I have two beautiful, healthy daughters. They are so perfect that I don’t know how or why I am so lucky, so let me start with that. But bringing them into this world was a trauma. It doesn’t affect my love for them, but it affects my life and my mental health every day.
I’ve realized I can’t really tell the story of my second delivery, the one that almost killed me, unless I tell the story of the first one.
In the last week of 2012, I was 36 weeks pregnant and spending my time reading books about natural childbirth, practicing pain management, talking constantly with my wife about how together we would deal with my pain and anxiety during labor. We had been together for over seven years and she was well-versed in helping me through my mental health challenges, of which I had many. I completely trusted her to get me through it – I even looked forward to it as a bonding experience.
That said, I am a big fan of modern medicine and never considered anything but a standard hospital birth. I wanted to try to manage labor without intervention if I could, and my California hospital was friendly to that decision. Unfortunately for me, nobody checked my daughter’s presenting position until I was already full term, shortly after the turn of the new year. At my 37-week appointment, my OB couldn’t find her head through the cervix. An ultrasound confirmed that she was frank breech. I tried everything on spinning babies, contorting my pregnant body into so many awkward positions that I gave myself migraines. I found a chiropractor and tried the Webster technique; I found an acupuncturist and tried moxibustion. A week later, I was headed for a C-section unless I wanted to try an external cephalic version (ECV).
For a first pregnancy, the success rate of attempting to manually reposition the baby in the womb is about that of getting heads on a coin flip. I read extensively about the risks, which seemed acceptable to me, and certainly not worse than those associated with a surgical birth. My wife completely deferred to me on the decision; most other people uniformly disagreed with, or didn’t understand, my decision to try it.
I have terrible doctor anxiety, so the morning of the procedure, I was terrified. They gave me a dose of terbutaline to relax my abdominal muscles, and it felt like an awesome caffeine jolt, a feeling I sorely missed after eight months of pregnancy. But fun fact: ECVs hurt, a lot. I was cursing and grunting and crushing my wife’s hand while two doctors pushed and twisted my huge pregnant belly. Two tries were unsuccessful, and I was crying from pain. They asked me if I wanted to try one more time.
“Baby’s okay?” I croaked.
“Ultrasound and monitor look great.”
I left disappointed, but glad that I tried everything I could. They told me that I would schedule my C-section at my OB appointment the next day. Wife and I grabbed lunch on the way home since I hadn’t been allowed to eat anything before the procedure. On the drive home, I noticed a lot of discharge. I worried that they had broken my water, but didn’t say anything out loud. I could not acknowledge that thought.
In the bathroom at home I learned that it wasn’t amniotic fluid leaking onto my underwear, but bright red blood. On the drive back to the hospital I numbly thought, “Well, either they’ve damaged my internal organs or it’s a placental abruption.”
It was the latter, of course. They occur in 0.1% of ECV attempts, and I knew that, and I’d accepted those odds. After an agonizing wait for a doctor to examine me, I learned I’d be having a baby that day. I told that doctor over and over again that no, I couldn’t today, I wasn’t ready, no no no. But the baby was full term, and the placental abruption had the final say. Seven hours later (because I’d just eaten a big meal and was considered non-emergent), my E.M. arrived by C-section, healthy and beautiful.
Pretty much immediately after her birth, I plunged into the depths of post-partum depression. Looking back, I think that the birth experience was a huge contributor, and that I actually had undiagnosed symptoms of PTSD. I cried every day all the way to and from work. My panic attacks were on a hair trigger. I couldn’t read news stories about anything involving violence without feeling it had just happened to me; the internal screaming was deafening. And I knew – I just KNEW – that either my daughter or I was going to die. I didn’t know how, and I wasn’t suicidal, but I would console myself by saying, at least you got to know her for three months.
I had never planned to have more than once pregnancy. We had planned that my wife would carry the second child and after that we would foster or adopt. But by the time EM was four months old, despite my mental state or maybe because of it in some desperate cry for a do-over, I knew I wanted to carry another baby. And I was already completely immersed in VBAC literature.
In the spring of 2016, seven months pregnant with my second daughter, I told my VBAC class my birth story. When the instructor asked what I wanted from my second birth I said, “I want the chance to try it vaginally, and naturally as much as possible. But mostly, whatever happens, I want to feel connected to it. I felt so out of control with my first birth; I was completely unprepared. This time I understand that anything can happen… I just want to be emotionally present for it.”
I understood that I could wind up with a second surgery, but I was okay with that if I got to hold her right away, got to feel excitement and positive anticipation about her arrival in my arms.
Facts are facts: 1% of VBACs end in uterine rupture. Of those, 6% of the babies die.
