Tuesday, July 31, 2012

Birth Story, Part 3

This is the part I always try to avoid. This is the part where the pain is so exquisite I can't touch it, like air on a third-degree burn.

I started seeing a therapist a week after Balthazar died and at our first session she said, "I don't know what happened, other than that you've had a loss. Tell me what happened."
I told her about finding out. I told her about the labor, and the delivery. Then I started talking about how my parents reacted and how it felt to pick my son up from school and see all of the parents three days out.

If I were writing a novel I would unconsciously skip this part altogether and some editor would gently remind me that it's the most important thing, the heart of the story. This is the part with the dead baby in it.

The OB brought Balthazar to me. He had vernix on his face, which looked like clown makeup. They couldn't wipe it off, they explained, because his skin was fragile and might come off with it. Other than that he looked like a baby. He had dark hair. His nose and mouth were like his brother's. His eyes were closed and looked slightly swollen. He was still warm from being inside my body, but he didn't cry and he didn't move. He was a six pound, eight ounce lump. He was there, but he was not there. He was fully formed, but absent. There was nothing obviously wrong with him, but he was gone.

At birth Jasper was already so definitively himself, his right fist held close to his face, over his eye, as a shield, as a comfort, as a way to bash his way out. Who was Balthazar? He was an empty page, a blank. The charity that claims they come and take professional pictures of dead babies never came and so the nurse took the pictures herself. She asked me to kiss his head and I did, feeling guilty about my hesitation. I felt his fragility and his distance and I moved gingerly.

After awhile I gave him to Jonathan to hold. He broke down when he realized that he was unconsciously rocking a baby who had no need of being soothed. "Everyone does it," the nurse, said, unsurprised. "It's an instinct."

He kept pooping. I didn't know that a body could do that, which I guess just shows my ignorance and unfamiliarity with death. The nurse kept trying to wipe him clean, eventually taking a big piece of skin off of his behind. After that she put a diaper on him. But it was horrifying, seeing that happen. My son was injured, wounded. It shouldn't have mattered-after all, he couldn't feel it. But it did matter. The image of it kept me awake at night for weeks-the flap of skin coming off, the raw and damaged flesh.

Later the nurse put him in a bassinet next to my bed. She said that he could stay with us as long as we wanted and so he remained there all night. Once the nurse determined I was not hemorrhaging or feverish she left us alone. There was no way that I could sleep. I read the literature I'd been given like a college student pulling an all-nighter. Jonathan tried to sleep on the padded bench and then at 3 am gave up and went home. I was actually glad, because I needed some time alone with my son.

I told him that  loved him, and that his Daddy loved him, and how sorry we were that we wouldn't get to take him home. I apologized and said I had tried my best. I told him that I knew he had tried his best.

Before Jasper was born, I had a miscarriage at ten weeks. After the D&C the gynecologist told us that it hadn't been a fully formed embryo. It hadn't even made a yolk sac. Once we were over our initial shock and sadness, Jonathan and I used to joke grimly about the poor showing of that pregnancy. "Couldn't even make a yolk sac," we'd say to each other in mock disgust. But this was an entirely different thing.

What did he feel? What did he know? Was he scared? Do feelings and thoughts even obtain for someone who has never existed outside the womb? Can someone who doesn't know where he is or what is happening be scared? The questions would be impossible to answer even if we knew why he died, which we don't.

We would always love him, I said, and we would always be his mommy and daddy. There was really nothing else to say after that. Love was all I had to offer him. 

In the morning Jonathan came back with the hospital bag I hadn't been able to bring. The nurse helped me to dress Balthazar in a gray and white striped hanna andersson onesie and gray wiggle pants-his going home outfit. I wrapped him in a blanket from Churchill Weavers in Louisville, Kentucky, one my aunt's partner had given me when Jasper was born. The blanket was a beautiful cornflower blue.

Another minister came and sat with me, and I have a lot to say about that in another post. Then the geneticist came and looked over Balthazar. He had wild mad scientist hair and and wore corduroys and sandals with socks. He said that based on his examination he could see nothing wrong, but he took a tissue sample to do a chromosomal analysis.

By then I was dressed. We had signed the papers giving the hospital permission to perform an autopsy. We had called the funeral home and arranged for him to be cremated. And so, fourteen hours after he was born, we had to leave him.

