Finally, someone understood. I wasn't just being impatient. 

“I’m willing to induce you,” she said. “I could do it as soon as Friday if you want.”

There was just one hitch – my cervix had to be ready. Dr. Baby-Maker put on gloves and did an internal exam. I stared at the ceiling and hoped for good news. She seemed to be really digging deep inside of me. This didn't bode well.

“Your cervix is completely closed,” she said, and snapped her gloves off. “I tried to see if I could get even a fingertip in there, but nope.”

Because of my “unfavorable cervix,” Dr. Baby-Maker couldn’t do an induction until I reached 41 weeks. That would put us at May 22, over a week away. It felt like forever. How much bigger would the baby be then? Would she even fit through the birth canal?

“Come back early next week,” Dr. Baby-Maker said. “We’ll do another ultrasound and cervical check.”

I wasn’t happy about having to wait, but at least this plan would put me a few days ahead of the birth center protocol. With the latter, I wouldn’t even get induced until May 26, and their methods (castor oil smoothie, herbs, amniotomy) could take days to get labor going. Given the baby’s size, I might very well end up transferring to the hospital anyway.

“I may have to accept that this won’t be a natural birth in any shape or form,” I wrote in my journal. “I think I can accept that. I might even be willing to do the epidural if the pain is too much. Oh, Lord, please let the birth be gentle and safe, no matter how it happens.”

Later that day, my daughters and I joked about how the baby was going to be so mature by the time she was born that she was just going to walk right out of the womb and say, “Hey, mom, give me the car keys. I’ll drive myself home.” Or: “Hey, mom, what’s the Netflix password?” There were endless punchlines to this joke.

The next day, I registered with the hospital for the induction and scheduled a coronavirus test (per the hospital’s protocol). Then the birth center called.

“We had a meeting to discuss our induction policy,” the midwife said. “And we believe you’re a good candidate for induction. We’d like to offer that for you if your cervix is ripe.”

The timing of this offer was very suspicious. Why was I suddenly a “good candidate” for induction when I’d been so harshly turned down just days before? The birth center knew I was transferring care because I’d requested to have my records sent to Dr. Baby-Maker. I suspected the only reason the birth center was offering induction wasn’t because it was best for me and my baby, but because birth is big business and if the midwives didn’t induce me, they knew they would lose me as a “customer,” and therefore forfeit thousands of dollars in insurance payments.

I explained that I’d already visited Dr. Baby-Maker, that my cervix was not ripe, and that I was scheduled for a medical induction at the hospital on May 22. I didn’t see what else there was to discuss.

“If you come in on May 21, we can check your cervix, do a stress test, and then induce you,” the midwife said.

The birth center was like a bad ex-boyfriend I couldn't say no to. I reluctantly agreed to the appointment, but I kept my hospital induction appointment, too. I could always cancel either – or both, if I went into labor spontaneously before then.

“My hope, and prayer, and wish, is that I will just go into labor on my own before any of these appointments have to happen,” I wrote in my journal. “You’ve got three days, little baby, before we get on this non-stop train to induction, which could end any number of ways. God help us both.”

My due date came and went. At my follow-up appointment with Dr. Baby-Maker, an internal exam revealed that my cervix was a “tight 1” but that I had effaced 80 to 90 percent.

“You never know,” Dr. Baby-Maker, ever the optimist, said. “You could still go into spontaneous labor before the induction!”

I smiled weakly in response. I’d given up hope that the baby would come on her own. 

Dr. Baby-Maker walked me through the induction plan: in two days, I would check in at the hospital at 7 p.m. I would be given a cervical softening agent, followed by Pitocin. The baby would be born sometime the next day, likely in the afternoon. My husband could stay with me throughout delivery and recovery, but once he entered the hospital, he was not allowed to leave.

“Is there any reason that we might schedule a C-section instead, given the baby’s size?” I asked.

“No,” Dr. Baby-Maker said. “The baby would have to be measuring 11 pounds for us to have that conversation, and even then, I’ve delivered many big babies vaginally. The only reasons this might end up as a C-section is if you labored to, say, 5 centimeters and then stalled for a long time, if the baby’s head wasn’t moving down the birth canal fast enough, or because of shoulder dystocia.”

Though I’d doubted Dr. Baby-Maker’s competency and experience in the past, I now felt fully confident in her abilities. And while I was disappointed that I wasn’t going to go into labor spontaneously, I was glad that Dr. Baby-Maker would be attending the birth. I couldn't think of a more enthusiastic person to deliver my baby. 

I headed home, had lunch, then set off for a walk with my husband and my daughters. We’d increased our walking frequency lately in hopes of encouraging the baby down and out. It seemed to be yet another old wives’ tale that didn’t work.

Until it did.