If that were to happen to my baby, I knew I would never forgive myself. But I trusted my hospital, my doctors. It was absolutely crucial to my mental health, to my experience as a mother, that I give myself the chance to try.
They had been concerned about my blood pressure the entire pregnancy. At my first appointment at 8 weeks, my reading in their office was 180/95. When I say I have doctor anxiety, I’m not kidding – my readings at home, well into the ninth month, were in the 120s/70s. That did not matter when I clocked a 165/100 at my 39 week appointment. I got sent to labor and delivery.
I had known that they were going to try to strip my membranes to trigger labor at that appointment, and so my older daughter was already tucked away at my parents’ house. When I called my wife and told her to come to the hospital, neither of us was terribly surprised that the doctors felt it was time for new baby’s arrival. My cervix was 1cm dilated, high, and not effaced. I was given three options. Go home and wait (not recommended, but ultimately my decision), have a C-section that afternoon, or be induced.
Induced? For a VBAC? I was confused.
A “gentle” induction involves a Foley bulb to widen the cervix and a slow, low dose Pitocin drip. I was told it could take days. For all my desire for the chance for a vaginal birth, at that moment that did not sound like a marathon I was prepared to run. But I didn’t want to go home; I wanted to have the baby that day. My daughter was taken care of. My wife was there. I was ready. I wanted to meet my baby girl. I was scared and the “devil I knew” was appealing and even, in that moment, comforting. I told the resident I wanted the C-section.
One of my doctors, whom I had talked to extensively about my VBAC desire, heard about this decision and put a hold on the proceedings. He sent in another doctor to talk to me further. She was warm, empathetic, and extremely forthcoming about the procedures when I asked a million questions. Ultimately, she confirmed what I truly wanted and talked me down from my anxiety-induced decision. Despite everything that happened after, I am extremely grateful for that doctor. I wish I had told her that when she visited me the next day in the ICU with tears in her eyes. Now I don’t even remember her name.
With the decision made, they wheeled me into my delivery room. It was around 3PM. I hadn’t eaten since 8, so they let me order lunch, knowing delivery was a safe distance in the future. I can’t remember what I ate. I think there was pizza.
The placement of the Foley bulb was the first procedure. It hurt, much like bad period cramps. She had to try it twice because she couldn’t get it to stay the first time. When she told me I was all set, I smiled. She said if I could smile after that, I was going to do great.
They hooked me up to the Pitocin, and the waiting began. I watched the electronic trace of the contractions rise and fall on the monitor. I couldn’t feel anything besides muscle tightening, and wondered when the pain would begin. A few hours later, I went to the bathroom and the bulb fell out in the toilet. There was bleeding, and my heart dropped to the pit of my stomach. But my nurse was thrilled – it meant my cervix was dilated. The blood was normal.
More uneventful waiting ensued. The contractions got stronger; I could feel (and see) my abdomen tightening. Sometimes it would be strong enough that I would get a little breathless, but I still didn’t have any pain.
Women who have VBACs are highly encouraged, though not required, to get an epidural. I’d had to make peace with that months earlier, because in the event of an emergency, having an already placed epidural can be lifesaving when seconds count. It can also provide the mother with the chance to be awake for the surgical birth of her baby instead of having to undergo general anesthesia. By 9PM, I knew in my gut it was time. I cried the whole way through the procedure. I didn’t want it. I was scared of the side effects, scared of the unknown. But most of all, now I knew I was about to have my second baby, and would never get to feel a single labor pain. The feeling of loss was immense. It is not an overstatement to say that the feeling of disconnection from my body and the work it was doing was devastating.
The epidural placement went smoothly. The anesthesiologist was wonderful and tender with me through all of my emotions. When it took effect, I was surprised to feel I could still move my legs a bit, that they just felt heavy and sluggish. About an hour later, I felt like I had to pee. The nurse seemed surprised, because usually the epidural takes away the feeling in your bladder, but she gave me a bed pan. I couldn’t go.
The nurse said at this point, my job was to try to get some rest before things really got going. Wife and I lay down, and put on the TV. Ocean’s Eleven was on.
As I lay there, sleepy but knowing full well the idea of actually sleeping was laughable, I felt a little nauseated, a little dizzy, and a little sweaty. I knew labor could do that sometimes, and I knew I had drugs in my system. It may have been normal. It may have been a series of warning signs. I’ll never know.
Around 11, I think, I felt my whole body jolt, like an electric shock had run through me. That was followed shortly by a gush of fluid between my legs. I threw off the blankets and looked at the sheet, and touched the fluid on my body. It was clear – not blood, not greenish or brownish. Relief. I had to wake Wife up. “Sweetie… my water broke.”
I am so grateful for the classic labor milestones that I did get to experience.
