Birth

Bonnie

The doctor pulled out her tape measure and serious expression, but surely couldn't expect me to find them alarming anymore.  In much the same way that other women come to hate the smell of tea, or the sight of their partner, my pregnancy had brought a vicious loathing of measuring tapes.

            At twenty-eight weeks, I'd gained about five pounds.  I couldn't even claim self-denial as the reason.  Since the moment of conception, I had given in to every sugary feast the little girl inside me demanded: dolly mixture, candy shrimps, sweet cigarettes . . . My partner despaired and brought me oranges.  But pregnancy was my place of accidental rebellion.  I went to Waitrose for salmon and green vegetables, and stopped on the way home for a Big Mac and fries.  In those first twelve weeks, when what I ate was crucial to my child's brain, nervous system and . . . well, everything, I could stomach only crap.

            My Dail Mail-loving grandmother rang me at ten weeks with the news: What happens in the womb dictates how well a child does at school.  So there it was.  Failure.  Already.  Probably just as well – a university education these days is about the same price as a continent, and we didn't even own a house yet.  But still, the Mail's allegations of a candy shrimp effect haunted me.  I played plenty of Mozart in the weeks that followed. 

            But time wore on, the sickness passed, I managed to spend the first two weeks of August walking Coast-toCoast across England, and brown rice and pasta found their way back into my life.  In October, we had a scan.  Casually, they mentioned a low-lying placenta.  Then they mentioned a girl.  A girl!  Huckleberry became Hucklebetty.  Tentatively, I bought her some clothes and arranged her a husband.

            And then the third trimester was upon us.  There was a suddeness to this.  Without warning, despite the minimal weight gain and the barely-visible bump, I could no longer bend over to put my shoes on.  I was shocked to find I could hardly walk for ten minutes when just a few months ago I'd gone 192 miles, and then the baby's feet lodged themselves beneath my ribs, meaning that I spent most of my time lying flat on my back with my arms above my head, telling myself it would all be worth it in the end.

            And this, right when my body was failing under the weight of its baby, was when the midwife began to arm herself with the tape measure.  At every appointment from then on, she would apply it to my bump, frown and say, 'You're measuring [insert any number between four and eleven] weeks smaller than your dates.'  And off I would go for a scan, and another scan, and another scan, until I began to feel we were invading the baby's privacy.  Everything about her was displayed on screen - heart, brain, liver, spine -  raw, vital organs that were meant to be wrapped in skin, unseen.  And then the sonographer would shatter the energy I'd put into nights of worry and say,  'I have no concerns at all about this baby.  Is there anything you'd like to ask?' 

            Yes. 

            'Is she ginger?'

            She laughed a dainty, stern kind of laugh that immediately left me chastised by the entire NHS.  I shouldn't be so flippant in the face of my baby's health.  Two-weekly scanning was serious.  But I knew by now that the baby was fine, and I was getting quietly resentful of these constant, unnecessary dramas.  My baby was there inside me, active as oceans.  And every week, in feisty foetal defiance of the measuring tapes, her movements grew larger and stronger.  I was shutting down now.  I was refusing to be concerned.   

            And yet here I was again, a day after the last scan, facing yet another medical professional and a tape measure.  As baby-monitoring went, it was a pathetic and archaic piece of equipment, like a leftover from days when women carried sewing baskets and no doubt measured their bumps to relieve the tedium of darning stockings.

            'You're showing twenty-nine weeks' growth instead of thirty-seven.'

            'I know.'

            'But I'm not worried.  You're smaller than average, so it's likely you'll have a baby who is smaller than average, too.'

            Shock.  A new simplicity.  It took me aback.

            She continued, 'But your most recent scan shows you still have a low-lying placenta.  It finishes just two centimetres from the cervix.'  The serious expression grew a shade more serious and she looked me straight in the eyes. 'This means you will have to deliver your baby by caesarean section.'

            Oh, hallelujah.  Oh, thank you, God.

            Frankly, I had never, ever wanted to deliver a baby by any other means.  The condition – fear of childbirth - is called Tocophobia, and generally not taken seriously (women have, after all, been doing this for thousands of years – ok, some used to die, but these days most survive to tell tales of agony, forceps, tearing, stitches, a worn-out pelvic floor and a lifetime of incontinence).  It's the result of many factors, ranging from too much Casualty back when social angst forced a teenager on the sofa every Saturday night, to a more serious fear of violation and also, probably, of death.

