Your Birth Plan
Just after 1 a.m. on a Friday, you and your fiancé pull into the parking lot of the local birthing center, which is shared by a dance school, a vegetarian restaurant, and a movie theater. The previous afternoon, parked at Whole Foods, you pressed your hands against your belly. You could feel it, the crisscrossed muscle fibers tightening as firm as a semi-ripe avocado. Your contractions had started. You closed your eyes to let the sun warm your face while your fingertips traced the longitude of your hardening belly. Inside the store, your fiancé was gathering last-minute provisions: a jar of local honey and protein bars for the overnight bag—the bag he now grabs from the back of the SUV. You pivot yourself out of the vehicle. He sends a group text, Arrived at birthing center!
Inside, the decor is dated but homier for it. You both agreed that this would be the best of both worlds—a birthing center offers a bit of home, a bit of hospital. You have a private bathroom, a living room with a couch, and a bed with a bedspread—it’s just right. You will give birth here, a natural childbirth.
A month ago, you wrote a succinct, one-page birth plan listing what’s okay and not okay, just in case things go awry and, God forbid, they transfer you to a hospital: You don’t want your placenta yanked out after the baby comes; you do want your baby placed on your skin right away (immediate skin-to-skin contact regulates a baby’s heart rate and breathing). You’re going to decline the injection that will take away the pain as well as the drip that will make your uterus contract over and over. As the natural birth books warn, doctors push those drugs to keep things controlled and efficient—yours isn’t the only baby being born this morning. But you’re not one of those ‘just get the baby out’ women. You want to see what your body can do.
Not to worry. At the birthing center, none of that will be an issue. Your bungalow has low lighting, a birthing pool just in case the baby wants a water birth (you do), and the medical equipment is out of sight.
Your fiancé holds onto the overnight bag while you strip down to your sports bra and sit on the edge of the bed. When the midwife squats down between your knees to check your cervix, you clutch the bedspread and catch your breath, shocked by how swiftly she reaches into you.
“Nice work,” she says. Your cervix is past five centimeters. “You can stay.”
You’re proud to have gotten it right. Too many women show up eager and early, only to be sent home. As if a baby could just quickly slip out like spaghetti through the tines of a fork.
You’re eager to step into the birthing tub, which reminds you of a children’s wading pool. This is what you’ve been talking to friends and family about, your water birth. Your sports bra darkens as you lower yourself in. You crab-walk to the middle, then try to float, wondering how soon things will happen: When will it be time to push? When will the baby emerge from your body—into the water rippling in the low light? You gaze over at a closet with accordion doors. Is that where the medical equipment is hidden? Oxygen? Pitocin and what else—buckets?
Even underwater, your Tiffany & Co. engagement ring glints. You chose a half-eternity setting to ease your discomfort with traditional jewelry. You’re more of a box-of-Cracker-Jacks-prize-inside ring kind of girl. Whatever. You’re 37 years old and crushing it. Move to California? Check. Working remotely for a Boston-based business? Check. Wedding date. Wedding cake on deposit. Now—voilá—here comes baby! Check, check, check.
You marvel at how fluid the events leading up to this moment have been. After fifteen years on the east coast, you moved back to California and got pregnant within two months. Perhaps your return was predictable, a sea turtle navigating along magnetic poles, home to lay your eggs in the sand of the same beach, again and again—like Mother.
You’re already deeply in love with your maybe son (you sense it’s a boy).
“Most women want daughters,” one helpful family friend had told you.
“Sons marry away,” another said, “daughters stay.”
So be it. You’re built for abandonment. And, anyway, you are ready. Ready-ready. In the last month, your mother-in-law-to-be bought you a Bugaboo sleeper stroller, Dad splurged on a crib, and you bought a dresser, rug, pack ‘n play, bouncy chair, organic bamboo fiber swaddling blankets, a hemp mattress, and diapers—cloth.
She arrives at 3:30 a.m., the one who will be your emotional anchor through the entire birth, no matter how long it takes: your doula.
“Hello, mama,” she says with a shy, loving smile. “I’m Rebecca.”
She kneels down by the birthing tub and asks how you are feeling.
“The contractions are really intense,” you admit.
In fact, just before she arrived, you realized the intensity of the contractions across your abdomen was causing you to regret the emails you’d sent to friends the night before describing labor as totally do-able. Let’s be honest, childbirth isn’t a spa day (although maybe you thought it was, just a little bit).