Only a couple of blocks into the walk, I felt a huge gush of fluid between my legs. It soaked through the pad I was wearing. My water had never broken on its own (I had amniotomies with my previous births) so I thought I’d just peed myself yet again. We continued walking, but then the contractions started – contractions so painful I had to stop and catch my breath. My younger daughter timed them. Three minutes. Two minutes. Was this it?

At home, I got a hot pack for my lower back and assumed a position on all fours, but the contractions strengthened, to the point where I couldn't talk while they were happening. It was like being slammed with waves of pain. I barely had time to breathe and regroup in between.

It was decision time. Birth center or hospital? Who you gonna call?

“You were just here!” the nurse at Dr. Baby-Maker’s clinic said when I gave her my name over the phone.

“I know,” I said. “But now I think I’m in labor.”

I explained my symptoms and she told me to head to the hospital. I was ecstatic. It seemed I wouldn't have to be induced after all...

Time's A Wastin'

I spent eight months waiting to get pregnant and another eight months being pregnant. By week 37 of gestation, I couldn’t wait to not be pregnant anymore.

I was physically weary of carrying my big belly around. (While I’d only gained 20 pounds, I was, as they say, “all baby.”) I was tired of getting up five times a night to pee. I was at the point where I fantasized about going to a prenatal appointment and hearing the midwives say, “We need to deliver you right away!” Of course, I didn’t want anything to be wrong with the baby. I just wanted her to be here.

Midway through week 37, I woke up at 1:30 a.m. to go to the bathroom, but as soon as I sat up, fluid rushed out of me and dripped down both my legs, leaving a trail to the bathroom. The spillage seemed more forceful than an “I peed myself” scenario (which was happening more and more frequently). I wasn’t laughing or coughing or sneezing or doing anything else that would normally precede me peeing myself. I went into fluid investigator mode. I turned on the light to see what color the fluid was: clear. I tried to smell it: nothing.

With shaking hands, I dialed the number for the birth center pager, returned to bed, and waited. No one called, so after 15 minutes, I paged again, per the birth center’s instructions.

Finally, a midwife called. Though of course they all had names (and various tattoos and piercings), because I’d only been a patient there for a short time, in my mind they were all interchangeable.

“If your water broke, the fluid will pool in your vagina,” she said. “Lie down for 15 minutes, then stand up and see what happens. If no more fluid leaks, it was just your bladder releasing.”

This didn’t sound very scientific. I knew that if I’d called Dr. Baby-Maker’s office instead, she’d have me come in to test the fluid and maybe even do an ultrasound. Low amniotic fluid had become one of my new worries because it can be dangerous for the baby, necessitating induction or a C-section. Also, if my water had broken, and labor didn’t start soon, I was opening myself up to infection.

Still, I followed instructions. I laid down for 15 minutes. Then I got up again. There was no more fluid. False alarm.

At my 38-week appointment, I asked what I could do to jump-start labor naturally. I’d already tried the obvious tricks: exercise, sex, raspberry leaf tea.

The midwife recommended chiropractic, acupuncture, and acupressure. I would have tried all three of those, but, hello! There was a pandemic going on. Our state was still in lockdown, and I didn’t know of any acupuncturist seeing clients. While I’d been getting adjustments from a chiropractor pre-coronavirus, returning to her clinic now seemed risky. Acupressure, at least, I could do myself or ask my husband to do. (Which we did every night for a week; it didn’t work.)

The midwife had one more suggestion: “Patience!” she trilled.

Yeah, no. That was definitely not an option.

“At what point do you induce?” I asked.

“We won’t even discuss induction until after your due date passes,” the midwife replied.

I couldn’t help but note the irony that I’d left Dr. Baby-Maker because she wanted to induce me at 39 weeks and now I would’ve given anything for some Pitocin.

My doubts about the midwives grew louder. Did they really know what they were doing? Would they know if something was wrong? Why weren’t internal checks standard practice? (And why didn’t I ask for one?) Why didn’t they do a late-pregnancy ultrasound like other clinics did? If they didn’t do that, how would they know if my amniotic fluid was low?

Though I read and watched everything I could on unmedicated birth, my steely resolve to welcome my baby into the world “naturally” at the birth center was waning. In a way, everything about this pregnancy had been an uphill battle – getting pregnant, staying pregnant – and now it seemed the birth was going to be an uphill battle, too.

Depression crept in. I felt hopeless. I was alternately weepy and irritable. “This is all an illusion,” the dark voice inside me said. “The baby is never going to come. You don’t deserve this blessing. Life is going to do what is always does – shit on everything.”

I didn’t like thinking this way and I didn’t dare repeat these things aloud so as not to jinx anything. But I was beyond frustrated at my complete lack of control in this situation.

It was time to advocate for myself. At the start of my 39-week virtual visit with the birth center, I said, “I want an induction plan.”