            The doctor, now thinking she was breaking the devastating news of how I was about to be denied my lifetime's desire to push a giant human head through my fanny, had obviously not read my notes.  Somewhere towards the front was the correspondence I'd had with the consultant obstetrician two years previously, where she and I and a counsellor had decided together that the best – in fact, the only – possible way for me to have the baby I was too afraid to even conceive was by granting me an elective caesarean.

            It was a fact I mostly kept to myself, from fear of the NCT.  But now here I was, being handed an excuse, a reason for opting out of natural birth and escaping judgement from even the most pro-vagina-busting of birth fanatics.

            The doctor carried on talking.  'Low-lying placenta is a life-threatening condition.  You are at high risk of haemorrhage and need to be admitted to hospital before the birth of your baby.  If your placenta ruptures, you could lose all your blood in ten minutes, so we need to keep you near theatre and make sure we've cross-matched enough donor blood.'

            I laughed at this.  The doctor nodded sympathetically.  Obviously, I was hysterical, a little in denial, a little in shock.  I shrugged.  My blood group was an uncommon one.  There was no way they'd save me. 

            I could have got anxious, except that I didn't believe it.  Any of it.

            The doctor left the room to speak to the consultant.  I sat and waited, ten minutes from death.  There was something quite giddily bleak and Victorian about it. 

            She came back.  'The consultant says everything's fine.  You can go home.  We'll see you in two weeks for the birth of your baby.  Make sure you don't have sex in the meantime.'

            So I went home, stopping on the way to buy an industrial-sized pack of maternity pads from Mothercare.  It seemed like the only thing to do, as I am a believer in preparation for major dramatic events, and my partner would never deal with the demands of mopping up eight pints of blood.  He can barely assemble a chest of drawers without vast unnecessary mess and a need for anger management training. 

            Placenta Previa.  It came with a list of instructions, the most important being not to go into labour.  My caesarean section was booked for Friday, 19^th February, and all I could do was wait for the date to roll around, and take an optimistic view.

           

As ever, Valentine's Day went unmarked in our house, but Pancake Day was another matter altogether. 

That night, I ate:

2 pancakes with lemon juice and sugar

1 pancake with pineapple  

1 pancake with lemon juice, sugar, pineapple and maple syrup

            Afterwards, I couldn't move much.  I read a chapter of a novel.  I wrote a Facebook status update:  'When pancakes are competing with a full-term baby for space inside you, you know you've eaten too many.'     

            I went to bed, full of pancake remorse.  My partner fell asleep in minutes.  I lay there for a while, then got up.  Oh.  Water everywhere. 

            A hand on my belly, and the baby was even closer, just there beneath my skin.  From the bathroom, I called my partner.  'We need to go to hospital.  My waters have broken,' I said, and sounded calm.

            'Ok,' he called back.  Then he appeared naked on the landing.  'What do we do?'

            'We go to hospital,' I told him.  I shook a lot as I spoke.  I was hours away from major surgery.  I'd planned the next two days to prepare myself for it and now, the days were gone.  I thought about labour, and continued to shake.  I rang my mum, who was asleep.  'Don't worry' she said groggily. 

            It was 12.30 by the time we left, and from the car I sent text messages: to the friend who was meant to be coming for lunch tomorrow; to the other friend who worked in a pub and might still be up; to my step-mother.  Courage, said the friend who was meant to be coming to lunch.  Having delivered a premature, 1lb 8oz baby ten months ago, she knew what she was talking about.  The others all stayed silent.

            When we got there, the hospital's maternity unit was in full swing.  They took us to a room in the delivery suite, and I thought what a nice touch that was – to call it a suite, as though they wanted me to think I was in a hotel, rather than a human abbatoir.  In the rooms all around us were women in various stages of labour – some were lowing, others wailing.  Some noises were indescribable, and not human at all.  I opened the door to head for the bathroom and immediately shut it again as I caught glimpse of a poor, wretched woman being walked round the corridors, a midwife on each arm, sweat bouncing off her face like hailstones.

