Saturday, April 9

Her heart, My love

10 days old, before the appointment
When Madison West was 10 days old, during a routine pediatric appointment, she was diagnosed with a heart murmur.  I was shocked, confused, and very very worried.  This original pediatrician, whom we never visited again, shuffled us out of the room, talking about cardiologists, a profession that sounded horrible to me at that moment, telling us to "keep an eye on her breathing and color," and assuring us it would all be fine while providing us no real information at all.  This was a Tuesday.

After spending most of 40 weeks maintaining a low level, generalized worry about "the baby," I had enjoyed an amazing, blissed-out, 10 days of pure joyfulness.  What followed this diagnosis was a devastating 3 days of panic and sorrow.  During this time, my friend Stephanie came to visit with her new baby and I lost it into an hour of tears.  On Wednesday evening, we were doing as told, monitoring the baby's breathing and color, which landed us at the Children's Hospital Urgent Care Clinic because we didn't know what a baby was supposed to look like and all newborns breathe weirdly!  It was there at 11 days old we subjected her to an x-ray at midnight.

On Thursday we had our first appointment with the cardiologist, and Madison underwent an echocardiogram, an EKG, a blood oxygenation test, and a blood pressure measurement.  I was especially sad seeing our little baby hooked up to all the wires of the EKG machine.  I remember half wanting to take a picture, but also knowing I would never want to see that again, so I didn't.  Dr. Weldin, a heart specialist who is about our age and with children of his own, spent HOURS with us that day, carefully explaining the heart, the ventricles, the atria, the valves, drawing us pictures, and showing us a three-dimensional heart display.
One of Dr. Weldin's drawings
Madison was diagnosed with a Ventricular Septal Defect or VSD.  This is a hole between the left and right ventricles allowing blood that has already been oxygenated by the lungs and is supposed to be sent back out into the body to instead re-circulate back into the lungs.  It can lead to fluid in the lungs, enlarged chambers in the heart, and can exhaust the baby so much that she can't grow.  If this happens, the hole must be surgically closed.  Dr. Weldin told us to come back in one week.  He also recommended us a new pediatrician.

On Friday, we visited Dr. Jackson, who turned out to be a magical pediatrician.  (He is actually the Virginia Mason poster boy, visible in the big banner here.)  He assured us he had many patients with VSDs, knew what to look for in these early months of growth especially, and would take the time to answer our questions.  He told us Madison looked great for now.  As we walked around outside after this appointment, I relaxed for the first time in 72 hours.  I took a full breath and felt we were on a better path.

We saw Dr. Weldin weekly for 3 weeks and during this time I hit the books.  Never previously interested in medicine, I found myself pouring over technical articles like this one.  I now know more about the biology of the human heart than I ever wanted to know!  I discovered a VSD is more likely to close on its own when it is small and down low in the muscular section.  Madison's was moderate in size and up high, in the peri-membraneous region.  Dr. Weldin said we had to wait and see if it would behave more like a small VSD or like a large VSD as to how likely surgery would be versus spontaneous closure.

It may not surprise many of you, but Karl and I are different.  We both crave information, data, explanations, and understanding.  But where he won't worry until he's told it's time to worry, I will worry nonstop until the risk has passed.  (Which is a good way to set yourself up for a lifetime of worry, because life is full of risks.)  What this meant for us is that Karl wouldn't worry about surgery until we were told she needed it, while I had to get comfortable with a possible surgery, and fast.

The surgery is tough, for those of us who can't imagine people actually do this kind of thing.  For a cardiac pediatric surgeon, however, it is quite routine.  It involves cutting the chest open, employing a heart-lung machine to keep the blood flowing through the body, and stitching a few tiny tiny stitches into a tiny tiny baby heart before putting her all back together again.  Humpty dumpty came to mind; it sounded insane to me.  But, I continued my research.  This kind of surgery is done on 20,000 infants annually in the U.S., with 250 done yearly at our Seattle Children's Hospital.  One for every day of the workweek!  It truly is a low risk, routine surgery for the people who do it, and provides excellent outcomes.  I got to where I could trust, for these surgeons, it was doable, if not altogether easy, and I began to accept either possibility: surgery or spontaneous closure.

It was hard to tell anyone though.  I didn't tell my mother directly, but had a friend do it.  I couldn't bear to hear Karl's parents' response either.  The first few friends I told reacted with shock and fear and that worst of reactions: pity.  Or at least that's what compassion can feel like in this society.

I have spent some time, in the intervening months, dwelling on the need for perfection in our culture, the expectation that anything less is sorrow-causing.  And I was trapped by this.  I couldn't tell people widely.  I couldn't hear their responses, "Oh, I'm so sorry."  NO!  I didn't want to be in the position of having to reassure people she would be fine, that she was already fine.  I was having a hard enough time convincing myself!  And so many of you, my wonderful friends, are hearing about all of this for the first time this week.