“We do not induce until 41 weeks and 4 days,” the midwife said. “And that even then, the induction process is long.”

I wish I’d known that before I transferred to the birth center, but of course I didn’t ask because I never expected it to make it this far! What happened to the birth center's ethos of letting pregnant women decide what was best for their births?

“Are you feeling all right physically?” she asked.

I didn’t understand the question. What difference did it make if my discomfort was physical or mental? Would my desire to induce provoke more compassion if I complained of back pain instead of depression?

I said something like, “Yes, but the waiting is really hard.”

“What’s the hardest part of waiting?” she asked.

“I just thought the baby would be early, like my daughters. I’ve been mentally ready for two weeks. Now every day that passes and she’s not here feels like a disappointment.”

I had to hold back tears at this point, but my sadness was palpable, even over Zoom.

“What are you doing to keep busy?” she asked.

Again: not the point. Distraction is not a treatment for depression. I wanted to say, “Well, I had planned to be busy taking care of my baby this week!” Instead, I told her I was working and exercising and spending time with my family.

“Do you have anything special planned?” she asked.

“The options are kind of limited right now with coronavirus,” I said.

“I meant something like getting take-out.”

(‘Cause that’s so fun. Even if we did that, there goes 30 minutes. And then what?)

If coronavirus weren’t a thing, the final stretch of pregnancy would have been so much easier. I could’ve gone to a concert or to the movies. I could’ve scheduled a haircut, a massage, acupuncture, and a chiropractic adjustment. I could’ve gone shopping in an actual store. But all those options were off-limits now.

The midwife seemed to sense she wasn’t going to get anywhere with logic, so she tried encouragement instead. “You’re going to do this,” she said. “It’s going to happen naturally.”

Then she laid out the timeline for the next couple of weeks: I would have a 40-week in-person appointment, a stress test at week 41, and an ultrasound after that. And then maybe we would discuss induction. “But you’re not going to make it that far,” the midwife said. “You’ll have the baby before then.”

I had my doubts.

Before signing off, the midwife said, “I’m on call tonight if you want to come in and have a baby later!” 

She was trying to be kind, and I do believe in the power of suggestion, but her comment felt incredibly cruel because, if I could choose to have a baby, I would have chosen to have her by now!

But I didn’t really have a choice, did I?

Or did I?

After closing the Zoom session with the midwife, I picked up the phone…and made an appointment with Dr. Baby-Maker. I was going to take her up on that offer for induction…

Pregnant In A Pandemic

 I entered the third trimester of pregnancy with joyous anticipation. Then coronavirus came.

The first sign that something was amiss was the toilet paper shortage. My husband returned from a trip to the wholesale club empty-handed. Apparently, they’d sold out of TP. At first, I couldn’t believe it. I thought that because I was the primary household shopper, he just didn’t know where to look. But nope. He looked. He asked. They were out. “I’ll solve this!” I thought, and went online to order some. They were sold out there, too.

I waited a couple of days, then headed to the warehouse club as soon as it opened, when it was usually a ghost town. This time, it was packed. Swarms of people scurried around the store, filling carts beyond capacity. The atmosphere was crazed, like we were all contestants on Supermarket Sweep.

I made a beeline for the toilet paper section. Along the way, I overheard someone ask an associate where the TP was.

"We're all out, but we have some napkins," the associate said.

This was unacceptable. There had to be toilet paper. There had to be! I went to see for myself and managed to nab two of the remaining six boxes of the cheapest TP available. A minute later, an old man hobbled by me and noticed the toilet paper in my cart.

“Where did you find that?” he asked.

I pointed in the direction of the corresponding wall, knowing full well there wouldn't be any toilet paper left by the time he got there. I felt awful, like I should offer to give him one of my boxes – and yet, as a woman (and a very pregnant one at that), I felt entitled to a substantial toilet paper stash.

I stocked up on hand soap and sponges, only later wishing I'd snatched up paper towels, napkins, and baby wipes, too, because those all soon sold out, as did red meat, chicken, bread, and any other edible staple my family used to take for granted. I swung into hoarder mode, visiting multiple stores in one day to stock up on non-perishables and frozen food, driven by a fear of not having enough nourishment for the remainder of the pregnancy. Yet as a former anorexic, seeing the cupboards, fridge, and two freezers bursting full made me feel panicked, not reassured. Who was going to eat all this food?

By mid-March, there were several cases in our county. It was time to hunker down. My daughters shifted to online learning. My husband started working partially from home. 

There were two public places I frequented religiously: the gym and church. But with COVID-19 cases on the rise, both seemed risky. I canceled our gym membership and we stopped going to church. I’d been going to the same gym for 15 years and my husband and I hadn’t missed a week of Mass in over two years. While I didn’t interact with many people in either place, having those routines torn out of our lives felt like a real loss – at a time when I was already anxious about how much life would change once the baby was born.

