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Best Laid Plans

When I was still in my first trimester of pregnancy, the hospital sent me a Birthing Plan. I was unfamiliar with these and found myself leafing through pages of questions about birthing preferences and requests I had not even considered.

What might I like for background music?

Might I prefer the delivery room to be dimly lit?

There were even questions about the visitor list. Did I want my baby’s birth to be an intimate and private gathering, attended by a chosen few, or should there be more of a small crowd?

And by the way, after the whole labor and delivery business was said and done, what would I like to have for my first post-delivery meal?

I was daunted. What if I was taking this whole Birthing Plan business too lightly? What might be the unintended consequences of hasty choices, poorly made? What if I chose a soulful ballad to be played during the delivery of my baby, only for her to grow up wishing she had been welcomed into the world by the theme to “Rocky”?

After deliberating for a few days without much progress on the actual form, I decided I needed input. But from whom? The other moms I knew were moms of older kids, women who’d had children before this time period when checklists and childbirth were inextricably linked.

I decided to find a doula or birth attendant. Someone with whom, as a single-mother-to-be, I could consult.

In truth, when I first heard of doulas, I was reticent. I had a mental image of a matronly, earthy-crunchy woman who’d be vaguely if not radically anti-medicine. I was not sure this would mesh well with my strongly-held view that in the event of terrible pain, medication would be a very good thing. Still, my need for support was undeniable, so I started compiling a list of phone numbers for area doulas.

I don’t know what made me gravitate toward Jane, except to say that she sounded over the phone like she was both kind and grounded, qualities I felt were particularly important. We agreed to meet in a local bookstore café. She had long, wavy black hair pulled back in a no-nonsense ponytail, and as we started to chat, she reached into a bag, produced a laptop, and started typing. This was illogically reassuring; though I hadn’t broached the subject of childbirth pain yet, I had the sense that someone who took notes on a laptop was probably unlikely to scold me for wanting pain medication if I ended up being in childbirth agony.

Somehow during the course of our first meeting, I found myself confiding in this almost-stranger about what it was like to be pregnant in the context of a troubled and dying relationship. She listened quietly, abandoning her note-taking, nodding at the right moments. After tackling that conversation, the rest seemed like a piece of cake. So I took out the Birthing Plan, smoothed out the creases, and began to discuss my options with her.

By the end of the afternoon, I had hired Jane, filled in all the Birthing Plan blanks, tucked the form into its return envelope, and sent it on its way with a smile. There is nothing like careful planning to make you feel like an upcoming event will practically take care of itself, and now, with a Birthing Plan and a doula, I felt like a preparedness rock star.

The second trimester of pregnancy is supposed to be the easiest, most comfortable time. That’s what all the pregnancy books and websites say.

So I was blindsided when, during the latter part of my second trimester, I began to feel like I was dying. Having been spared most of the legendary first trimester morning sickness, I was baffled to find myself constantly nauseous, sometimes vomiting. Worse, I began to have headaches, blinding ones, which felt like shards of metal storming through my brain.

Jane, corresponding by email, was equally baffled. “These sound a little like migraines. Do you have a history of migraines?”

My face and legs got puffy. Increasingly, feelings of weakness and malaise sent me back to bed, often keeping me there for fours. It was clear to me that something was happening to my body besides just pregnancy.

At Week 25, I was diagnosed with preeclampsia, a potentially dangerous disorder of pregnancy marked by high blood pressure and protein in the urine.

“I don’t understand,” I said to Jane. “I’ve eaten well. I don’t smoke. I quit coffee. Why is this happening?”

I knew I was whining a little, but I couldn’t help it. I still had months left before my due date, and I had already had to take an early leave from my job as a court clinic social worker.

Jane took all the new information in quietly and tried to help me stay focused on what aspects I could still control. We talked about the new game plan: Blood pressure medicine, near-constant bed rest, frequent doctor appointments and labs. She wanted to know how she could be supportive under these new circumstances.

I wasn’t sure, but I wanted to hug her for asking me.

In my 32nd week of pregnancy, two months before I was “due”, My doctor frowned at my lab work. She said that with the steady worsening of my condition, I had reached a point where the risk of continuing the pregnancy outweighed the risk of premature delivery. An emergency delivery would need to take place that day, at a larger, high-tech hospital in Springfield which was equipped to handle high-risk pregnancies and premature infants.

My head was spinning. The hospital was an hour’s drive, and an ambulance was on its way. A phlebotomist rushed in to start on IV with magnesium sulfate, a medication they hoped would prevent my having a seizure. I called my parents and gave them the update, my voice shaking.