Our visits to Dr. Weldin continued to spread out because Madison was growing and thriving, such that immediate surgery was not needed.  We had the luxury of being able to wait and see if the hole could close on its own.  At 4 months we repeated the echo, and the hole was significantly smaller than it had been, and Dr. Weldin didn't need to see us again until she was a year old.  Many of you have asked me why we went on our Great Russia Adventure and this is one important reason - because the doctor told us we could.  And I am not one to wait on living life.

I had at least two crucial conversations during all this.  In the first, my good friend Richelle very matter-of-factly, but with a kind of compassion that felt good, concluded: "well it sounds serious, but fixable."  This was just what I needed at that moment, not to be dismissed, but not to fall into a deep fear-fest either.  In the second, my fear-fest revealed itself completely as I told my friend Jen after the 4 month echo, "Madison will live to Christmas."  And her shocked response, "Oh my gosh Abigail, I didn't know you thought this way!"  Yes, I have been known to be more than a little worst-case-scenario in my thoughts and attitudes.

Thus was I presented with the opportunity to work.  I didn't want to miss her newbornhood by being sad and afraid.  I wanted to be joyful and at peace.  For her, for me, and for Karl.  So I practiced it.  The waiting was hard.  My cousin has a baby with something similar that did need surgery when he was 8 weeks old.  And 2 weeks later he was pronounced fully cured.  I felt a little envious at the early conclusion they were given so much so that I frequently had to remind myself: avoiding surgery was the goal, and being able to wait was a gift.

Now, we have just had her one year echo and the hole is so tiny it is as good as closed.  VSDs are measured, not by an image of the hole because they can't do this, but by the amount and velocity of blood passing through it.  Madison's hole is so tiny now they can't even measure the blood passing through it.  The murmur is gone.  She can do anything she wants, including row on an Olympic team (but don't tell her I said that, expectations are dreadful things).  I only want her to be free and able to pursue anything she wants.  The tiny amount of blood passing the wrong way out of the ventricle won't slow down the efficiency or strength of her heart, not one bit.  If she wants to be a fighter pilot or an astronaut, it will need to be all the way closed and she can do this too.  (Though most of us are probably disqualified from these two particular professions for a whole host of reasons anyways!)
Fighter pilot in training
I no longer dread the word "cardiologist," and, in fact, cannot say enough wonderful things about Dr. Weldin in particular and this profession in general.  They treat and save babies, and help parents through difficult, worrisome times with information and kindness.

And as Karl aptly put it as we were walking to the car, "now we can worry about everything else parents worry about!"  Not me, I'm back to my blissed out mommy love.  I'll worry when they tell me it's time to worry, that's my goal anyway!
Madison West, conquering Kite Hill

Tuesday, June 2

115 hours: Bringing Madison West into the world

We had a plan.  And it was a good plan.  But babies, and bodies, and hospitals, and anesthesiologists have a way of messing with even the most well-thought-out and adaptable of plans.  No I wasn't in labor for 115 hours.  But when we emerged from the hospital, days after we had entered, it felt like we'd been in a cave-like vortex of nurses, midwives, doctors, the screams of other laboring soon-to-be-parents, and it was as if the hospital itself re-birthed us into the middle of a gorgeous spring day, and it was such a surprise that the world had continued to spin while we undertook the immense task of Getting The Baby Out.

I'm a very healthy person.  Always have been.  But during pregnancy I developed a condition called thrombocytopenia, aka: low platelets.  Really low.  And dropping.  (Platelets are what allow the blood to clot, so that you can stop bleeding.)  By our due date, many typical delivery tools were unavailable to me, specifically an epidural if I wanted it (I didn't), and a cesarean with anything other than full anesthesia (I really didn't want that.)  It also meant many commonly used methods for assisting a stubborn baby, like a vacuum, were off the table because we didn't and couldn't know her platelet count.

And then, at 40 weeks and 5 days, my platelets took a sudden, albeit small, jump up.  My favorite law professor once told me, when his wife was pregnant with their second child and he was beside himself with fear, that childbirth is the most dangerous thing an otherwise healthy young woman ever does.  When you're talking about a, let's-face-it, bloody enterprise, the ability to clot is quite relevant.  So we decided to induce labor.  That day.  Which was Thursday.

We called the doula.  We emailed our parents.  I talked to my sponsor.  I checked in with my best nurse friend who agreed, "You go get that baby out.  Now!"

I'm going to get specific here.  You've been warned.  Thursday evening we checked into the hospital room that we would call home for the next six days.  Our midwife inserted a Cook catheter, which is a small device with two empty balloons that is inserted with one balloon inside and one outside the uterus.  The balloons are then filled with saline until they each expand to a diameter of 5 centimeters.   The physical pressure for a sustained period (overnight, in my case) dilates the cervix.  Other than the fact that the procedure sent me screaming into contractions for about an hour while my body was adjusting to this foreign object, the catheter was not unpleasant.  By morning, it fell out on its own, meaning my cervix was open at least that far.  So far, so good ...