Then the entire state went into lockdown. Life became very small, and every day was the same. Wake up. Elliptical. Shower. Eat. Work. Eat. Walk. Stretch. Nap. Eat. Work. Eat. Play cards. Stream. Sleep.

New terms popped up in our daily lexicon: COVID. Pandemic. Quarantine. Shelter in place. Social distancing. Respiratory droplets.

Every day I checked the state statistics on confirmed coronavirus cases and watched them go up, up, up. I had nightmares about stores running out of food and people standing too close to me.

“How is the hospital going to handle coronavirus?” I asked my new midwife (who we’ll call Jenny, even though she won’t be around for long). I now felt nervous about delivering in a hospital, especially the bougie one, which was among the first in the state to create a coronavirus wing.

“Good question,” she said, “but I don’t know the answer to that yet. We have a staff meeting this week to discuss it.”

The pandemic was in its infancy, but it seemed like a serious oversight for the labor and delivery team not to have a plan in place for how to keep pregnant women and newborn babies safe. There were so many unknowns about the virus, like: could it be transmitted in utero? During birth? In breast milk? Were new mothers or babies more at risk than the general population? Could infants die from it? Would Minnesota hospitals forbid fathers from being present at births, as some New York medical centers had?

The hospital setting now seemed like a dangerous place to spend 48 hours postpartum with a newborn. A birth center, which would let me and the baby go home only hours after the birth, started to look more and more appealing.

After a short Googling session, I realized I wasn’t the only woman reconsidering her birth plan in the wake of COVID-19. There were several newspaper articles, both local and national, about pregnant women switching to birth centers, which were deemed lower risk for contracting coronavirus. 

"Given how important having a natural birth is to me, it’s kind of odd that I didn’t pursue a birth center further before," I wrote in my journal. "I guess my fear was driving me into a hospital setting; and now, in a way, fear is driving me away from that."

There were three birth centers in the metro area that would accept a transfer patient as far along in pregnancy as I was. I contacted the one closest to me and set up a consultation.

The birth center was located inside an antiquated, stately house in St. Paul. It had been renovated to accommodate two birthing women at a time, plus acupuncture and chiropractic treatments, as well as classrooms for birth, parenting, and yoga instruction. Just walking in the door, I felt more at ease. The space was decorated with modern but neutral décor, with a wall full of baby pictures. The midwives wore street clothes and were makeup-free. They spoke calmly and were very laid back about this whole birthing-in-a-pandemic thing. The birthing suites were gorgeous; big, inviting beds, huge birthing tubs, walk-in showers, and every imaginable birthing tool you could think of.

There were some downsides though. First, a ton of bureaucracy. The paperwork was novella-length. There were phone calls to the financial coordinator to ensure insurance would cover the birth center’s fees. They required me to attend two (virtual) classes: one on breastfeeding and another on postpartum care, despite the fact that I had already given birth twice.

A lot of the birth center incidentals were DIY, too, which was a slew of to-dos I really didn’t need in the midst of a pandemic. I had to purchase my own postpartum care items, like disposable underwear and “padsicles” (maxi pads with witch hazel and/or ice packs inside). There would be no free onesies, caps, blankets, or even diapers for the baby. I also had to pack my own food and beverages, because the birth center didn’t provide any (despite having a requirement that new moms eat a meal before going home). We had to bring everything. It seemed like a lot of preparation for what would be a brief stay.

I was on the fence. Ultimately, I didn’t so much make the decision to switch to the birth center as it was made for me – in the form of a phone call from Jenny’s office.

“Midwives will not be attending births until June,” the receptionist told me. “We’re transferring you to an OB for care.”

Despite Jenny's experience and support for my unmedicated birth plan, I wasn't attached to her. She was cold and unenthusiastic compared to the cheerleader-like attitude of Dr. Baby-Maker. But getting transferred to an OB defeated the whole purpose of switching clinics in the first place. If I wanted an OB, I’d go back to Dr. Baby-Maker. I told Jenny's clinic thanks but no thanks, I was transferring to the birth center.

But as I soon discovered, the birth center, which prided itself on empowering women to create their own birth experiences, was not as advertised…

Picture Perfect (For A Hot Minute)

With the due date in sight, I started prepping in earnest for the baby’s arrival. First up was figuring out the nursery. We didn’t have a spare room in the house, so it took some creative reorganizing to free one up. My husband painted the walls ballerina pink and put up a unicorn applique. (Unicorn was our “theme,” as much as we had one, as I considered this our “unicorn baby.”) Despite my big belly, my husband and I managed to move a creaky old rocker recliner from the living room to the nursery.

I bargain-hunted at Ikea and Target for sturdy but affordable furniture, picked up a handful of cheap newborn outfits from the warehouse club, stockpiled diapers, and sterilized a breast pump and all its accessories. 

