Alan Arvesen (aarvesen) wrote,
Alan Arvesen

The Labor

Depending on how you count it, the labor had already been going on for 62 hours. Michelle's contractions started on Sunday morning at 4 am. By noon they had gotten down to four minutes apart and we went to the hospital for the first time. The doctor said she wasn't dilated and that the contractions, though well timed, were not "productive". He sent us home.

Contractions continued all the next day. We went back to the doctor at 1 on Monday afternoon and there was still no dilation. We were just two days away from the due date, so we discussed what our options would be. The doctor suggested that we could induce labor if contractions continued much longer. He took the folder that her medical records were in and drew a quick chart. He explained that the best time for the baby to be born was right about now, as it would not be too early (when they may have breathing problems, etc) nor too late (when they are bigger and more difficult to pass, and they may possibly have a bowel movement while still in utero). He pointed to the dip he had put on his chart and said that this is where we were right now in terms of risk for the baby. He drew a flat line across the chart, very low, to indicate the risk of induction. He said that there were possible risks, but that they remained constant, regardless of when we induced.

We agreed to give induction a shot on Thursday if nothing had happened.

Monday night and early Tuesday morning, the contractions greatly increased in strength. We had stopped bothering to time them. Michelle could not sleep. I could barely sleep. At about four in the morning, Michelle's spirits were at a nadir. The pain had increased along with the strength. I tried to calm her down. I told her, it's normal to feel pain. I told her, Trapper's office opens at 7:30, we can call immediately when they open. I told her, we can call him right now if you'd like. I told her, we can induce tomorrow if that's what we need.

Right at 7:30, we called Trapper's office. They said meet him over at the hospital, he was already there delivering. When we got there and they examined Michelle, she had dilated to 4 centimeters. Trapper observed, "We've got a keeper."

Michelle's contractions were very strong, but they were no longer regular. Trapper suggested that we go ahead and start a pertossin drip. This is what they use to induce labor, but in this case it would be to get the contractions closer together. He suggested that Michelle had endured enough and would probably be best getting an epidural.

Epidural at 11:15. Pertossin about 11:45. Trapper broke her bag of waters during the noon hour, and Michelle managed to get a little bit of sleep. The baby continued to move lower during the afternoon, and at 4 pm Trapper pronounced Michelle fully dilated and said it was time to push. He advised us that first time moms take a little longer, but he hoped that we'd have a baby by six o'clock.

Michelle pushed for two and half hours. Around 6:30, our nurse was consulting the endless readouts that measure both the mom's contractions and the baby's heart rate. She told us, "just push every other time now."

Trapper came in a few minutes later, perhaps to a silent summons from our nurse. He also looked at the readouts. He asked Michelle to stop pushing.

From the looks of things, he explained, the baby appears to be getting tired. At this point, it's not good for her to keep on pushing. We have to discuss our other options.

These options are essentially either a mechanical extraction, in this case forceps, or a caesarian section birth. Trappers assures us that he is an old pro with the 'ceps; two of his four kids were born that way. However, there are risks to the baby, all the way from bruises to brain damage. He believes that the c-section is less risky for the baby, but that it is a much higher risk for the mother.

"Any way we turn now, there is risk."

His suggestion: prep for the caesarian. While Michelle is on the operating table, he will give the forceps a shot. If those don't work, they can immediately preform the cut.

I am holding Michelle's hand. All I can smell in the room is blood. I can see Trapper standing there, patiently waiting for an answer. I don't know if our nurse is looking at us. Michelle is looking at me and she is thinking.

I think of the women I have know who have had caesarians. They are laid up for weeks after the birth. A c-section is major surgery, cutting open the woman I love, possibly watching her die on the operating table. I think of Michelle before she was pregnant, of holding her smooth, flat belly in my hands and wondering what the scars would look like, what would happen to the tender veins and the hard muscles once the knife tore into her.

I think about some distant image I conceived of when I was small, back when I had asked someone, probably my mom, about forceps. I have no idea when this was. I was probably five years old. But I clearly see the tongs of the forceps, which in my mind look like the tongs my father used to move hot charcoal in our grill, crushing the head of small child in an x-ray like view. I know the forceps look nothing like that. I know that people are delivered this way. And yet, and yet.

The forceps we saw in our baby class are much larger than those tongs. The blades are as large as your hands. They are light and metal and hollow, almost as if they were something you'd find on an expensive racing bicycle. I imagine those bladed hands entering my wife, I imagine those bladed hands crushing my child.

No matter which we way we turn, we are faced with risk. There is violence at every turn.

Probably no more than a second has passed. Michelle is still looking at me and thinking.