            The Delivery Suite certainly won the prize for being the worst place I'd ever spent a night – it even eclipsed the Sinai desert, back when I was 21 and convinced I'd been led there by a Bedouin tribe for no other reason than to feed me poisoned kebabs and steal my spleen.  At least then I was seeing things through a haze of drug abuse. 

            'Thank God I don't have to do this,' I said to my partner.

            He agreed.  Thank God.  But then there was football on the telly, and his experience of the Delivery Suite became quite different to mine.

            A doctor came and put a canulla in my hand, so I was ready for the caesarean whenever they decided to do it.  Then a midwife  came in and  wired me up to a machine that monitored the baby's heartbeat and my contractions (excuse me, but I was never, ever meant to have these – not even for a minute, not even one).  'I've spoken to the registrar on duty.  Because of your low placenta, he doesn't want to do the caesarean until daylight hours.  It won't be for some time yet.'

            I checked the time.  1.30am.  Oh, God.  'Why?' I asked, and caught the pathetic note of desperation in my voice.

            'Because of the risk of heavy bleeding.  We need a full team of staff on to deal with a dangerous procedure.  Now, you're unlikely to have strong contractions between now and then, but let me know if the pain gets severe.'

            She left the room.  I turned to my partner.  'When does it get light?'

            'About eight.'

            Jesus.

           

The pain kicked in around 3.15  I walked.  I breathed.  I did not moan.  I walked.

            It was ok.  It was fine.  I walked.  I breathed.

            3.45.  I returned to the room.  I hadn't prepared for this.  I'd paid a small fortune for a hypnotherapist to deliver messages to my subconscious about the jubilant beauty of being butchered by a surgeon's knife, but I'd done nothing at all to deal with natural labour, except arrange a way out of it. 'It's getting quite bad,' I said stoically.

            'Maybe you should tell the midwife.'

            'No.  I think it's ok.'  I decided to time the frequency of the contractions.  One . . . 4.00 . . .

Two . . . 4.02.  'Actually, maybe I will tell her.'

            I found her sitting behind the desk at reception, humming cheerily to a song on the early-morning radio.  This was mildly annoying – that someone could sing while I was in pain.  Ok, not bad pain, but pain nonetheless, and a pain I hadn't signed up to.

            'This is hurting,' I told her.

            She barely looked up.  'I cannae examine you.  You've got placenta previa.  It could cause a haemorrhage.'

            'When can I have the caesarean?'

            'It won't be til at least 9.30.  I suggest you go back to your room.'

            'Can I have some water?'

            'No.  You cannae have anything before an operation.'

            'Nothing?'

            'Nu-uh.' 

            I went back to my room.  My partner opened his eyes.  I had a few contractions.  I went walking again.

            The midwife was getting tetchy.  I had interrupted her tea and toast with my breathing.  Goddamn you, woman.  I need water.

            'You cannae have water.'

            'But when I came for my caesarean preparation class, they said we could have water.'

            She shook her head.  'I'm sorry.  They gave you the wrong information.'

            'Can I just swish some round my mouth and spit it out?' 

            'No.  You cannae.  Go back to your room and I'll get the obstetrician to examine you.'

            Back I went again.  I was supposed to lie on the bed, but I'd developed a compulsive need to walk.  I paced the floor.  'There's not enough space in this bloody room.'

            My boyfriend smiled sympathetically.  He was lost.

            4.30.  The midwife returned.  'The obstetrician's on his way.'

            'Will he give me water?'

            'No.'

            She left again.

            'She's a bitch,' I said as she shut the door.  I expect she heard me.

            My boyfriend – who I admit is much, much nicer than me, but in my defence, was not in labour and being denied water at the time - looked genuinely confused.  'Why?' 

            I might have lost my temper, but the obstetrician came in with the midwife.  He was smiling, waving white gloves.  'Hello, Sarah.  I'm just going to see how far you are from going into labour, then we'll make a decision about when to do the operation.'

            I stared at them both.  'So is this not labour?  Is this just the beginning?  Because this is the pits.'

            The midwife nodded.  'Just the beginning, sweetheart.'  She might as well have added, 'You fucking posh wimp.'

            The obstetrician got to work.  I made a fuss.  He was, I felt sure, taking an unnecessarily long time over it.