My mom had come around on welcoming the baby, which translated to her purchasing all the big items off of our registry – a stroller and car seat combo, a swing, a playpen, a baby carrier, and an activity center. It was amazing to see how much space our little one was already taking up – and she wasn’t even “here” yet!

But she sure was making her presence known. The baby's kicks, flips, and hiccups were constant reminders that she was on the way. The kicks were strong enough that I could even see them in the mirror sometimes. My daughters loved placing their palms on my belly when she was especially active (usually after my afternoon fresh fruit bowl) and feeling her squirm around inside me.

Convinced this was my last pregnancy, I decided documentation was in order. I didn’t have any good pictures from when I was pregnant with my daughters, so this time around I splurged on a maternity photo session with a local photographer who we’ll call Haley.

When I was 30 weeks pregnant (the earliest Haley would do a maternity shoot), Haley greeted me inside her 2,600 square-foot storefront studio. One wall of the space was covered with props, outfits, screens, and everything else you could imagine to photograph preggos, families, and newborns. She even had a very inviting all-white bed made up.

I had planned to wear a tight black maternity dress from Target with my favorite knee-high boots for a “badass preggo” look, but when I sent a pic of the dress to Haley a few weeks before the session, she shut it down right away. Instead, she directed me to a maternity gown website (who knew this was an industry?!) and told me to choose one, her treat. They were all so feminine and elegant, which was not really my style, but I went ahead and picked a strapless gown in a burgundy hue. Now, she pulled out that dress and invited me to choose a couple others from her stockpile to try on.

I hate having my picture taken, and even being pregnant (and feeling gloriously so) didn’t make me more comfortable with the camera. “Would you mind keeping my face out of the pictures?” I asked before Haley started shooting. “Or at least can I be looking away?”

I knew this probably sounded weird (“Here’s a couple hundred dollars to take my photo, but don’t get my face in the frame, thanks!”) but I wanted to cherish the photos and if my face was too prominent, I would just keep thinking how old I looked – too old to be pregnant and proud of it.

Haley photographed me in three different dresses (burgundy, pink, and black) against two backgrounds (white and gray). Along the way, she let me peek at some of the images on her camera screen. They looked very elegant and dramatic. I guess she knew what she was doing after all.

While Haley photographed me, she told me all about her family. Her husband was in the military and got deployed during her first pregnancy. When her OB discovered her amniotic fluid was low, she had to be induced. I couldn’t imagine giving birth alone, much less being induced alone. To make matters worse, she was at a military hospital with minimal staff, so if she wanted pain relief, they had to administer it along with the induction drugs.

“I got Pitocin and an epidural at the same time, so I didn’t feel a thing the entire birth, not even one contraction,” she told me. “So when I went into labor with my second, I was curious what birth felt like, so I labored without medication for a while. After a few good contractions, I thought, forget this, and got the epidural again.”

I had learned to keep my opinions about birth to myself, and just nodded along as I listened to her stories. I hoped I wouldn't need to be induced and that I’d be strong enough to resist the epidural.

Haley had one boy and one girl. She insinuated that her husband got a vasectomy. “So we’re done now,” she said.

I wanted to reply, “We’ll see about that!” but didn’t.

“I thought I was done,” I told her, “but then my daughters became teenagers and I realized I wasn’t ready to be an empty-nester.”

“Well, now you’ve re-upped for 18 more years!” she said.

Indeed.

When the final images came back three weeks later, I felt somewhat vindicated – the best ones were those that didn’t feature my face. But because a pro took the pics, they looked lovely. Finally, the beautiful way my body felt while pregnant was reflected back to me.

I picked the best image, made my own edits, then posted it on social media. As happy as I felt to be sharing my news, I also wondered what the rumor mill would churn out. Some people in my social circle knew that my husband had had a vasectomy (and nobody knew we’d had it reversed); others had heard me say in the past that I didn’t want more children. Would they think our baby was a mistake? That I’d gotten pregnant on the sly? I wished there was a graceful way to announce that our baby was not only planned but very much wanted and that she was ours in all the ways that mattered. But I wasn’t ready to spill all the details of our embaby’s conception yet. After all, even our families still didn’t know the full story.

Perhaps we would tell them all at the baptism, which we tentatively planned for the summer. We attended a mandatory baptism class at our Catholic parish and filled out the official paperwork for the archdiocese. Seeing our baby’s full name (straight out of the Bible) on the form that would go to the archdiocese felt so official. At least there would be one place she would be accepted exactly as she was: our parish.