We started pitocin.  This is a drug synthesized to mimic the natural oxytocin the body releases to start labor.  For 10 hours we slowly ramped up the pitocin, from a lowly 2 units all the way to 16 or so.  Throughout this, the baby was hooked up to constant monitoring (meaning my belly was strapped with monitors that itched and I was connected permanently to an IV - I could walk around but had to take the rolling stand with me and I wasn't allowed to go beyond the reception of the monitors - I got to know the south wing birth center halls really well).  That day we watched the old version of 101 Dalmatians.  We looked out the windows at the flowers.  And we walked slow circles in the hospital halls.

My uterus was contracting, but I couldn't feel a thing.  Not so good ...

At 9pm Friday, my midwife suggested breaking my water.  This posed a risk: once the water broke, the baby should ideally make her exit within about 24 hours.  If she didn't come on her own, cesarean would become the only choice.  But breaking the water should (and did) speed up and intensify contractions.  Now it was on.

Full labor, full contractions, screaming, moaning, getting in the tub, the whole works.  At one point my doula said, "you can do it!  It's like running a marathon."  And I screamed/moaned/croaked back through gritted teeth, "a marathon is nothing to this."

Karl and I had been determined to do this without pain medications.  We took the class, we hired the doula, we practiced the breathing, we had a plan.  I remember at about midnight calling my AA sponsor to give her an update.  An update!  There I was, chatting on the phone in between contractions, pausing when the next one came.  We were doing great.

But my body wasn't cooperating.  By 5am I was still only about 6 cm dilated, and it had been almost 24 hours on the pitocin.  And the pain was really bad.  Indescribable.

The trouble with inducing, we had learned in our birth class, is that, statistically, one intervention is more likely to lead to another (like breaking the water), which is more likely to lead to another (like an epidural), and more likely to lead to another (like a cesarean.)  I could see the beginnings of this road laid out before me.  If I had been further along, like 8 or 9 cms, I might have endured the pain.  But at 5am I still had so far to go.  I wanted the epidural.  Karl had been prepped to say no, to suggest other tools to manage the pain.  But I was beyond managing.  The pain by itself was bringing me in and out of consciousness.  I remember at one point the midwife Mary Lou practically on top of me while I lay on my side screaming and crying through a contraction.  She said, loudly, right into my ear, "I know, it sucks!"

The risk of the epidural with low platelets is bleeding into the epidural space, which is in the spine, leading to paralysis.  I was terrified.  The decision to induce balanced the slight rise in platelets, making an epidural at least possible, with the increased likelihood of needing one.  But given all this, and the sacrifice of my dreams of an unmedicated labor, I had to have this thing.  At 5am.

Trouble was, the anesthesiologist was busy with some woman down the hall (who we had heard screaming through her own unmedicated labor, only to need some kind of emergency surgery after her baby was born).  We had to call in another one.  And he didn't arrive for 2 hours.

Two hours.  Anyone who has been through labor knows what this wait was like.  Words cannot do it justice.  I asked to shut off the pitocin.  Then I opted for the most undesirable of options just to get through it: the narcotic, fentanyl, introduced through the IV.  I made them give me only a half dose.  Thank goodness I had discussed all of these possibilities with my AA sponsor, never thinking they might actually become reality.  I barely felt the narcotic.  What it did, however, was cover me long enough until the anesthesiologist was at least on the premises, and then I gritted my teeth until he appeared.

Nobody liked this anesthesiologist.  The room was full of a few nurses, one or two midwives, the doula, Karl, maybe even an obstetrician, I'm a little fuzzy on the details.  The anesthesiologist ran through the risks, talked about the needle and the procedure, but not very warmly.  Not warm at all, this guy.  I didn't really mind; I'm a lawyer and understood CYA, which is what he was doing.  Bedside manner was the least of my concerns.

For the epidural I sat on the edge of the bed, with my gown open at my back, leaning into one of the nurses, the nice, tall one who held me in a big hug throughout this procedure.  She was helping me stay still.  Flinching would not be good.  I was so scared, more than at any other time through this whole birthing thing.  I remember looking at Karl, eyes wide, wondering if I had walked my last steps in life.

When the needle was done, they laid me on my back again and my blood pressure dropped.  I had always received good health marks for my low blood pressure.  Frequently 100 over 70, 90 over 60, that sort of thing.  I don't know what it was dropping to, but the anesthesiologist wasted no time with his next action: rummaging his kit, opening something, grabbing the IV cord and injecting it.  I remember wondering if Mary Lou knew what was happening and if it was okay.  Nobody was talking.

Ephedrine, they told me later.  Great, I thought, same family as meth.  Just what I want.  A few seconds later, my chest, my chest was tightening!  I was grabbing towards my heart, I was flat on my back and vomited, now I was choking.  I couldn't roll myself over or sit up because of the anesthetic.  So much terror!  They rolled me on my side.  It gets a little blurry for me here.  I think they may have given me some other medication, maybe something for the anxiety, the tightening.  Whatever it was, this whole experience was the worst!  It felt like my body was fighting every step of the way.