            He stopped, looked at me, and said, 'You have a choice.  We can set up the caesarean section now.  It will take forty minutes to prepare the theatre, but we can give you something to stop  the pain.  But you need to know that the baby's head is clear of the placenta and you are eight centimetres dilated.  You can  have your baby naturally if you wish.'

            I looked ahead of me at natural birth – the pushing, the forceps, the head – the head! - the cord that always got wound their necks, the denial of oxygen to the brain and inevitable cerebral palsy, the tearing, the stitches, the shock.  'I want a caesarean,' I said.

            It was not the answer they were looking for.  But when presenting a woman who is eight centimetres dilated with a major decision, there is always a risk that she'll make the wrong one.  They went off to find the anaesthetist.

            I had another contraction, during which I flung my arms and legs wide across the bed, with some frenzied notion that the opening up of my body would be easier if I spread out and gave it space.  (Oh, God.  The pancakes.)  My partner took it as evidence of torture and stood back, helpless and guilty.

            The midwife and obstetrician returned with the anaesthetist.  Clearly, it had become the anaesthetist's job to talk me into Doing it Naturally.  'I can stop your pain in five minutes,' she promised.  'If you have a caesarean, it will take forty-five minutes.  Your baby is small.  Pushing won't be hard.  She'll be here in two hours.'

            Here we were again.  Not a tape measure in sight, and yet still all this talk of a small baby.  'How small?' I asked.  'Too small?'

            There were some words of reassurance, some more promises of drugs and an easy delivery.  In between the talk, I went on contracting.  'I can't make a fucking decision like this.'

            'By now, you will be nine centimetres dilated,' the anaesthetist said.  'There really is no point in having major surgery.'

            And so there I was, agreeing to natural birth, tricked by my own baby.

            Action!  Midwives appeared.  Someone offered me a wheelchair.  I laughed, 'I'm not a cripple.  I can walk.'  They looked a little doubtful, and held on to me during the short trip to the delivery room.  'This was a great decision,' one of them enthused.  'Really great.  You'll be able to drive, you can look after your baby.  It's the best thing.'

            I nodded.  

            They helped me on to the bed.  'Is there anything you want?'

            'Water.  I just want water and an epidural.'

            An entire jug of water appeared.  My partner poured me a glass and tried to administer it to my lips as though I were a frail old woman.  I grabbed it from him and downed it in seconds.  'More,' I gasped. 

            They wired me up to a drip.

            The anaesthetist set up the epidural – a low dose, she explained, just to take the edge off the pain, but I would need to feel everything in order to push the baby out.           

            'How long will it take to work?'

            'Ten minutes.'

            'I haven't got ten minutes.'

            Someone I hadn't met came into the room wanting keys to the cleaning cupboard.  I nearly lost it.  Tactfully, they ushered her away.  The epidural was administered.  The anaesthetist left.

            'Where's the anaesthetic lady?' I asked when the pain had worn off.

            'She's gone.'

            'I'm sorry I swore before.  You really haven't been seeing me at my best.'

            They checked one of however many monitors I was attached to.  I was fully dilated, but they wanted to wait an hour for the baby's head to descend before the proper drama could start.  My partner rang  my mum to tell her what was going on.  She was in the shower, so he spoke to my step-dad instead, who didn't ask enough questions, so my mum rang back.  We had a five-minute conversation while the baby's head – or was it just a giant shit? - started to come down.

            Afterwards, I lay there drinking water, feeling no pain and a lot of pressure in my pelvis.  But despite this lack of pain, I still, to my surprise, began to go slightly mental.  People were talking all around me - two midwives and one paramedic, who'd come for the experience of observing a birth.  My partner was somewhere, but I wasn't sure where.  He was probably hiding behind the drip.

            What I wanted to do was tell them all to go away – to go away and leave me to get on with this by myself.  I said, 'This baby's head has descended.  I'm ready.'

            Action again.  There was some suspense while we waited for a contraction, and then there I was, doing what I'd vowed I'd never do: lying on a hospital bed, my legs in stirrups ('because your pelvis is so small – we need to open it'), while my own personal squad cheered me on.  'Come on!  You can do it!  Push!'