(Aside: the Catholic Church and God are not synonymous in my mind. While the Catholic Church does not approve of IVF, my parish welcomes everyone. A gay couple who conceived through IVF with a surrogate were even invited to share their journey at Mass once (which got our parish in a whole heck of a lot of hot water with the archdiocese). But the Church is a man-made organization, and a sexist one at that, so I honestly don't care what a bunch of never-married, childless, celibate men think about infertility treatments. I can't fathom a God who would disapprove of IVF or any use of science for well-intentioned, faith-filled, thoughtful people to grow their families.)

Everything was ready for our embaby, or as ready as it was ever going to be. I loved looking in on her room, which felt brand new and full of good vibes, and imagining myself rocking her to sleep.

I should have known that this bliss wouldn’t last, though. Amid these felicitous baby preparations, something happened, something that upended the entire world, along with the third trimester of my pregnancy and my birth plan: coronavirus.

Choose Your Own (Birthing) Adventure

A week before Valentine’s Day, my husband and I bundled up and headed out in the frosty morning for a tour of the bougie hospital where Dr. Baby-Maker’s patients delivered.

The tour group was huge; over a dozen couples. Most looked like they were further along than me (or just had more prominent bellies) and much younger than me, like in their 20s.

The set-up at the bougie hospital was a little bit different than the other hospitals where I’d given birth. For my previous deliveries, I was admitted, given a room, and stayed put. At the bougie hospital, however, patients started in the maternal assessment area, a grim, dark, and windowless space where nurses used fetal monitoring and internal exams to determine if you really were in labor (or, if you were scheduled for a C-section, to get prepped).

Once labor was confirmed, patients were moved to a birthing room (or the operating room if scheduled for a C-section). The birthing rooms were newly renovated, spacious, and featured lots of natural light. Some even had huge soaking tubs. Two hours after birth, patients were moved yet again to the postpartum floor, which featured small, no-frills style private rooms.

Some hospital procedures had changed since I last gave birth. Most notably, the hospital now emphasized “the golden hour” as a sacred time. It’s the first hour after a baby is born, which moms and babies are encouraged to spend together skin-to-skin to help the baby transition from the womb into the world. Nurses didn’t even clean the babies off anymore before handing them to the mothers. This sounded like a welcome change to what my previous deliveries had been like – newborns immediately whisked away for cleaning, weighing, and Apgar testing followed by mass intrusion of well-intentioned but overbearing family members. 

While the bougie hospital offered comfort tools like birthing balls, birthing stools, and those luxurious tubs, the nurses were upfront about what a hospital birth meant – drugs. “Our focus is on pain management,” the nurse leading the tour told us. She rattled off some of the available options, including narcotics, epidurals, and nitrous oxide.

I now believe that all births are natural, whether they are medicated or unmedicated, vaginal or C-section, but at the time, I was really hoping for an unmedicated birth and considered them superior to any other kind of birth. I admired women like Ina May Gaskin, perhaps the most famous midwife in the world and author of the unmedicated birth bible Spiritual Midwifery, as well as Rikki Lake, who advocated for home births in the documentary The Business of Being Born.

While the hospital setting scared me a little, the what-ifs scared me more. I’d seen a lot of news stories about pregnant women who had strokes or other health emergencies during labor. I also remembered that I had been in incredible pain during both of my daughters’ births. What if this birth was longer or more painful than my previous deliveries? Though my goal was an unmedicated birth, I liked the idea of having drugs at hand if I needed them.

At my 24-week prenatal appointment, Dr. Baby-Maker asked about the deliveries of my daughters. The first, at 39 weeks, was long and tortuous – around 21 hours – and involved a totally useless shot of Nubain, which I would never ask for again because it did nothing to ease the pain and made me so dizzy I couldn't stand up. The second delivery, at 38 weeks, was so fast I barely made it to the hospital. I begged for painkillers but I was fully dilated and effaced, so the only way to find relief was to push. I did, three times, and my second daughter was born.

“I’m hoping for another quick birth like that one,” I told Dr. Baby-Maker.

“It’s been a while since you last delivered,” she said. “It might take your body some time to remember how to do it.”

That was not what I wanted to hear.

“But we offer induction at 39 weeks if you want to avoid a home birth or a car birth," Dr. Baby-Maker said. “Something to think about.”

I did think about it and I had two thoughts: 1) "I won't get to 39 weeks!" (In my mind’s math, if I’d had my first baby at 39 weeks and my second at 38 weeks, shouldn’t my third come around 37 weeks?) And 2) "An induction is exactly what I'm hoping to avoid."

I had heard so many induction stories – on message boards, in documentaries, in books – and none of them were positive. Many of them included horrific levels of pain, long labors that stalled, and emergency C-sections. “Uterine rupture” was a terrifying term that was sometimes associated with induction drugs.

So why was Dr. Baby-Maker offering induction so casually, without a medical reason, like it was no big deal? Women have died from being induced. Why would I electively do that? (Oh, just you wait…)

Similar to when I was at the maternal-fetal medicine clinic, I started wondering if the medical model was best for me, my delivery, and my baby. Or was it a lot of unnecessary interventions? Could I advocate for myself in a hospital setting?