Once the anesthesiologist left, everybody started complaining about him, but I just kind of rolled over as a blob.  The pain was going away.  It had been done, and there wasn't any undoing it now.

They restarted the pitocin, and really ramped it up.  I had been contracting throughout the wait, but the contractions had slowed down and gotten further apart.  From this time on, I just kind of lay there, now unable to walk, even to the bathroom.  Now I was really a hospital patient.  Complete with urine catheter.  It was Saturday morning.

In the beginning of our stay, I wouldn't let the nurses and staff do much for me.  I changed sheets myself, folded my own towels, tidied up the room.  Now, I pushed the button for every need, small and large.  To pick up a pillow.  To untangle me from IV cords.  To bring me ice.  (Oh, yeah, food was withdrawn once the epidural occurred, making my last calories at 8pm Friday night.  Except for my bandit Coca-Cola ... Karl would allow me, reluctantly, a few sips when I really begged.)  Total helplessness on my part.  Ugh.

As the hours wore on I was vaguely aware of the change in nursing shifts.  They stopped telling me the pitocin level but I heard something about special permission to go above 30 units.  I encouraged Karl to take a nap.  Jenne, our awesome doula, disappeared for a while for the same thing.

And the epidural wore off.  On my left side.  At first, I didn't tell anyone.  I was actually glad to feel some of the contractions again.  I could feel them in a numbed down state, and only on my left side.  It was nice to know something was still happening to progress the baby out.  This was, after all, about her.

Eventually, though, I told the nurse.  She got the anesthesiologist, a different one now, this time he was a big guy with grey hair from Bulgaria, with a beautiful accent.  He increased the anesthetic and my right side went out completely.  Couldn't feel my toes, couldn't move a muscle.  The left was never all the way gone, but almost.  Even so, I could feel the fatigue in my uterus.  We'd been in the hospital close to 48 hours and had been running pitocin for nearly 36.  As the afternoon wore on toward evening, I felt my insides were just stressed.  Physically overextended.  There wasn't any pain or a specific phenomenon happening, it was just an overall sense that my body couldn't take much more of this.  I was at 8 centimeters.

During a quiet time, late in the afternoon, when it was only Karl and Jenne with me in the room, I turned to Karl and said, "Do you think we should consult with an obstetrician?  I'm worried.  This isn't going well.  It's not working."  Nobody had suggested this to me, and I'd never been through childbirth before.  But there was a sense that it wasn't right.  And it wasn't going to fix itself.

Within the hour, when our midwife Cindy next came in, she had a look of regret on her face and validated my concerns: "I've been consulting with the obstetrician on call and I think you should talk to her."   I knew where this was going.  Midwives don't consult with obstetricians unless they really have to.  "We're talking cesarean," I confirmed.  The doom!  This was the last thing we wanted.  It was always a possibility, but only that.  A last resort.  Something to be done in case of emergency.  Cindy mentioned that the baby hadn't been descending enough, and she said, "the uterus could rupture."  What?  "What does that mean?!  Rupture?  Does it mean hysterectomy?"  (Because even as I lay, fearing death and paralysis, it was crucial that I preserve my ability to do this again.)

"No, not a hysterectomy.  But it could split open."  Ah, this is what I had been feeling and couldn't put my finger on: my uterus was wearing out.  When faced with this reality, what I felt was a sense of relief.  "Bring in the OB," I said.  Cindy mentioned that the doctor looked like she was 22.  I'm glad she warned me!  Dr. Oman talked a little bit, she seemed nice, and adequately competent.  She checked my cervix and said I was now closer to 9cm dilated.  She said she was reconsidering her position and that I might be able to go just a little bit longer and then try pushing.  Cindy and the nurse exclaimed with a joy that I did not share.  "Then what?" I asked the doctor.  "What are my chances?"  Pushing can take 45 minutes or 4 hours, I knew.  They might need to use the vacuum on the baby's head but this was still not a possibility for our baby.  My uterus was in a weakened state.  "I could get her further along and still need a cesarean, right?  What then?"  The doctor nailed it for me: "It will be worse to do the cesarean later."  Worse for me, worse for the baby, a more difficult procedure, done under emergency settings.

No, I said.  Now.

It still makes me cry.  The giving up of the plan.  It was more than a plan, it was a rite of passage, literally, for the baby and me.  Gone.  Not happening.

I called my sponsor Laura.  I didn't actually remember doing this until Jenne reminded me a week later.  Laura later told me I sounded really calm, that I was scared but lucid.  "The nurses are doing something to me, I guess I have to go," I told her before hanging up.  Once we put this decision into motion, things moved quickly.  The lovely Bulgarian came back.  He stood by my head and told me what would happen.  "You won't leave me, right?"  I asked him.  "I'll be there the whole time," he promised.  And indeed it was his hand that I held during the surgery, his voice that was the most constant.