I knew it would be the hardest thing, and it was. I was worried that they might not treat him carefully or respectfully. I was afraid they might not put his clothes and blanket back on him after the autopsy. All of that, though, was out of my control. I tried not to look at the body bag that was waiting for after we left. But it was time to leave. Our short moment together was necessarily limited by the exigencies of biology. His body was breaking down and no amount of time in the hospital with him could change that.

Our living son hadn't seen us in 30 hours. So we did the only thing we could do, and went home to him.

Friday, July 27, 2012

Birth Story, Part 2

The blue-eyed nurse ran the Doppler over my belly. Nothing. She asked me how far along I was. "Thirty-seven weeks, five days," I answered. The longer she tried to find the heartbeat, the sicker I got. I knew already. I just couldn't believe what I knew. Someone went to get the ultrasound machine.

"Oh my God, I can't believe this," I said stupidly, the way that every person in shock has ever said it. "I should have come in yesterday," I said to my husband. For a second the nurse with the Doppler thought she had a heartbeat, and I started to cry in relief. But it was just my own heart.

I saw his empty chest on the ultrasound machine. "There's no heartbeat," I said.
"His hand is in front of his chest," someone said hopefully. But I'd had six ultrasounds.  I knew this baby. The last time I'd seen him, four days before, he'd been playing with his cord. His hand had never hung limply by his side like that.

My baby is dead," I said to the doctor. It was not a question.

"It looks like it," she said. She made eye contact with me, but she looked more worried than anything else. Was she afraid I would throw myself on the floor and start tearing at my hair and clothes? I don't know how other people react to this kind of news. I suspect that, like me, a lot of them just shut down. She told me they were going to bring in a special machine to check for a specific form of prenatal arrhythmia. We waited. They checked. It was not an arrhythmia.

"What's next?" I said. "Induction?" I wanted to do something, anything. Get me to the next room, the next place, the next step. Anywhere but in that room where I had found out that my son had died.

The doctor nodded. "But you can go home and come back, you can take some time, talk about things..." I shook my head. There was no way I was leaving that hospital, knowing what I knew.

Jonathan was crying, but I told him he had to call our friend Gwen and let her know so that she could pick up Jasper from school and take him to her house for the night. I don't know how he managed to make that call, but when he came back in the room we all trooped down the hall to a labor and delivery room. It was a little after noon.

After that it was almost like any other labor. Except that there was only one monitor, on me. A couple of Korean nurses came in and chatted with each other while they tried to extract a lot of blood out of the vein on the top of my forearm, for all the tests they were going to run in an effort to find out what happened. I said "Ow!" rather pointedly when they painfully poked and pushed on my forearm, but I didn't say "Fuck!" until another nurse came back and told me that the other nurses hadn't gotten enough blood and she would have to take more, from the inside vein of the other arm.

Mostly, though, it was extremely important to me that I be polite to everyone. I said thank you to everyone. I did not cry.

Jonathan called his father. "Zimbo's dead," he said. I called my brother. "I have some bad news," I said. I asked my brother to call my parents and tell them, and also let them know I'd call them the next day, after the labor was over. I just couldn't talk to them, knowing what I had to get through.

I got a dose of Misoprostl. We ordered dinner. I seem to remember that we ate it somehow. I have no idea how those hours passed, but six hours later I got another dose of Misoprostl that finally brought on the heavy contractions. In fact, they were the strongest I had ever had, stronger than I'd had with Jasper, who was also induced. The nurse shot me up with Fentanyl, and we tried to watch the 40 Year-Old Virgin, but I couldn't focus on it. I felt high as a kite, but the pain was just as strong. I asked for an epidural, which was done carefully in between contractions. When the doctor came to check me after the epidural was in place, I was 7 centimeters dilated.

I was shaking uncontrollably, so they piled blankets on me. We watched The Voice, which I had never seen. I had a conversation with the nurse about Christina Aguilera, how everyone picks on her for being fat but she's really not fat all.

When the nurse took my temperature, I had a fever. I'm going to die too, I thought to myself. I have a raging infection and it killed my baby and they won't be able to control it and it will kill me too. I didn't feel much about it one way or the other. But when she took a bunch of the blankets off of me my temperature went back down to normal.

Much sooner than I expected it was time to push. Now I was scared. Did I remember how to push? Would it go on for 2 hours and 40 minutes, as it had with Jasper? What would my dead baby look like? I was terrified to see him.