But I was definitely not feeling well by this point. Woozy, sweaty. I have terrible anxiety and shit was getting real, so I chalked it up to that. At one point a doctor came in and repositioned my fetal monitor, the belt of electrodes around my belly.
I’m not sure exactly what time it happened. It feels to me now that it was very soon after my water broke, but based on the timing of the birth it must have been at least an hour later.
Out of the blue, like a truck hit me, I was enveloped by the worst pain of my life. (And keep in mind, I’d had an epidural already.) It felt like someone had reached into my body and was pulling apart my abdominal muscles. It felt like a vise gripped my bladder and twisted. It coincided with contractions. I became the classic “woman in labor screaming in the hospital bed.” I curled up on my side in the fetal position to try to get away from the pain. My nurse asked me questions, but I was in too much pain to answer her. She told me I needed a bolus of my pain relief. Wife put the controller in my hand, but I couldn’t hold onto it, and it dropped to the floor.
I thought, “Well, I guess now I know what labor feels like.” And that conclusion came with a bit of disappointment, because I knew I could never withstand that level of pain for hours, no way in hell.
The timing of the next events is hazy to me. I know that I underwent a couple more of those excruciating contractions before the frenzy began. I know that the doctor who had been occasionally checking me for dilation progress was called out of a meeting, and I know the room began to flood with people, some of them in scrubs, some of them with walkie-talkies. I know now it was because my daughter’s heart rate was dropping.
Suddenly the lights were bright. The doctor sat down at the foot of my bed and reached inside me and I will never, ever forget the puzzled look on his face.
“This baby is sky-high,” he said.
I’d read enough to know that the baby’s loss of station in the pelvis is diagnostically indicative of a uterine rupture.
The doctor went to the monitors, scanning readouts, clicking on things. “Doctor, should we get her to the OR, given her history?” a woman said.
“Just get her out,” I said. “I’m scared.”
Wife noted, and told me later, that at this point my heart rate was 155. I was tachycardic and going into hypovolemic shock. They had to wheel me to the OR without Wife, who had to get dressed and, I later learned, had to be held outside until the doctors were sure that our baby wasn’t dead. As they wheeled me down the hall, I heard one of them say the word rupture.
“My uterus ruptured?” I asked.
“Your membranes ruptured,” she said. She was protecting me, I know that now. They saw me bleeding as they were wheeling me down the hall. They knew. Wife heard them call “Condition O” over the loudspeakers. Obstetric emergency, all hands on deck.
From the time the doctor was called to check on me to the time I was cut open, a total of nine minutes passed. I was heavily drugged and woozy from blood loss, staring up at the ceiling, bright lights in my eyes. Wife wasn’t there yet. I noted that I did not feel the tugging sensation that I’d felt when they delivered E.M. I didn’t hear the baby cry, either.
I wanted to pass out. My brain really, really wanted to go to sleep. My eyes were closing and I had to fight it. I kept thinking, “If you pass out, that is bad. Don’t do it. Stay awake.”
Every time I started to feel my head spin like I was going to faint, I would look up at this woman who was standing by my head. I didn’t have to say anything; she would look at my face and know I was in trouble, and she would do something to my IV and it would fix it. I still don’t know who she was or what she was doing. Nobody has been able to answer me that.
Wife finally joined me, sat down next to my head. She had tears in her eyes but I was a little too out of it to register at that time what she must have been through. I cried and she held me, at least as much as she could while I was strapped to an operating table.
The first time we saw our daughter C.J.’s face was in an iPhone picture taken by an OR nurse. I remember gasping and sobbing twice with joy when I saw those pictures. She was okay. She was here. She was real. Her APGARs, miraculously, were 5 and 8.
I was on that operating table for two hours, about three times as long as a standard C-section procedure. I’d experienced a complete uterine rupture, which means that the contents of my uterus were open to my abdomen. When they opened me up, the placenta spontaneously delivered, and C.J. was in my upper abdomen. When I later asked how long she had been like that the answer was, “Well… it couldn’t have been very long.”
They estimated that I lost three liters of blood. They did not give me a transfusion, but did give me two units of platelets to make sure I didn’t bleed more. My rupture extended to the broad ligament on the left side, which is a long, flat, structure that connects the uterus to the abdominal wall. When I get menstrual cramps now, I still have sharp pains in that ligament – a lovely monthly reminder.
When they were confident they’d repaired the damage and the bleeding had subsided, I had some time in the ICU. I know I got to hold the baby that night, but I don’t really remember doing so. I was pretty drugged and actually slept a little; Wife sat in a chair next to me, crying. The next day I got visits from some familiar faces, many of the doctors who had treated me throughout the process. I don’t remember much about what they said to me. I tried to eat and drink but vomited everything back up. I barely had the energy to hold the baby. I felt numb.