They wouldn't let Jenne in the operating room.  Karl started putting on the blue hat and gown.  It was so very medical.  They had me drink a brown liquid, telling me to hold my nose and chug it.  I did and started vomiting almost immediately.  By now I'd learned to turn my head to the side ahead of time.  (Ironically, it was an antacid intended to calm my stomach.)  They wheeled me a short distance down the hall and through the dark, foreboding double doors....  I vaguely wondered if any other laboring women were wandering the halls thinking, "I'm so glad that's not me."

Karl was kept out for a few minutes.  Long enough for me to vomit again, and explain to the nurse who introduced herself as the baby's nurse that Karl was my health care power of attorney and that I forgot the paperwork.  "Don't let me die on this table where the last thing I consciously do is vomit over the side."  In my mind I was really articulate and clear.  Who knows?  But she treated me with so much respect.  "Yes, I understand,"  she smiled.  And despite all, my humor was not altogether gone, "This is just the fastest route to a Coca-Cola," I explained.

The procedure is really fuzzy for me.  Karl came in, and sat to the left of my head.  The Bulgarian was behind me on my right.  Cindy was there, assisting the doctor.  I didn't feel the cutting.  Someone said, when they got through the uterine wall, that the baby was face up.  What I remember most vividly was Cindy joyfully exclaiming, "Oh, it's such a big baby!"  And I waited for what every mother out there knows I was waiting for: the screaming.  Time reaches implausible depths of slowness when a new mother waits to hear her baby scream.  No matter how many people were in the room, no matter what anyone was saying or doing, I was waiting for one sound, from one, tiny person.  And then I heard her.  A cry more than a scream.  A sweet, sweet cry.  It was 6:55 pm Saturday.

I hadn't seen her yet, they took her to the left, behind Karl.  I was waiting on the weight and the APGAR scores.  Nine pounds, someone said.  They brought her to me and laid her screaming, red, squirmy, weird newborn little body on my chest.  "I don't know how to hold her!" was followed quickly by "What was her APGAR?"  They told me 9 and I demanded what she had missed: "slightly bluish hands and feet," they reassured me (the most common one.)  I was flat on my back, with bizarre levels of anesthetic and who-knows-what-else coursing through me.  I held her awkwardly for less than a minute; this time they say is so important for the baby to bond, to feel her mother's warmth from my chest specifically designed to provide it, yet I made them take her back.  I couldn't hold her.

Karl and I had a plan for this, we just didn't think we'd need it: Eyes On The Baby.  Karl was to stay, at all times, with the baby.  Forget me, stay with the baby.  He told me later his eyes never left her.  So he is as fuzzy as I am on what happened to me.  I'm glad.  I remember the nurses laughing when she exploded her first poop all over him, somehow getting it inside his gown and even down the inside of his pantleg!

45 minutes went by.  I was in and out of consciousness.  I started yelling that I could feel the pain of what they were doing to me.  Later, the doctors would insist that I was merely feeling "pressure," but when they ripped the tape off my belly and I nearly jumped off the table, the nurses knew.  I remember someone complaining about my metabolism being really high, messing with the anesthetic, burning through it.  You aren't supposed to feel surgery.  But I could; and it hurt!

When I came to (and indeed it felt like coming out of an alcoholic blackout, something I never wanted to feel again) I was back in our room, Karl in the rocking chair with our baby.  In my delirium I insisted we call our parents.  "Call my mom!"  He brought the phone, placed it near my head on speaker and we called my mom, who, terrified upon hearing my weak, croaky voice that I imagined was perfectly clear and audible, probably thought I was dying.  Karl did the talking after that.  Next I had him text the first pictures to our friends; I was rattling off who should be included, forgetting several close friends.  At some point I discovered joyously that I could wiggle my toes.

And there was a baby.  All this commotion, all this effort and fear, and medications, and screaming, and planning, and decision-making.  There was this little human.

Madison West Cromwell, born 6:55pm on April 18, 2015.  9 pounds, zero ounces, 21 inches tall.
5 minutes after being born!
She was really good at nursing right away, a true gift because I was in no position to help her much that first night.  Mary Lou was back on duty and would sort of smush my breast into a point and mash Madison's face onto it.  They had me on heavy duty pain meds all night, and maybe some other stuff, I've been afraid to look at my records.  Sometimes Madison would sleep on my chest, held safe by the walls of my bed.  For a few hours Karl held her so I could sleep more thoroughly.  But I would wake in a panic, look at him in the rocker with her and ask, "You're not sleeping are you?!"  I was so afraid he might drop her if he dozed off.  But he was awake and focused like a man never was before or since.