Incidentally, contractions are passive; they occur. Pushing, on the other hand, takes effort. Like a surfer paddling up a rising wave, your job is to capitalize on your body’s natural forces and heave yourself aloft without capsizing. Too many books have compared birthing to a bowel movement. Sure, a bowel movement can provoke a shudder and make your eyes water, but childbirth—pushing a baby from inside to outside—is like moving your brain matter out through your ears or your kidneys into the tips of your fingers. Think octopus through a keyhole.
You must turn yourself inside-out.
The doula touches your shoulder. “Let’s try laboring in another position,” she says.
You’re not sure if this is her way of protecting your joints from stiffening or because your pushing isn’t successful.
At one point, you lie back on the bedspread, and she leans forward to wipe your brow. A contraction quickly builds.
“Whoah!” you say.
“Breathe,” she says. “You’re doing great.”
The midwife sits down on the edge of the bed, facing you. Your doula sits on the other side.
“When the next contraction hits, we are going to open your hips while you push,” the midwife says and lifts one of your legs so that your ankle is resting on her shoulder. She gestures for the doula to do the same with your other leg. If you were on a yoga mat, this would be called Happy Baby pose.
“Oof—here it comes,” you say, feeling the squeeze of a contraction. (You briefly question whether you actually read in a birthing book that some women orgasm during labor.)
They hug your legs to their chests and lean forward, opening your hips, as promised. They shout, “Push!”
But you’re not ready to push again so soon.
You’re shocked at how rough they are with your body. The midwife handles you like a whole raw chicken, pushing your leg back farther and angling it till she finds that soft place to make the cut, to free up a passage blocked by your joints. You thought midwives were supposed to be more like pastry chefs than butchers.
“Opening your hips shortens the birth canal,” the midwife explains. “Seems like this baby needs a shorter route.”
For three more hours, you labor. Not only on the bed but throughout the bungalow—bathroom, living room, and your beloved birthing pool. You try laboring while squatting, while floating, and while standing in the middle of the room, grasping your doula’s forearms. At one point, you sit on the edge of the bed, and your fiancé slowly feeds you a spoonful of honey and small pieces torn from one of the protein bars. Intense, yes, but this resembles the birth experience you had imagined. Mostly.
Another contraction rises. As it strikes, your fiancé steps away and you lie back. The doula and midwife do their leg-hoisting-over-shoulder thing, pushing your thighs straight back, then out.
A small space between your heart and lungs collapses. Segments of your spirit break away and float; one or two pieces bob to the surface farther out to sea. The word push has lost its shine. You know that when they shout, “Push!” it’s coming from a friendly, supportive place, but it’s starting to sound like, “Try harder.”
At 6:15 a.m., the lid of a weathered shoebox opens inside you, like the one grandfather helped you bury in his backyard after a robin redbreast smacked into the picture window. One look inside this shoebox and you cover your face with your hands. You roll onto your side and begin to weep.
Your fiancé places his hand on your calf. You’re grateful that he touches you somewhere so far from your crotch. You cry harder.
“She did this, then didn’t raise me?” you wail. “All this effort to just leave?”
In a few years, you’ll sift through the envelope stuffed with paperwork from the birthing center and see the note they must have written at this moment: Feels emotional.
This wasn’t in your birth plan. Your mother’s absence never got in the way. Why would it show up now? Sure, it was a scar that your fiancé stubbed his toe on from time to time, but the subject was easily changed. The fact that she left you with her parents and never returned, not as a mother, didn’t prevent you from going to college or holding down jobs—hey, you got engaged! Twice. She was repressed—compressed—until a tiny nugget of coal formed, which you tucked in your emotional shoebox against the dead bird. Her disappearance from all but the periphery of your life—except for her rare, dramatic appearances—never capsized you. Not until you become a mother will her astonishing absence reach you.
Each time your child’s timeline resembles your own, you will cry again like this. You will learn that the emotional injuries buried in the shoebox can always jump out. I was his age when she disappeared from my life—not even a kindergartener. You won’t be in control of the timing. How could you have understood, really understood, how low the waterline was—how small a four-year-old is, how clumsy, hungry, and eager to crawl into her mother’s lap?
You fall asleep.
You wake up close to 9 a.m. and take in the fact that there is still a baby to give birth to. Your doula is sitting nearby. A new midwife sits in a chair next to the bed—you’d slept through their shift change. She’s the head midwife.
“Things are at a bit of a lull,” she says after you wake up and groan through a few sets of contractions. Not a lullaby, a lull.
“Lull?” your fiancé asks. He had napped right along with you.
“Her contractions are there, but they’re not building, and we need them to—” her arm juts up from the elbow, “ramp up.”