My next call, to Jane, began with a disclaimer. “I don’t expect you to be able to drop everything and do this on a Sunday,” I said, “but I wanted to let you know what’s happening.”

“I’ll be there,” she answered without hesitation.

Such a good decision I’d made, getting myself a doula.

The ambulance ride was bumpy and loud, but the emergency techs distracted me with small talk and jokes. Halfway to the hospital, there was a loud, sharp bang, gunshot-like. I startled, but the emergency techs, who joked about potholes and pyrotechnics, kept me focused and even mildly amused in the small space we inhabited. Later, I would learn that a rock which had been kicked up by another vehicle had smacked against the windshield with such force to have left a large spider web of cracks shooting out from a significant hole. The fact that they kept calm amidst this, and kept me fairly calm in the process, is remarkable to me.

It wasn’t until we were pulling into the hospital parking lot that I remembered my Birthing Plan. I could picture it perfectly.

It was sitting in a file cabinet at the small hospital back home that did not deal with high-risk childbirths.

At the new hospital, things happened quickly. Nurses, doctors, and lab techs hurried in and out. There was discussion about whether the delivery could possibly be delayed by even a day, but my blood pressure readings and lab results said otherwise. I was whisked to another room to have an ultrasound to determine the baby’s approximate weight and position. The baby’s position was “frank breech”: upside down, butt first, legs folded up. This, I was told, meant a C-Section.

Amidst all this, Jane arrived, the picture of grace, bearing a light pink peony she had just picked from her garden. It was beautiful, the color of calm. She placed it at my bedside, and it became my focal point as I took slow, deep breaths and tried to digest all the new information.

A nurse said, “Someone from NICU will be in to talk to you about your baby’s care.”

There were questions about what and when I ate last, discussions about the surgeon’s schedule. Then, all at once: “You need to be prepped for surgery. Now.”

As they wheeled my away, I thought, nobody’s been here from the NICU…

Is it possible to know what to expect from a C-Section? I imagined it would go something like this: After one clean, precise cut across my lower abdomen, during which I would feel nothing, a surgeon would lift my daughter out of my body as if she were an English muffin coming out of a toaster.

The reality was nothing like that.

After being assured that the spinal anesthesia needle would feel like a “bee sting” (it actually felt more like having a dull pencil forced through my skin), I was ushered to the operating table.

Jane, now in a blue surgical cap and gown, was at my side, holding my hand. I felt a wave of gratitude, along with a vague feeling of shame. Though she was aware of my views about pain medication, she was, generally speaking, an advocate for nature childbirth. Now here she was, tending to me during an emergency delivery that was anything but “natural.” When I said this to her, she made a gesture like she was swatting at a fly, and said, “Don’t be silly. Natural childbirth is beautiful. But you know, with a pregnancy like yours, surviving your childbirth is also a good thing.”

I could not disagree.

A sage curtain was drawn across my midriff. I appeared, I’m sure, like the sawed-in-half circus girl. My belly, now numb, seemed like a phantom limb.

Chit-chat and laughter floated from different parts of the room. There were half a dozen doctors and at least as many students in the room, but none talked to me. The bantering I heard between them seemed oddly festive, a counterpoint to the frenzied rummaging around my body that was happening

Near the place where the curtain divided the room, I saw a thick plastic tube. Blood was passing quickly through it, and it took a minute to realize it was coming from me.

Jane followed my gaze, then casually positioned herself between my disembodied upper half and the tube, obstructing my view. “You’re doing great,” she said. Though at this point, I was not doing much besides blinking.

Then, the surgery was over, and a whirl of activity ensued.

My newborn daughter was held up by a pair of gloved hands for me to see, then whisked away so quickly that I couldn’t even hold a mental image of what I’d just seen. “Did you see her? Is she ok?” I asked Jane.

“She’s great, she’s beautiful,” she said.

She’s ok.

My eyes filled up as I waited for my daughter to be handed to me.

In retrospect, this was completely illogical. The doctors had estimated that my daughter was only three pounds — it was clear, should have been clear, that she would need intensive care immediately. Still, this last remnant from the Birthing Plan scenario, this moment of first contact I had imagined and re-imagined so many times, had not been rewritten in my mind yet.

So I waited to hold my little girl. And when I realized she’d been whisked away, and was in fragile condition at best — my preemie girl, the daughter I’d already begun to love — tears started down my face.

“I know,” said Jane, who, returning to my side, assumed she was witnessing tears of joy. “She’s beautiful, right? Congratulations, mama.”