By 6am I shut off the pain meds.  By 9am I told them I wanted only Advil and Tylenol.  They said no, you need this.  Your goal for the day is to stand up for 3 minutes.  They knew I was a recovering alcoholic.  I let them turn it back it on.  While I had researched the decision-making surrounding a cesarean, so that I felt comfortable if I got to that point, I had gone no further.  I had no concept of major abdominal surgery, or recovery from it.

Importantly, thankfully, joyfully, they let me eat.  I had gone 36 hours with only a few sips of illicit Coca Cola and I was famished.  We ordered breakfast as soon as the cafe opened and I enjoyed the mother's rush of adrenaline, joy, and energy that lasted all day long.  Despite being awake for most of the last 48 hours, and enduring the most physically challenging experience my body had ever faced, I was effortlessly awake.  While Karl slept, so hard that yelling and throwing things at him could not roust the man, I called our parents on Skype and Facetime so they could see their new, first grandchild.  I called friends, posted to facebook, and loved on this child all day long.

That was Sunday.  Because of the surgery we stayed in the hospital for several days.  This part was so wonderful.  The pediatrician on call gleefully exclaimed, "look at these muscles!"  We asked the nurses so many questions, they gave us tips we would never have known to ask for.  They swaddled her, they helped us hold her, they checked on her day and night.  And they took care of me, so much so that by the time we were getting ready to leave, I hadn't realized how weak I really was.  I needed to lie down between packing up and actually leaving.

If I were back on that original Thursday when we went into the hospital, I would make every decision exactly the same way, even knowing where it all took us.  At 9 pounds and faced forward, at 40 weeks and 5 days, at my platelet level and my body's general unwillingness to let go of this baby, everything went exactly as it needed to, when it needed to.

We stepped out into the broad daylight, April 21st.  Tuesday.  Madison wearing her dinosaur outfit that we picked out and was too big for her so she wore it over the top of another outfit.  The day was so bright for her little eyes, which had been protected by the womb for so many months and the muted hospital room for her first few days of life.  On our way to the hospital the previous Thursday, Karl had said it was the most nervous he had ever been while driving.  Until the following Tuesday.

As we exited the gates and paid our parking, I asked to keep the ticket.  115 hours, I calculated.  115 hours to change your lives.

Friday, March 20

Adventures in Breech

Two weeks ago, during an otherwise normal appointment at the Midwives, where we expected no new news (and therefore were unprepared for any), we learned that the baby was breech.  Earlier that week we had completed our 7-week Birthing class, hired a doula, and were generally feeling strong and confident about an unmedicated, natural delivery.  Plus, the baby had been head down a few weeks earlier so breech wasn't something we were even thinking about.  This was not welcome news.

In this country today, nearly all breech babies are delivered by cesarean, a major surgery and the complete opposite of what we hoped for.  Not only that, but the recommendation is to take the baby early in order to avoid spontaneous labor.

All this might not sound so bad, and it probably wouldn't have to me before this whole pregnancy experience, but what I've learned over the past 8 months it that it is worse for the baby, worse for the mother, and carries its own set of very real risks.

So I did what I do, and sped into action.  The midwives gave me a card for a chiropractor, told me to go to acupuncture, directed me to a website dedicated to "spinning" babies in utero for more favorable positions.  I went to massage and acupuncture that same day and the chiropractor the next.  I read the dreadful website, published by someone who may know her field but does not how to design a website.  I called the midwives again because I read about hip dysplasia, distorted heads, and other possibilities for breech babies.  They told me to do handstands in a swimming pool (one of my favorite activities in life, who ever thought it would be prescribed?!)  I read about cesareans, anesthesia, needles in the spine, pain medications post-surgery, and recovery from this major surgery while tending to a newborn.  And I started to cry.

I cried at least once a day for 12 days.

During this time, I did all these suggested things, running from one appointment to the next, we did voodoo moxibustion for 20 minutes morning and night, Karl read a baby book to the lower part of my uterus, quietly so the baby would turn to hear him better.  I learned the theories behind all these efforts, and I studied the statistics, which looked good.  Except the baby didn't turn.
Karl with moxibustion at my little toes
By the end, I needed to call someone who would simply let me cry without trying to "fix" it.  (We all need someone like this in our lives.  And we should strive to be this for friends when they need it.)  I also talked at length with a friend who had had a breech baby that simply wouldn't turn and a necessary cesarean.  This conversation gave me the peace I needed because I grasped some acceptance of this outcome for the first time.

