“Look down,” my doctor demanded.
Groaning I forced my eyes open, drawing myself from a haze of pain in time to see a slippery bundle being lifted up over the sheet and laid on my breathless chest.
“Congratulations,” he said, “it’s a girl.”
Peeking out from under the blood stained flannel blanket was a smooth round cheek punctuated with a perfect dimple.
My husband and I were awestruck. We had come into the hospital as a family of two and now in our arms was another person and we had made her. She breathed a little sigh and went about nursing as if it was something we had both done a dozen times before.
As we sat staring the anxious voice of a nurse rose over the murmurs of the delivery room,
“Did you show her doctor?”
“Not yet,” he said, holding up for me to see a scrawny strand of umbilical cord that a few minutes ago my husband had cut with a quivering hand.
“It’s a true knot,” he said.
My doctor was also my Program Director, I was in my second year of a Family Medicine Residency. Often times an umbilical cord can have an irregular shape making it appear knotted or twisted. The term “true knot” then is used to clarify that it is actually a knot, at some point in the pregnancy the baby looped itself around through its own cord. A True Knot is relatively rare and in a thick cord can be fairly benign. But in a thin cord like mine there is a real risk that a movement of the baby during pregnancy or more likely during the strain of delivery the knot can tighten cutting off the baby’s blood supply resulting in immediate death.
. . .
My pregnancy came after 3 years of trying. Most thought we were wise to delay reproducing until the end of my medical training, but this didn’t matter to me a bit. I had always wanted a family more than I had wanted a career. I only went to medical school after putting off what I can best describe as a calling for 8 years. I couldn’t shake the feeling that I ought to go to medical school and at the time I was both unattached and jobless. Medical school felt more like a last resort than a destination to me.
By the time my daughter was conceived I had spent a small fortune on negative pregnancy tests and was so discouraged that I waited a full month before confirming even to myself that I was indeed pregnant. Even with the confirmation of those double lines followed by an ultrasound I was hesitant. I was half way through my pregnancy before I announced it even to my close friends.
But overall pregnancy was easy for me. That is, it didn’t make anything harder. Life wasn’t exactly painless as I made my way through my second year of residency. Late nights, early mornings, hospital food and strained conversations at home thanks to chronic stress and fatigue were the norm. But with the exception of a few extra naps in the call room after morning rounds pregnancy didn’t affect me much, I slept well when I could and ate better.
I was so busy that it rarely dawned on me how very little movement I felt from my baby. Occasionally I would notice what I later realized to be hick-ups, otherwise she was motionless. My patients (I was taking care of pregnant women at that time too) would complain of kicks and pokes and beg me for sleeping pills and pain pills while I would go hours and barely feel a gentle nudge from inside.
All parents worry about their children but I think the weight of anxiety is even heavier on those who work in medicine. At this point in my training I had spent many nights attending the labors of women who knew they would never hear the beautiful cry of their child and I had stood beside them afterward trying to keep the tiny limp bodies swaddled as their mothers wept. So when I did have time to stop and think about my pregnancy I felt mostly anxious. The fact that she seemed to be growing reasonably well didn’t do much to reassure me. I coped by trying to detach. I avoided imagining what my baby would be like and as much as I could barred myself from the engrossing joy of hopeful anticipation. I tried to take it one day at a time and put off any baby preparations as long as possible.
Still my pregnancy passed uneventfully. The day of her birth (one day before her due date) I woke up even before my 4 A.M. alarm with the first notable moment of discomfort. Making rounds that morning my co-workers found me swaying and deep breathing through contractions in the hallway before entering patient’s rooms to see how their night had gone.
My contractions remained irregular as we finished our morning work. I was still on call and was hopeful that I could finish out this weekend before giving birth so as not to require my co-workers to cover for me (my program was incredibly generous with pregnancies among residents though it didn’t mean there wasn’t an added strain on everyone when a new baby arrived). I went home and updated my husband but didn’t expect much. I had patients who complained of contractions for weeks before their delivery and this was the first day that I felt anything at all. We decided to go to the nearby park for a walk as we often did and see if this had any affect, either calming or stimulating on my body. As we made our first quarter mile loop I began to feel a strange sensation. For the first time it felt like something was alive inside of me. Our baby began moving, twisting, turning, kicking. I felt jabs and jumps, this I could see would keep a person up at night.
“She is finally moving,” I said marveling.
The change alarmed my husband and he decided we should go to the hospital to have her monitored.
With Fetal Monitor in place we confirmed that she was doing fine and that I was indeed in labor. With this reassurance I decided to call in my back up, hand off my on-call pager and go home.
It was getting close to dinner by this time and we tossed around the idea of going by our church which was hosting a pot luck when my labor began to change. Within a few minutes my contractions intensified and I found myself face down on the guest-bed groaning, all deep breathing and relaxation techniques vanished from my head. I was terrified and insisted that my husband stay at my side. At the same time I demanded that he re-heat the microwavable heating pad and replace it on my back with each contraction. That was the start of an exhausting evening for both of us and his presence and that heating pad were my greatest comforts.