For weeks, I was a NICU mommy . One of the consequences of my daughter’s premature birth was that she did not have her suck-swallow-breathe mechanism in place yet. She had to be fed through a tube, and the skin-to-skin bonding of breastfeeding I had wanted for us was replaced by “pumping”, machines and feeding tubes between us.

During the early days, when she was too fragile to be outside the incubator, I’d reach in through the portal touched her tiny arms or legs. To my relief, she was declared a “feeder and grower”, meaning that had no serious medical problems and would simply need to grow enough to be brought home.

NICU milestones are different. First, there was the point when she could be outside the incubator for periods of time, though still being fed through a tube. I sang to her and practiced “kangaroo care”, her fragile, bird-like body nestled up against my chest.

Next, she mastered nursing. This was a huge triumph, though not the last of her feeding tube days — she initially exerted so much energy nursing that she slept for hours afterwards, ultimately losing weight.

Eventually, she was deemed ready to go to the Continuing Care Nursery and try an “open air crib”, meaning that she, herself, rather than the incubator, would be regulating her body temperature. It was there that she reached the magic four pounds, the minimum weight requirement for being discharged.

The final hurdle was transportation home. The car seat I had purchased was far too big to carry her safely. A special preemie car seat was obtained, which only meant that she was now ready for her Car Seat Test: she had to sit for five minutes in a specially-made preemie car seat without her vital signs crashing.

When she failed the Car Seat Test, I was clobbered with a feeling of discouragement that I had not experienced since my worsening illness. It seemed that life outside the hospital would never become a reality for us.

The hospital social worker gave me information about a special car bed for infants who could not use regular car seats. It would have her lying flat, the bed seat belted, in the backseat. I immediately authorized the purchase of one. At long last, I began to arrange our return home.

The last obstacle came when the preemie clothes I had purchased for her slid right off her tiny body. My mom came to the rescue with doll clothes, bonnet included. My baby looked like Laura Ingalls Wilder, prompting me to post a picture of her later with the caption: “Little Preemie on the Prairie.”

The first months home were a whirlwind of visiting nurse appointments, pediatrician visits, and early intervention sessions. During this time, I requested all of my medical records, from nursing notes to lab result reports. I wanted to see everything, which must have worried the medical team worried that a lawsuit was coming.

Actually, I was not thinking in terms of a lawsuit at all. What I wanted was a sense of understanding the trajectory. Seeing where and how we went from this detailed childbirth plan I had committed to paper, to the wild ambulance ride, surgery, and NICU weeks. I wanted answers.

So I gathered and pored over my medical records. I researched preeclampsia and premature birth. I looked at all of it exhaustively, but found no trail of bread crumbs to follow.

The reality was this. I was heading one way, the way of The Usual Pregnancy and Delivery, then veered dramatically in the opposite direction. If it was preventable somehow, I may not ever know. Certainly I do not know now.

Today, my daughter is eight, and we are a household of two. She has light brown hair, goes to dance lessons, and says with authority that you can’t see a dinosaur anymore because dinosaurs are now “distinct”.

Though I will never forget the dramatic events surrounding her birth, the older she gets, the more those anxious days of first being so ill and then keeping vigil at the Neonatal Intensive Care Unit recede into the past. Still, I find myself revisiting her birth sometimes, an event so unlike the birth I had tried to outline in advance for us.

Through the process of creating a Birthing Plan, I had envisioned the details of my daughter’s imaginary birth with the thoroughness of a Broadway show director. Nowhere on the form had I specified the ride in the ambulance, the fear that one or both of us wouldn’t make it, the unselected hospital with the surgeon who held up my uterus for inspection by a group of strangers. Yet, I’m not sorry that I imagined my optimal birth in such detail, because it helped me to feel more in control and relaxed at the time, and you know, it could’ve gone that other way, too.

Life, after all, is made up of two categories of experiences. First, there’s the stuff of plans. Things we decide upon, orchestrate. Blueprints and objectives. Small steps we take toward larger goals.

Then there’s the rest of what happens to us. Those experience outside the margins of To Do Lists and best-laid plans. Sometimes bizarre, sometimes terrifying. Often spontaneously beautiful. The moments that take us by surprise, descending unexpectedly like a disconnected spider web after its journey on the wind. And whether we enjoy them or survive them or elements of both, they change us. They make us know more deeply who we are.

And so unfolds the story I tell when my daughter asks me, wide-eyed, “What was it like when I was born?” The Birthing Plan story lines up on one side, and the actual childbirth story on the other. I pull her close to me and smell her apple shampoo-scented hair and say, “It was like this…”