You need really vigorous contractions to get the baby out, much stronger than anything you’ve felt yet.
Half an hour later, she says something about the hospital.
“We can get access to Pitocin there, to strengthen your contractions.”
Pitocin, a drug that stimulates the uterus to contract, a drug used in medicalized births—a drug your birth plan says is not okay. She sounds to you a bit like a vegetarian chef suggesting filet mignon.
“Is this because I fell asleep?” you ask. How could they let me sleep?
“Not at all.” She shakes her head. “Naps are fine. Your body needed to recharge.”
“Is it because I’m not pushing right?” you ask.
“God, no. We only want to keep things moving—but not rushed—for the baby’s sake.”
“But the baby’s heart rate is okay?”
“Yep, so far. Absolutely.”
Surely the baby would drop at any moment—or at least soon? What the hell has everyone been doing for the past ten hours? Have they been indulging me?
“Would we stay at the hospital?”
“We would. But we’ll be there with you.”
Okay, you think and look at your fiancé. I can see us using the hospital for Pitocin.
“Can we wait half an hour—try a bit longer?” you ask.
“You can absolutely try for another half hour.”
You do. You push and flip inside-out, stand, squat, and float, yet nothing new happens in those thirty minutes. Rather than progress and descend, your baby instead crowns and retreats, again and again.
You ride to the hospital like a 1970s child playing in the backseat of a car, kneeling on the floor behind the driver’s seat, except you’re slumped forward into the midwife’s lap. Every time the car makes a turn, you whimper. Every time a contraction strikes, you cry out.
Just past 1 p.m., you settle into a delivery room at the hospital. You blink against the brightness and shine of the linoleum, metal, and machines. Everything you didn't want.
The midwife briefs the labor and delivery nurses, and the two teams become one—green smoothie meets bacon and eggs. You’re well cared for. It’s the obstetrician who will cool the room.
One of the nurses pulls a belt with two bands around your belly, one for the baby’s heart rate and one for yours. Paper begins to print from a machine connected to one of the wires: your contractions are being monitored for all to see. Still, you don’t say a word when a contraction begins to rise. You’re not ready to push again. You don’t know when you’ll be ready, but it feels like never. The nurses don’t seem to notice as you quietly shudder.
You have always afforded yourself time for readiness, certainty, whether it’s “just another couple of minutes” with a restaurant menu or taking more years to decide on graduate school than it takes to complete your MFA. Readiness isn't really an option here. Even if you continue to pretend that contractions aren’t actually enveloping your whole body, or you take a freaking nap, ultimately, you will have to jump. Pitocin is flooding your body.
I get the hesitation, you say to the baby that is head-down inside of you. Once you’re out, you’re in the world. No backsies, honey. The baby is enveloped in its own birth story.
Over the next couple of hours, the strip they taped to your baby’s head disappears and reappears over and over again. Two inches down, then two back up in there, proving that you can change the location of your childbirth, but you can’t change the structure of your pelvis or the size or angle of your baby’s head. He’s inverted—head down but facing forward. You want to have the baby, but you also want the nurses and midwife to drop your thighs and remove their pinchy fingers from your nipples, take their eyes off your vagina and stop looking at the contraction monitor for one goddamn moment—just let me catch my breath.
They are full of tricks. A nurse climbs onto the bed and sinks into a deep squat between your feet. Your knees are spread so far apart you can’t feel them. Everything but the child inside is detached, numb, theoretical. She holds out a large rubber ring—something a child would throw around the neck of a bottle at a carnival, but bigger. You grasp it with both hands, just like the nurse. Every one of the nurse’s fingers (and one thumb) is ringed with bands of silver, a couple with onyx and turquoise settings, stacked haphazardly like she’s been wearing them for years.
The idea is that you pull back on the ring while she pulls in the opposite direction. Pulling you forward shortens your vagina. “Get ready to push,” she says once she notices a line beginning to peak on the paper printout.
Each time you push, you disappear into a place the nurse cannot see.
Between contractions, you wipe sweaty palms on the bedsheet. The rubber of the ring is tacky and mostly easy to grip. But several pushes in, sweat forms between your fingers too rapidly, and your fingers slide off the ring, and the nurse flies off the bed like you’ve shot a small dog from a circus cannon. She hits the wall and falls to the floor.
But then she’s back up and waves off your apologies.
“We’re good. Let’s go!”
The next wave of contractions is not to be squandered.
“Grab it,” she cries, holding out the rubber ring again. This is your kind of proposal.
“Push,” they all cry: midwife, nurses, doula.