On Day 13, we went in for an attempt at External Cephalic Version.  This procedure is done by an obstetrician who tries to manually rotate the baby 180 degrees.  It has a roughly 50% success rate, and low risk.  However, the "low" risk it does present is that the baby will need to be delivered then and there.  At 36 weeks and a day, for only a moderate success rate, we weren't sure about taking on even a small chance of emergency delivery because it was simply too early to be born.  But we knew we could back out at any point.  (One lesson through all this is the important fact that we remain in charge of our medical decisions.  Sometimes it feels like we lose this power, but we don't, and no one should be allowed to take these decisions from us.)
Waiting for ECV, post-handstands and staying non-vertical
We talked for 2 hours to nurses, the obstetrician, an anesthesiologist (in case of surgical delivery that day), our doula, and each other.  Then, we did it.  Specifically, the doctor did it.  But I helped, a lot.  It hurts to have somebody jam her thumbs into your uterus and push the baby!  In the first attempt, she got the butt up a bit and started to guide the head around, made it from about 12 o'clock to 2 o'clock with the head where it became really painful, and my muscles were clenching terribly, and the baby slipped below her thumbs back to where she'd been.  OW!  And the doctor said, "I'm willing to try again if you are."  This was a clue that there wouldn't be too many attempts, and this might be the last.  She started again pretty quickly and got to that same spot, but this time I went to some kind of la-la place, rolled my eyes back in my head, clutched Karl's hands and simply made my muscles relax.  The baby went and kept on going, right to where she was supposed to be.

I couldn't believe it.  It was maybe a 5-minute procedure.  We stayed in the hospital another 3 and a half hours while they monitored the baby and me until they felt safe letting us go home with all sorts of instructions about when to call or come back in during the night.
This is from the midwives office; thankfully Karl skipped snapping any of me in the hospital gown for the ECV!
24 hours later and the baby is still head down and actively kicking.  Hurray!  I believe that all our efforts at the chiropractor, the pool, and elsewhere helped make the version successful.  It set up my body in the most open way possible.

Through all this, I learned that when people say you will have the birth you will have, despite your plans or hopes, they mean it.  So much happens in pregnancy and delivery that being flexible and open-minded truly is the best plan.

We are far from done here, but I am walking every day to encourage the baby to stay down and drop lower.  I know that if something else arises, I will feel upset but we will also be able to make the decisions that are called for and accept the birth we are given.

I am done with handstands for now, but you may all keep them up.

Sunday, January 25

A child held by her father

I'm a little over six months pregnant.  I'm at the stage where sleeping is a sometimes peaceful experience, when I can get the pillows just right below my ever-increasing belly and enjoy limited kicking and stirring from the baby.  Such sleep is a relief, when I don't have to carry the weight of the baby nor of myself; it is almost as good as floating in warm water.  The sleep effort, however, often involves more tossing and groaning than resting, with the baby spinning and slapping me from the inside, and Robert and Carrie pinning me beneath the cover while Karl irritatingly dozes through it all.  Last night was one of this second category.

We had been playing Risk until late last night, and only tore ourselves away mid-game so we could wind down before trying to sleep.  I awoke in the early dark hours to the always odd sensation of life inside my belly, kicking and churning around.  As consciousness rolled in, I began plotting my next strategic moves in our game.  I tossed and rolled and moaned to no avail, booting Robert only to have him nuzzle in closer, and Carrie following him in.  I was uncomfortable and sleep was not going to return.

As the baby reached into the nether regions with her latest jab, jolting me from my focus on our game, I was visited by a series of thoughts and images that are becoming more vibrant as this pregnancy develops and the reality of what my mother went through becomes more imaginable.  When she awoke in the night, 6 months pregnant, with me poking and kicking, or her belly uncomfortably unsupported, her first thought would have been of my dying father, and not of a board game.  She would have been daily jarred awake with the concern over his breathing, his strength, his comfort.  Her ability to get comfortable was limited by the narrow cot in the hospital room.  As I go through these same evolutionary changes in my body that she went through, with all my complaining and discomfort, I have a new conception of her pregnancy and the wild and very sad struggle that must have accompanied it.

I always carried so much sorrow that my father, who died 51 days before I was born, never held me.  The sorrow was not only for myself, a tiny baby who wouldn't remember anyway, but also for him, a man who never got to look at his only child, never got to hold her, and never got to say anything to her before he passed on.  But now that I am pregnant, I know that he would have been able to feel me kicking.  He would have easily felt the little being that was me pounding away at my mother's belly with only some skin and tissue between me and his strong hand.  I never realized this until this morning.  How often do I reach for Karl's hand to warmly soothe my belly and take the brunt of some of the kicks himself?

Within the first moments of our baby's life outside the womb, she and Karl will both be given something I always dreamed of and would never, ever have: a child held by her father.  I am looking forward to this more than anything else.

Friday, February 14

Calm and just a bit jittery

Guest Blogger: Karl

It was overcast, unusual for mid-day, coastal Tanzania. We took a ferry to the marine reserve Mbudya Island just off the coast. There were three other passengers and two crewmembers on the twenty-foot wooden boat that looked like it had made the trip 10,000 times before. The ocean was unusually calm and just a bit jittery. I had always imagined I would be a nervous wreck on this day. You see, I am going to this island to propose to Abigail, a proposition for forever. I could be a nervous wreck, or tense trying to make everything perfect, or preoccupied looking for some sign of the right moment, but that’s just not me. I remained present for the day, calm and just a bit jittery.