That night I got transferred to a standard recovery room. On the surface that was great news, because it meant I was healthy enough for standard and not intensive care. But it also meant I was treated like a standard C-section patient and not one who had undergone a life-threatening event. It was one of the worst nights of my life. My anxiety was nearly unbearable, I was shaking and in pain. The oxycodone was the only thing that kept me from losing it.
For all of that night, I was unable to urinate on my own. I felt a terrible urge, but once I dragged my shredded body to the toilet, the muscles would not work to make it happen. I don’t know if that’s because I had a catheter for 24 hours or because of the rupture. Either way, it was nearly unbearable. I would send for the nurse and then sit there on the bed in agony for nearly an hour before she would finally acquiesce and straight-cath me to empty my bladder. Because the volume was too low to warrant such an extreme urge, she took me less and less seriously each time. My wife, who is not confrontational by nature, had to demand that the nurse get me Ativan to rescue me from my torment.
It’s clear to me now I must have sustained some damage to my bladder or those muscles and that caused the feelings – it was the same thing I felt soon after getting the epidural. In the morning, I was finally able to pass some urine on my own, although it would take minutes and minutes.
I spent most of the recovery period alone in the hospital. My family did visit for a few hours the next day, but for the remaining three days I sent Wife home to get rest and take care of our E.M. I needed her to be well rested so she could take care of us when we got home.
In those bleary, painful, lonely days of recovery. . . when I held C.J. to my chest, skin to skin, it was pure bliss. I was connected to her immediately, which was not the case with EM.
Which is not to say I was okay. I broke down in tears upon being woken up from a precious nap to have my blood pressure taken, and the technician chastised me sharply. “With your blood pressure history, we have to cover our butts.”
The morning I was due to be discharged, the doctor who had delivered C.J. came to check on me, and I was curled up crying. She was the first person to mention PTSD to me. I was interviewed by more than one social worker about my support network and how capable I felt to take care of my daughter.
The recovery at home was brutal. When your body has been pregnant and realizes it no longer is in that state, it works to reduce your blood volume. This is a reasonable physiological response, but when you lose three liters of blood and need to build up your supply, it is a counterproductive one. I was weak and devoid of energy. I needed so much sleep that my wife was practically a single mother for the first few weeks. The guilt was horrible, but I couldn’t fight my physiology. I literally didn’t have enough blood in my body. I ate cheeseburgers and spinach every day to combat the anemia.
The nightmares where I am being shot in a hospital parking lot, or torn open by wild animals, or holding a shriveled dead baby have only recently begun to subside.
My daughter is a year old today. I have a toddler again. She is absolutely perfect, with big blue eyes, little curly flips of hair on the back of her head, four tiny teeth, a round kissable tummy, and rolls of chub on her arms and legs. She dances like a maniac and shrieks when she’s excited, or angry, or bored, or about everything, really. Sometimes I still don’t understand how she is with us, except to realize that my doctors and nurses may not have been perfect, but I owe them her life and probably mine.
I am not religious. My spirituality derives from the science behind the mysteries of life and reality – from physics, from neurobiology. I am a human animal, and my connection to life, to nature, to evolution, is something I recognize in my rational mind and also in my gut… or in my soul, if you will. If I am to borrow the language of religion, there is nothing more “holy” in my heart than making a human life. It is a horrible, brutal, messy, terrifying, indescribable, transformative experience, and one of the most unifying components of being alive on Earth. It is one that should never be undertaken lightly and never chosen by or forced upon someone who doesn’t unequivocally want to experience it.
And for me, it is going to be a years-long, if not life long, process to accept that my experiences with pregnancy and childbirth have left me feeling disconnected from nature, betrayed by my body, and inferior to the mothers of all the generations before me. In that sense I am processing a trauma on two levels – the physical near-death experience for myself and my baby girl, and a profound sense of loss. The latter has left me unsatisfied in a very deep and spiritual way. I do NOT glamorize the pain of childbirth, but I deeply wanted to feel a baby being pushed from my body. I wanted to feel myself accomplish that. I wanted to be held by my wife while I birthed our child, whether it was in a delivery room or an operating room. I wanted a bloody, messy, wailing infant to be placed on my chest after we went through birth together.
And yes, I wanted us both to live. My gratitude that we did doesn’t erase what I feel as a loss. Those who would say things like “a healthy baby is all that matters” or “just be grateful, because 100 years ago you would have been dead” are of no use to me. Those statements tell me that you don’t see mothers as autonomous beings separate from their status as a vessel. You are no better than the people who would force a woman to go through this experience against her will. And in that vein, while my healing proceeds, one of my greatest hopes is that we as an animal species can cultivate a sense of the vitality of the dignity of mothers, in pregnancy, in labor, in birth, and in recovery.