I don't know whether it was because it was my second baby, or because he was dead, but three pushes and he was out. It was just after 10 pm.

"He's perfect," the OB said. "Just perfect."

And then I did cry. For my husband this was the worst moment, worse even than finding out he was dead, hearing my cry of anguish. I cried from the effort, the exhaustion, the relief of being done with the work, and the grief of the absolute futility of it all.

Wednesday, July 25, 2012

Birth Story, Part 1

It's hard to know where to begin a birth story like this. You start to feel like everything that ever happened to you your entire life was meant to lead you to this moment. Everything feels important, and you go back and back, looking for the beginning. Was it my fortieth birthday, when I told my husband that he needed to decide whether we tried for another child, or he got a vasectomy and I got a cat? Was it six years ago on Friday, when my friend Tanja's son Lincoln was stillborn and I got my first glimpse of a kind of grief I never imagined would one day be mine as well? Or does it begin in my childhood? Was all of that sadness meant to prepare me for this?

It's going to take a long time to work all of that out. For now, I'll begin at my thirty-six week prenatal appointment, March 21, 2012, when my uterus measured small. My midwife recommended I make an appointment for an ultrasound, which the woman in the x-ray department scheduled for April 6. I was already due to be induced on April 9.

My mother worries a lot and it makes me crazy, especially when there's nothing anyone can do, but in this case I agreed with her that it made no sense to wait that long. Wasn't the whole point to see if there was a problem? So I called back and insisted they see me sooner. My new appointment was on March 28.

Everything appeared fine at the ultrasound: heartbeat fine, amniotic fluid fine. His weight was estimated at 6 pounds 3 ounces, which put him in the 43rd percentile for his gestational age. The technician remarked approvingly that he was really active.

You see why I am having trouble knowing where to start. Was this important, or incidental? In light of future events it looks ominous, but did it mean anything?

Because I was still worried after the ultrasound. Balthazar's brother Jasper was 8 pounds 15 ounces at birth. Six pounds sounded awfully small for a baby of mine, even at 36 weeks and 6 days. I called my brother the pediatric geneticist. "Is everything OK?" I asked him. "I don't know," he said dubiously. But there was no medical intervention indicated for a baby who was just under average size.

"Hang in there and grow," I whispered to him, pushing against my belly to feel him kick, which he had always obligingly done.

On Sunday, April 1 I took Jasper to a birthday party at a playspace. My worry, which had been at a low level ever since the ultrasound, became acute. Balthazar was not moving much. I spent the party pressing on my belly, poking and prodding, trying to get him to respond. I ate a piece of birthday cake with raspberry filling, which I didn't want, with little effect. I went home and called the labor and delivery nurse, who predictably told me to lie down and do a kick count. I counted 10 kicks in 40 minutes, which was within the guidelines, though less than usual. Also fainter. But I thought I was probably overreacting.

That was the last time I felt him move. 

Monday, April 2 was my 41st birthday. I went to prenatal yoga and told everyone that I was worried. The teacher reassured me that everything was fine, that babies move less when they move down into the birth canal as they prepare to be born. "I wish I had a Doppler at home so I could check on him," I said apologetically and everyone laughed.

I guess I still hate that teacher, which isn't fair, really. There was no way she could know, and I suspect by then it was already too late. I thought I could feel his bottom pressing toward the front of my belly, but I now realize that those were just Braxton Hicks contractions.

He didn't die on my birthday after all. Instead he died on April Fool's Day, which has its own cruel irony. You thought you were getting a baby? April Fools!

That day I took my husband to a mall to buy running shoes. I browsed Anthropologie and bought a cupcake. That night I ordered a pizza and Jasper and I watched Kentucky beat Kansas to win the NCAA men's basketball tournament. I can't believe what stupid, frivolous, pointless things I did that day, while my child floated lifeless inside of me. How I managed to push down my worry, ignore my anxiety.

On Tuesday, April 3 I took my son to school. I went to a coffee shop and finished a piece I was working on. I mailed it to the writer who was helping me with my memoir. Then I went home and called Kaiser labor and delivery again and asked to come in for a non-stress test.

I still thought I would be reassured. I thought I might feel a little silly when everything turned out to be fine. I thought, that, at most, if anything were wrong I might have a C-section. Maybe even an emergency C-section, but then everything would be OK.