James Dickey said that the problem with peace time is that you never get to find out if you're a coward. I get to find out right now: I am awash in fear, crippled with the terror, and I have to make some sort of decision. I have to act. All my sins, all my lies, all my bullshit come down to this. What do you do? What do you choose?

Who do you choose?

In these fractions of second, I feel my fear crest. I let it come. It let it go. I feel inside of myself for a place of clam that I know will be there. Inside my chest, inside my heart, I can feel it, the softly ringing silence. I have been to this place before. I was here when I stopped that guy from coming down the aisle of the bus towards Traci. I was here when I told Andy that I was quitting, throwing away my career, getting in my car, and "driving East". I was here when I was fumbling for my words with Michelle, trying to pull the ring out of my pocket.

It's the place I always imagine you'd be if you were ocean size: huge and silent, no talking, just all action. It's the place I imagine where the tao lives, or what is left when you finally stare mu shin or sunyata in the face. I imagine it's where the saints and martyrs go.

Courage is not the absence of fear; it's having the proper amount of fear towards the proper things.

I want my baby. I want my wife. All choices are freighted with risk. I must be strong, I must be brave, I must not fear.

The calculus of ascending risk seems to me clear: forceps then c-section. Michelle is saying this to me. I am agreeing with her. This has all happened within seconds.

They put me into an operating gown, cover my had in a shower cap, give me enormous rubber boots and a mask. All of the nurses are now wearing masks as well; their eyes are watchful and detached above the blank squares of white. I make some weak joke asking Trapper if, since we are going to be in the OR together, he will please call me "Hawkeye". I don't remember what he says back to me.

They ask me to wait by the sinks where they scrub in. I am in a metal chair, hollow and light like the forceps themselves. No one is exactly ignoring me, but it is clear that no is talking to me either. I watch the blank faced nurses, intent on their tasks. I watch Trapper talking to a younger doctor, telling him "Not sure if I'll need you" but asking him to be ready just in case. I watch Trapper talk to an older doctor, kidding each other about "causing trouble". Just a couple of old boys doing their jobs.

The fear has not left. It's a palpable presence with me at my side. To keep it under control, I think about the Litany Against Fear. More than one person has confessed to me that they, too, have fallen back on this tiny bit of fictional comfort. In the midst of all the ridiculous, rococo world of Dune, the imaginary ninja-catholics got this right.

"I must not fear. Fear is the mind killer, fear is the little death. I will let me fear wash over me."

Days later, I will look up the Litany on the net to see how close I got it right

I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
I will permit it to pass over me and through me.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing.
Only I will remain.

Right after seven o'clock, they tell me that they are ready in the OR. Inside, the walls are yellow and the table is black leather. It all looks older than I thought it would. There are about ten people standing here. Michelle is on the table, a sheet draped across her middle just as you would expect it to be. They have moved the metal chair inside the room now, and put it by Michelle's head.

The doctor Trapper talked to earlier introduces himself as Kevin something. He is the anesthesiologist. His face, like mine, is covered. Another man talks to me over my other shoulder. His name is Cody and he is with the newborn ICU. They will examine the baby when she is born. His face is also covered. He asks me if I know the gender, and congratulates me. They both shake my hand. Everyone refers to me just as "Dad".

I sit by Michelle. I hold her hand with my left and with my right I stoke her hair. Behind me on the right is Kevin; behind me on the left is the team from the NICU. On the other side of the sheet are a half dozen nurses, including UT nursing students. They stand in a loose semi circle, quiet and watchful. To my left the machine which measures contractions is going again, and a single nurse is watching that.

Trapper stands in the middle, between Michelle's legs. He has an affair of absolute competence and authority. He walks forward with the forceps and shows them to us. They are cold and metal and hollow. He does a quick demonstration of pulling on his fist with the blades. I can't help but think this is like the medieval torturer, showing the victim the instruments before he is put to the Question.

Trapper resumes his spot below Michelle. Someone else is by him. Trapper advises us that the nurse by the monitor will tell us when the next contraction is. When it happens, Michelle will push three times. He will try the forceps for the three pushes of that contraction. Then, we will go to scalpel.

Trapper tells the nurse to tell us when the next contraction is. Then he announces to the room, "let's see if we can have ourselves a baby."

When the nurse says it's time to push, Michelle crushes her face in effort. She tells me later that she has never pushed harder for any reason at any time in her life.

Push, push again. Push a third time. Ninety seconds to go for the next contraction.

I can see that Trapper has put aside the forceps. I don't know what this means.

Ninety seconds later, the nurse excitedly tells us to push again. Michelle pushes once, pushes again. I hear someone say something about the head. I stand up to see over the sheet. In Trapper's hands, I can see our baby: silent, brilliant purple, one foot still in the birth canal, eyes wide and surprised to see this bright cold world.

It's 7:09 pm on Tuesday, February 3, 2009.
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