“Push!” They shout again.
“Push!” Their voices are somehow roaring now, and you are pushing, really pushing, the tendons running along your hips stretched beyond their elasticity, and you’re harnessing each contraction like Poseidon riding the crest of a wave.
This goes on and on for more hours than you will ever believe.
At 5:30 p.m., seventeen hours into labor, you realize two things: One, your baby is stuck and won’t come out like this. Two, you’re on your own. No one here is ‘on your side.’ The ringed nurse doesn’t have special magic that affords you a good, middle-class birth experience, nor do the midwives—though you’re right to believe in unmedicated birth. All present are witnessing something they cannot control, something they can only react to. They’re mitigators.
“The baby is stuck!” you wail. “Can we vacuum the baby out?”
You’re panting. You’re parenting. There’s a silence in the room that feels like thinking. Your idea is on the table.
Your baby’s heart rate is still cool-as-a-cucumber normal, even after all these hours, but he—or she—still isn’t progressing past your pelvic bone. Your nine-pound baby is like Winnie the Pooh with too much honey in his gut to leave Rabbit’s hovel.
“We can use suction,” the obstetrician concedes. “But you’re still going to have to push—really hard.”
Then she lays down the ultimate challenge: “You have one try. Then we will deliver this baby by cesarean section.” She says finally without saying it.
She’s throwing down the gauntlet. You were the hero of your own story, the short-haired woman giving birth according to her birth plan, written in Google Docs, and now the obstetrician was crossing out “no C-section” and writing her name at the top.
“Got it,” you say. One try.
The bright room is library-quiet. You await the next contraction. You hope for a strong one, a tall mountainous line on the printout that you can grab onto and flip inside-out with all your might.
When the contraction comes, you ride it. Yes—this is a big one. And oh, how you push.
“Puuush!” everyone bellows with such full lungs—they’re rooting for you, willing you to win the wager.
And out he comes. Or rather, shoots, to the sensation of ripping and the sound of your shrieking, getting parenting wrong right off the bat, Fuuuck!
The doula sets your baby upon your breast, his new home. He is “well-cooked,” as they say, with the even skin tone of a one-day-old. His head is conical, the only evidence of his vacuum-assisted birth.
The doula’s hands are cool on your cheek and shoulder as you cradle your baby with one arm and touch his face with the other. His father’s hands are there, too, resting on his son’s impossibly small back and touching your hand, your hair. It’s done. It is good. Your son is on your skin, curled up. His eyes are closed like a newborn kitten’s. He mews a bit and then seems to drink from your breast. He is all instinct.
He will be the light of your life, shining bright like a beacon through a broken engagement, single parenting, illness—all your plans undone.
Your mother didn’t stay, but you will. In time, you’ll come to believe that no curse was passed down. She was the rare mother who abandoned her daughter. You will be an ordinary mom, steadfast.
The doula appears with an apple and offers it to you. Time moves, or maybe it doesn’t. Glancing down at your forearm, you notice that the IV taped to your arm has slipped out. It’s just resting against your skin. Maybe it’s supposed to.
You refuse the apple. There is no hunger within you, only a craving for sleep—no, hibernation. You are a bear, and winter has come.
In reality, you are bleeding out.
The midwife rushes in, and before you can point out the needle dangling against your arm, she pushes down once—hard—on your deflated belly. The room fills with the sound of a bucket of water thrown onto a sidewalk. That’s a lot of blood.
Three or four nurses hurry into the room and stick you with needles in a kind of ludicrous surprise attack, sticking your arms and thighs, plunging liquid—your friend Pitocin—into your body.
Your baby is still in your arms. His father is right there. Your doula keeps close, too. A fourth nurse enters the room and offers you a clipboard with something to sign. A pen is held out for you to grasp with your free hand.
“No way,” you say.
You’re stacking up wins—first the suction idea and now this refusal to further medicalize your birth experience. But the clipboard returns, and this time, it's the nurse with the silver rings with the pen. “This is the only way to stop the bleeding,” she explains.
“Plan,” you say, turning your head and looking up at your fiancé. “Birth plan?”
You got your birth plan out of a book. It was a form of self-advocacy that lent you confidence and a sense of participation. Yet there is no template for exceptional births. You’ve got to wing it. Can you admit now that when you said you wanted a natural birth, you might have meant a perfect birth?
The nurse is patient. She doesn’t say, “We need to save your life.” It doesn’t occur to you or your fiancé that this bleeding is life-threatening. Baby came out, baby is fine. She doesn’t say you’ve already lost the first of the almost three liters of blood you’re losing tonight.