We picnicked with a hermit crab. We smiled a lot, and laughed a lot. We walked over an ancient coral reef that had grown around a giant clam and then was pushed up out of the ocean thousands of years ago. We scared a school of fish and dozens of them jumped into the air at once. We walked along the shore until the ocean called us in. Adorned with mask, fins and snorkel, away we went. To our surprise, two-foot deep shallows surrounded the southern part of the island. We saw a spiny starfish species and conch-shelled snails for the first time. It was both uncomfortable and exhilarating to be a few inches from this undersea paradise.

February 8th was a beautiful day. The jitters showed up. What if you don’t find the right moment? What if she wants to go back before you can ask? What if she steps on a sea urchin? Swimming through sea grass, I calmed myself. You cannot find the perfect moment; you must make the perfect moment. I remained present. Abigail sat up to watch the Indian Ocean break waves on a distant reef. It felt natural to sit next to her, face her, and ask loudly and certainly. I was struck that it felt so comfortable and right, even before … SHE SAID “YES”! We celebrated by flopping around – looking ridiculous – gently nudged by waves.

When we had taken our last long silent look at the horizon from that special spot, we were both overcome with the urge to tell our friends and family immediately. Hand in hand we began our swim back to shore. Signaled by a scream of surprise through her snorkel, an eel was the first to congratulate Abigail. We awaited the returning ferry in a sea-cave talking about our wedding day.

Wednesday, February 12

Engaged, and bursting with joy

The day began with one of my 2am wake ups where I start thinking and, once I do that, sleep is out of the question. On this Saturday morning, my thoughts surrounded my career and what to do about it. A cup of Starbucks sometime around 3am, and by 6:30 I was able to sleep again; post-morning-coffee naps, once the thinking stops, are some of my most peaceful rests of all.

By 8:15 I was jolted awake with the memory of a planned Skype call with my good friends Dan and Peggy out in Seattle. They are coming to visit us in March and I enjoyed our hour-long talk, catching up and planning their adventures in Tanzania.

It was a slightly gloomy morning and Karl and I almost didn't go to Mbudya, but we had been planning for some time on going to this small tropical island off the north coast of Dar es Salaam, the ferry a mere 15 minute bajaj ride from our house. The day was warm, and the clouds offered a nice break from the endless Tanzanian sun, so we went.

We packed a modest picnic of PB&J, Pringles, Primal Strips, water and our new picnic blanket handmade locally, one of the few purchases we've made in Africa. The boat ride was calm and the island pleasantly unpopulated. We wandered up the leeward side and found a nice spot to pitch the blanket and enjoy lunch. I can't remember now what we talked about? Hermit crabs that we noticed, the cleanliness of the beach, whether the tide was coming in or going out. It was just a Saturday, after all, like any other...

We sat for a bit and decided to walk further up the beach, towards the end of the island. We came to a flat, rocky patch and the trail permitted no further on foot, so we donned our snorkels and fins and left our backpacks on the shore. The water was shallow, crystal green and blue. Not too many fish to speak of, but the water allowed pleasant flopping and snorkeling. We could see the end of the island, beyond which lay the broad openness of the Indian Ocean.

We stopped at the island's end, knees in the sand, and watched the beautiful line of waves breaking over the submerged reef in the near distance. Tankers and container ships beyond, lined up waiting for port.

What happened next my human brain was unable to fully store in memory, but I have clear sensations that help me recapture most of the moments: I was partly on my knees and partly sitting, Karl was sitting with his flippers out in front of him. With every passing wave, we gently rocked around and were never static or solidly planted on the ocean floor. I had a beautiful view and was daydreaming of surfing. We hugged, kissed, and got gently tossed around with the movement of the great ocean, comparatively calm in our protected waters.

Karl started to talk. He was saying something about it being time to put things into place, or something like that. He was looking at me and I at him and I could hardly believe what was unfolding. He had his mask and snorkel on top his head, his flippers nosing out of the water as he bounced around. He looked ridiculous and perfect. I had my mask and snorkel on top my own head, my hair a disastrous mess, my eyes squinting as the sun was making its presence known at last. I could picture what we both looked like, and it was great. Like two happy children playing in the water. I started giggling uncontrollably, suddenly so shy or bashful or some such ridiculous emotion around this man whom I've shared my life with for more than three and a half years. I began to tear up and cry even as I couldn't stop giggling and smiling.

He was smiling as he asked. He said it simply, "Abigail, will you marry me?" Aaaahhh, all I did was hug him. I was feeling and sensing and experiencing, aware primarily of my physical body, embracing him and feeling how wonderful it felt, how well we fit together, how natural, how safe, how good.

Water girl that I am, a proposal couldn't have been better that this. And I was so surprised! So happily surprised! So happy that it was a surprise. My thinking self, the one that gets me up at 2am, was hardly to be found, but she did break through with a message that there was something I must articulate. "Yes," I said, smiling big and bursting with joy.