My husband had strict instructions from me to avoid the hospital until absolutely necessary. I had attended enough labors to know that I didn’t want any extra intervention and in my experience the longer one is in the hospital the more necessary interventions were likely to become. He had faithfully read, The Birth Partner and was ready for the task at hand. A friend brought lasagna from the pot luck which my husband managed to eat while I sipped on ginger-ale. We proceeded like this for hours, me groaning on the bed and him running back and forth to the microwave.
I had tucked away a few pair of sterile gloves and was able to check my own dilation. My husband texted my self-evaluations along with his tracking of my contractions to our doctor who continued to reassure us. I felt my baby’s soft hick-ups from time to time and so labor went on.
Around eight or nine P.M things, once again, began to accelerate and the pain became unbearable. I was ready to burn every natural childbirth book I had ever read. I told my husband I had changed my mind about natural birth and wanted him to take me to the hospital immediately (previously I had told him that this would happen so he had mentally prepared for it, God bless him). He continued timing me and instead of declining my requests, he stalled. He fed the dogs and packed our bags in between attending me during contractions putting off the hospital until he knew we were close to delivery. Meanwhile I made my way to the front door, laid down on the floor, groaning in pain and in hysterics told him that we absolutely must get in the car.
The five minute drive was an eternity and if memory serves me I laid down again in the parking lot writhing with discomfort before I made my way inside.
Entering the Labor and Delivery Ward I pointed to the first nurse I saw and told her to get me my epidural (I had just been working there earlier that day so giving orders to the nurses was nothing new). Prior to this moment I had been worried about the awkwardness of giving birth surrounded by my co-works, many of whom I supervised. As it turns out misery breaks down many barriers and I quickly stripped down naked, put on the wretched hospital gown and climbed onto the bed.
My doctor arrived neatly dressed and with a confident smile put my husband at ease. My doctor assured me that I could in fact make it through this ordeal unmedicated and that I had no other choice, it was too late for intervention.
I have few memories of what conspired in the following hour of my life. I distinctly remember praying out loud, The Jesus Prayer,
“Lord, Jesus Christ, son of God, have mercy on me a sinner.”
They told me later that during alternating contractions I was cursing like a sailor, saying words they rarely heard and never expected to come from my mouth (I have many vices but cursing isn’t typically one of them) apparently agony that is severing your body like a knife can bring out the unexpected and I’ve always been grateful that I don’t have now and never did have any memory of this part.
After an hour it was time to push. My doctor let me, sit up and deliver in a squat. I couldn’t even say that I felt contractions. I only had the distinct sensation that my body was being torn in half from the inside out. All preconceived ideas of dutifully breathing Lamaze style through this while my husband wiped my brow with a cool rag had long ago disintegrated. Instead I pulled my husband’s beard and screamed.
At one point I remember coming out of my daze of pain long enough to hear the heart rate decelerate (meaning the baby’s heart rate slowed significantly during a a contraction which you can hear on the monitor).
“That’s a decel,” I cried.
The nurse turned down the volume and told me to keep pushing.
Push and grunt, kick and scream I did. And without much intentional effort on my part my child was born a few minutes after midnight.
After years of trying it always felt a little selfish for me to be particular about the baby’s sex. I had suspected I would have a boy and knew I would be delighted whatever it was. But an extra jolt of joy shot through me when the doctor announced that I had given birth to a girl. A daughter all my own and perfect.
. . .
I held my tiny bundle and stared at the knot dangling in the air. It had been there all along threatening but not harming. We had made it. Nine months of no movement and anxiety had still produced a perfectly formed little girl.
I knew then that I would do anything to protect my daughter. I would gladly give my life to keep her safe. But the vision of that knot stands between her and I. Try as I might most of life is out of my hands. And it isn’t just her life. All of us live like this, never knowing how close we come to an unseen disaster. There is no such thing as safety. One day the knot will cinch.
And so on that day, her birth day, as my grip on her little body tightened, I began to let go and realize that the only life I could give her was one of surrender, one of death and one of resurrection. In the months that followed I was jealous for her. Work consumed me and I despised my time away. Still when I was quiet long enough I remembered, she was not my own, she was God’s gift to the world and she belonged to Him and to it.
Today is Mother’s Day. It has been 5 years of joy with my little girl and five years of hoping for a second child without another pregnancy. We celebrate our mothers and our children but grieve those that have passed, those that were never born and those that are estranged from us. Motherhood demands that we release our exceptions of ourselves, of our abilities, of our ambitions and our dreams of what we thought life was supposed to look like and be born again into the reality of life in its hope and sorrow and in this we can live without fear even as we dangle at the end of knotted cords.