They don’t say that you won’t be able to move your legs after the procedure, that they’ll weigh a thousand pounds, that you’ll need four bags of blood in all, that you’ll fear riding in cars, and your milk won’t come in. Yoga that opens your hips will make you cry for years.
Nobody tells you that if you give birth in America, you’re three times more likely to die in childbirth than someone in Europe. While you aren’t going to be one of the 700 Americans who die from childbirth every year, you are one of the 49,000 stricken with severe maternal morbidity—a.k.a. almost dying during or right after childbirth. Those are the heart attacks, renal failures, shock, hysterectomies, and persistent hemorrhages—like the one you’re having now.
The psych note in your file will read, “traumatic childbirth.”
You sign off on a procedure called a D&C at 8:45 p.m. “D” for dilation of the Cheerios-sized hole in the cervix that your baby just came through, something your body did nearly naturally twenty hours ago. “C” for curettage of the uterus, scraping out placental tissue like the innards of a pumpkin to remove the clingy pieces of placenta still attached to your uterus, to curb infection and stop the bleeding.
Your baby boy is handed to his father. Two orderlies, who must have been standing by, roll you out of the room. You remember feeling all your fight gone, your spirit as faint as your signature against the clipboard.
What you weren’t awake for, the doula describes for you. She visits a few days after you’re discharged, driving to your house atop the hills of a vineyard that murmurs, Hurry, Cinderella. The phrase you work into every conversation: We rent. This is ethereal.
“Pretty sure I wasn’t supposed to be in the OR,” the doula begins. “I knew something was different after the baby finally came, after your twenty-four-hour labor. I mean, you were holding the baby, and I love those first moments. So precious. So real. But I always offer moms a bit of food. And when you didn’t want the apple—remember that?—I was like, this is odd.”
"Refusing that apple was your tell. You were pale, not just worn out, but like a drained lake.
“After giving birth, most women have a certain vitality, all rosy and flushed and ravenous. I went into the hall where the midwives and the nurses were all doing their paperwork and told them, Something’s off.”
"Once they got you to the OR, they started a blood transfusion and put you under. The OB yanked open your fresh stitches, which the midwife had done such a careful job of.
“It was awful to see.”
"Even while she was scraping out your uterus—the D&C, which was rough and hurried—you kept bleeding. The procedure wasn’t working.
“She got pissed off and started shouting at the medical assistants, ‘This is how women die!’
“I felt so helpless. I was standing stock still just behind the nurses, whispering into my fingertips, Please stop bleeding.”
"She started to talk about removing your uterus.
"'This is how women die!'
"Please stop bleeding, I whispered.
“There’s a bag they attach to the edge of surgery tables to catch blood—I hadn’t seen it before. They weigh it to estimate blood loss. You lost a third of your blood! Women’s bodies fill up with blood for childbirth, but it’s not much, not enough to cover your hemorrhage. Taking your uterus would make the bleeding stop.”
"'This is how women die!'
"She was fighting to save you.
“Please stop bleeding. I prayed. Please stop—dear God, help her. I felt like the only one rooting for you.
“She had her tools ready to move forward with the hysterectomy—but suddenly, you stopped bleeding. I saw it with my own eyes and still can’t believe it.”
This trauma will want burying, too. You’ll even slip into the backyard one night with a garden spade as the baby sleeps, to dig up the damp shoebox. Indeed, your childbirth trauma would fit neatly between the dead robin redbreast and your mother’s letters, but as the scent of the soil reaches your nostrils, it forges a lull. You will kneel by the open shoebox and allow yourself to be softened by the pain.
You’ll stay at the hospital for a few nights. New nurses will come. They’ll teach you how to breastfeed, teach you the rugby hold. With every spare moment, you’ll visualize a towering marble statue of Aphrodite with milk streaming from her breasts.
Your milk comes in.
You name him Gabriel, strength of God in Hebrew. It’s early days, and your legs are still getting the hang of walking again. Your fiancé flies east for an advertising campaign and your sister—the daughter your mother had when you were twelve years old—flies west, to you. You and Gabriel spend most of your time together on the bed, where you set him in the sun to treat his jaundice. The fine downy hair that covers his face is illuminated, and a golden outline forms around his whole body. The hair is lanugo, Latin for wool. You stare at him for hours, touch him, feed him. You rock him side to side, humming songs you didn’t know you knew. This is where your sister finds you, propped up with pillows against the headboard, about to nod off, cradling Gabriel in the crook of your arm, each of you trying to stay awake for it all.