It was time to call on reinforcements, namely, a former boss of mine who had become a doula. She gave me the spiel about her services over the phone.

While I appreciated her passion for empowering women to have the kind of births they wanted, I wasn’t sure if I really wanted another person in the delivery room; on the other hand, I’d never given birth with my husband, and I wasn’t sure how helpful he was going to be during the delivery or if he would just end up irritating me.

Some of the services included in the doula’s package sounded a little woo-hoo to me, too. I really didn’t want a helper at my home postpartum, nor did I need guidance on processing or composing my birth story. But she did get me to think twice about the bougie hospital, where she said the likelihood of an unmedicated birth was low. She was also vehemently opposed to me being induced at 39 weeks – and even said that at my age, some doctors would refuse to induce me.

“Have you thought about a birth center?” she asked.

“I have, but I want to keep all my options open,” I said. “If I change my mind about pain medication or something goes wrong, I’d rather be at a hospital.”

At the very least, she recommended I switch to a midwifery practice that delivered at the hospital. I didn’t know there was such a thing.

Our conversation was helpful, but it didn't alleviate all my anxiety. Everyone has an idea of what the “best” way to give birth is, but the reality is that birth is not an event you can control, plan, or predict. While I'd scribbled down a birth plan just for myself (yes to movement, massage, hydrotherapy; maybe to nitrous oxide; no to induction, internal monitoring, epidural, episiotomy, vacuum extraction, forceps, or C-section), I knew that in an emergency, I would submit to whatever the doctor recommended.

After the conversation with the doula, I spent the afternoon Googling the bougie hospital. There wasn’t much online – almost as if the internet had been scrubbed of dirt – but there were a few message boards where women chimed in about their birth experiences there. They seemed to be equally split between bad (one woman said a nurse laughed when she stated her desire for an unmedicated birth) and good (surprisingly, by women who’d had C-sections).

Part of me wanted to just stick with Dr. Baby-Maker and the plan to birth at the bougie hospital. But another part of me wanted to give the unmedicated approach the best chance I could. The medical model made sense in the beginning of the pregnancy, given all the infertility hurdles and the subchorionic hemorrhage, but now that the pregnancy was progressing normally, maybe I didn’t need so much intervention.

While I decided against having a doula because of the cost and the nagging feeling that three would be a crowd, I did take the doula’s suggestion and transferred care to an OB practice that had a few midwives on staff who delivered at the bougie hospital.

Things seemed to be falling into place. The due date would be here before I knew it. Now it was time to bask in the beauty of the third trimester – by decorating the nursery, getting maternity photos taken, and arranging the baby’s baptism…

First, Do No Harm

I didn’t know what maternal-fetal medicine even was until I became pregnant with our embaby through IVF.

Essentially, it’s a practice for high-risk pregnancies, which IVF patients sometimes have. Babies conceived through artificial reproductive therapies (ART) are more likely to be born prematurely, have low birth weight, and have congenital heart defects. Because of this, it was standard practice for Dr. Baby Maker to refer IVF patients to a maternal-fetal medicine clinic for genetic counseling, a mid-pregnancy anatomy ultrasound, and an echocardiogram (basically, an ultrasound of the baby’s heart).

The sad little clinic had chairs and carpet the color of puke. The windows looked out into the hallway of an office park, but were shrouded with brown curtains, so it was dark in the waiting room. It was unclear to me if the curtains were meant to protect patient privacy, but they felt shaming, like no pregnant woman would want to be seen in the place.

A top-40 radio station was on and in between songs, the morning DJs chatted about the most heinous news stories. One involved a man in prison who sliced his tongue in half so that it would look like a snake’s. I wondered why they didn’t have relaxing music on, given that any pregnant woman needing care from a maternal-fetal medicine clinic was probably stressed out enough.

The receptionists seemed oblivious to the unwelcoming ambiance. They were chatting about patients who were either no-shows or who had canceled appointments at the last minute. This made no sense to me; if you’re going to the maternal-fetal medicine clinic, it’s because you have a high-risk pregnancy. Who’s not showing up for their baby (or babies, as was likely the case for some of them)?

On the wall across from where my husband and I sat, there were pamphlets that proclaimed “Powerful Choices” on the cover. I wondered what these powerful choices were, but was not curious enough to get up and grab one. 

The first part of our appointment was genetic counseling. I didn't understand what the point was given that our genetics were not at all involved in this pregnancy, and what we did know about our baby genes was minimal.

Our genetic counselor was a young man who looked like Dennis the Menace pretending to be an adult. It was weird talking about our baby’s genes and my bleeding and how I was feeling to a guy who seemed like he should be selling me a smartphone. I was polite, but guarded. Meanwhile, my husband refused to take off his coat and sat there with his arms crossed and a scowl on his face.