            I pushed.  There was no way I could do this.  I didn't have what it took – whatever that was – to push a baby out of me.  I decided I just had to lie back, do what they told me, and see what happened.  What I was expecting, by this stage, was not a baby, but a shit the size of a horse.

            The drip dripped fluid into my veins, the catheter dripped it out again, and my squad went on cheering.  They told me I was doing brilliantly, but I wouldn't believe them – they were just words they said to everyone, to keep them going, to keep them all from sitting back and saying, 'I'm too knackered for this.'         

            There were more contractions, more pushes, and some bother with the baby's heartbeat.  The midwives were keeping cool about it, but the earnest paramedic kept asking questions.  'Why is the baby's heartbeat slowing like that?'  'What does it mean?'  'Is the baby in danger?'

            The midwife said, 'The baby is a little tired, and this monitor isn't doing a good job of picking up the heartbeat.  Sarah, can I have your consent to attach a monitor to the baby's head?'

            'Yes.'

            The monitor was attached.  The heartbeat was back.  We went on.  I caught sight of my partner out of the corner of my eye and apologised for not talking to him.  He said it was ok.  I made some more inhuman noises.  'Sorry about all this,' I said again to the midwives.  'I don't usually sound like that.  But this really does feel like the very worst case of constipation anyone has ever had.  Am I getting anywhere?'

            'You're doing brilliantly.'

            Someone asked me if I consented to something else, and something else.  I had no idea what they were talking about.

             'I consent to everything,' I told them.

            The midwife and the paramedic went on talking about the heartbeat.  The other midwife kept cheering.  I pushed.  'Come on, Sarah!  You're nearly there.  You're nearly there.'

            I didn't believe them.  Then suddenly my partner appeared amidst the throng of heads between my legs.  'You are.  You're nearly there,' he said, and so it became true.  I was nearly there.

            'We need to get the resusitation table ready,' someone said.  Then she said, in soothing tones, 'Sarah, your baby is getting tired, just like you are.  We need to get her out, so with the next contraction, I'm going to make a little cut . . . Do I have your consent to this?'

            I saw the scissors.  I said yes.  She administered a local anaesthetic.  The contraction came, the scissors got to work, I pushed, and a baby fell out of me.

            It was over.  I looked up.  My partner was crying.  He cut the cord.  He went on crying.  I handed him the corner of my sheet.  A voice said, 'Look how quickly she pinked up.'  They took the resusitation table away.  There was no need for it.

            'Do you want her skin-to-skin?' the midwife asked.

            'Yes,' I said, and a baby appeared on my stomach.  My partner couldn't talk, but he did laugh.  I couldn't see the baby's face, and there was no way of adjusting her, because my legs were still in stirrups and I had a drip in my arm.  I studied her feet.  They were long and thin.  'She has piano playing toes,' I said.

            The midwife who'd done the episiotomy said, 'I'm sorry about that ending.  All we have to go on is what the machine is telling us, and it's not always reliable.'

            'That's ok.' 

            Someone came to stitch me up.  The earnest paramedic watched and was given a lesson: Degrees of Tearing in Labour.  The woman with the needle and thread talked about everything in detail, from first degree tears (skin only) to fourth (skin and muscle all the way to the rectum, requiring reparative surgery in theatre).

            'And what sort of tear is this?' the earnest paramedic asked.

            I said, 'Do we have to talk about this?'

            They stopped talking about it.  The earnest paramedic then said, 'You're doing an excellent job.'

            The woman with the needle and thread spoke with great pride, 'I've been doing this for thirty-five years.'

            Thirty-five years of stitching up fannies. And I thought I'd had some bad jobs.

            They weighed the baby.  6lbs 1oz.  'Is that big enough?' I asked.

            'It's perfect.'

            I waited for the ecstasy, the near-insane high that I'd been told comes in the delivery room and then never wears off.  It didn't come.  What came instead, and settled, was utter, deep-soul calm because my baby was beautiful and healthy and here. 

            'What are you like?' I wondered.  Almost immediately, people had started imposing a personality on her.  The shock of her arrival made her feisty, in charge.  The lack of crying made her contented and laid-back.  The drama at the breast – that vigorous, frenzied, wild-eyed sucking from which she gained over a pound in two weeks – made her slightly bonkers.  She was all of these things, and she was none of these things.  She is Bonnie.  A clean slate, entirely herself.