Though I had done the quad screen, a basic blood test that checked for Down Syndrome, and it had come back normal, Dennis tried to sell us on a pricey test called Maternity 21, which tests for Down Syndrome and other (extremely rare) chromosomal abnormalities. He also asked if we were interested in amniocentesis. It seemed a little late in the pregnancy to address these things; even if I was willing to spend the money on the former and undergo the invasive procedure of the latter (which involves a huge needle sucking amniotic fluid out of the womb), if we got bad news back from either (very unlikely), I couldn't imagine aborting our child.

I didn't say any of these things, so Dennis continued his sales pitch and showed me a chart with the rates of Down Syndrome by age. This was not new information, but it was also pretty irrelevant since our gametes were not involved in making this baby. I got the feeling that Dennis didn’t work often with donor-conceived pregnancies.

“Our donors were both in their early 20s, so I really don’t think we need any further testing,” I said. And that was that. We had nothing more to talk about. It was a total waste of time.

Up next was the anatomy ultrasound. At this point, our baby had had so many ultrasounds that they were starting to feel unnecessary, too. When I was pregnant back in the early aughts, preggos got one 2D ultrasound halfway through the pregnancy and that was it, unless something seriously wrong was suspected. Now it seemed like ultrasounds were mandatory at almost every OB appointment. While each ultrasound was reassuring, especially in the first trimester, I occasionally worried about the unintended or still unknown side effects of all that monitoring. 

The sonographer at this appointment was nice enough, but she dug the wand so deeply into my abdomen that at times I shirked back in pain. After 30 minutes of this, the wand started feeling hot, too, and I wondered if any of this was really good for the baby, who was seen frequently onscreen throwing up her hands and arms, as if trying to shield her eyes.

As soon as the sonographer declared everything looked normal (baby was measuring four days ahead with a heart rate of 153 BPM and a weight of 10 ounces), I was ready to go, but then she launched into another 10 minutes of 3D ultrasound imagery to give me some “glamour shots,” which felt downright abusive to me and the baby. I didn’t even like the 3D images and I really didn’t care for her poking and prodding my body to get them, given that they weren’t medically necessary. I guess my Minnesota Nice side got me again because I didn’t speak up.

The third and final part of our maternal-fetal medicine odyssey involved chatting with the in-house OB, who had zero bedside manner. 

“Everything looks normal on the ultrasound,” she said. “Though your placenta is kind of close to your cervix…”

I knew that a placenta covering the cervix was bad, though I wasn’t sure what would need to be done about that.

“I’m not concerned, though,” she added, which made me wonder why she bothered bringing it up at all.

A few weeks later, I returned to the maternal-fetal medicine clinic for the echocardiogram. I now felt fully confident in the viability of the pregnancy and the health of the baby and really didn’t feel the need to go. (All those no-shows and cancellations I’d overheard about now made sense.) But show up I did because that’s what responsible preggos do.

If the previous ultrasound was uncomfortable, this one was downright excruciating. The sonographer was rough, almost as if she was trying to hurt me. But, of course, I didn’t say anything because I’d never had an echocardiogram before and I didn’t know if this was normal. But it sure didn’t feel normal.

My body was stiff and clenched with tension. I tried to practice progressive relaxation, where you start at the top of your head and work your way down to your toes, consciously relaxing each body part along the way. It kind of worked, as did my silent reminders to breathe.

At one point, the sonographer asked me to turn to the side because she needed the baby to roll over. I did, and when she pressed her wand into me, my body jerked in response, like I’d just been punched.

 “Oh, is that tender spot?” she asked.

 “It’s all a tender spot, lady!” I wanted to scream back.

I couldn’t wait for the procedure to be over. The sonographer only spoke to give me directions, to tell me the heart rate (156 BPM), and to inform me that the baby was breech (not unusual at 22 weeks). After determining that the heart was completely normal and healthy (thank God), she tried to get a few 3D face shots. All she was able to manage was an image of the baby shielding her eyes and one of her scowling.

“The baby’s not in the best position for this,” she said.

“It’s OK, baby,” I thought. “I don’t like getting my picture taken, either.”

Besides, she had a cute scowl.

I was so done at this point. Why didn’t I just tell the sonographer I didn’t want any more images? Why did I have such a hard time advocating for myself – and my baby – in the presence of medical professionals? Assertiveness in these situations was something I really needed to work on.

I did follow up with the clinic and aired my grievances to the appropriate person, who apologized profusely and seemed to sincerely appreciate the feedback. Still, this experience made me wonder: Do I trust the medical establishment at all?

I hoped a tour of the hospital where I was supposed to deliver and my 24-week visit with Dr. Baby-Maker would offer up an answer…or would they leave me with more questions?