Saturday, January 14, 2012

"I'm so glad she was in a warm place"

This past winter I was so privileged to be a doula for my beautiful sister in law Aya, to attend hypnobirthing classes and prenatals with her, and to be present for the birth of my little niece Akane. Aya was excited to have a natural birth because that is her tradition in Japan, where birthing women rarely use pain medication, usually only in cases of emergency. Aya's sister had also given birth last July after 27 hours of labor, and Aya was very inspired by her. This is the story of the first birth I ever witnessed. 

Aya called me excitedly the night of January 12 to tell me she had been dilated to a 2 at her midwife appointment. Early the next morning she started surging and I was so excited she was beginning her birthing time on a weekend when I wouldn’t have to worry about canceling work. Laurel and Mary were already with her when I got there. Aya’s surges were about 4 minutes apart and remained between 4 and 3 minutes apart most of the day. She was handling them so cheerfully and gracefully. When a surge hit, she simply dropped to her knees as fluidly as water falling and quietly breathed through it as one of us put counterpressure on her back and whispered “Good, Aya. Good job, you’re doing beautifully.” We must have said those phrases thousands of times that day. When the surge ended, Aya would pop up with her sweet, calm smile and continue doing whatever she had been before. It was a long day of surging and getting more and more excited for baby. My brother came home early from work and Aya teared up when she saw him—she reached out for him and spoke tenderly in Japanese. 
**In an effort to be culturally conscious, we had Aya teach us some "calming" Japanese phrases and referred to our page of notes as we were doula-ing, but I'm fairly sure our pronunciation was wretched, although Aya was too sweet to tell us. When Diana arrived, she made fun of us and whispered "Toshibi." "Mitsubishi." "Sushi" and Aya cracked up. Well, we did our best.

We spent the rest of the afternoon quietly preparing for the birth. Aya went for a walk with the twins, surges got stronger, and at about 6 PM Garrett and Aya decided it was time to go to the hospital (AF). The surges slowed down in the car and then picked up once we walked through the parking lot. It was so exciting!
Aya dropped to her knees with a surge just as we walked through the automatic doors in the hospital entrance. She lowered her head, moaned and breathed through it as several people walked in past us. The mood was tense, exciting, vibrating with energy. Aya had another surge in the elevator and another just when we walked through the L&D doors. Mary and I hovered over her, rubbing her back the way she requested and whispering soothing words.

The nurses passionlessly observed us from behind their desks. They waited until we stood back up to ask their questions. Aya was checked in and put in triage.  Since triage was tiny, Mary and I left Aya with Garrett and ran off to get food (which we would never have done if we’d known about the trove of tasty treats available in the birthing suite). I remember looking around at all the people in the diner and marveling that they had all been born once, they had their own day when they were the joyful news.  For most of them, today was just an ordinary day—they were going about their business, grabbing a burger, while just a few minutes away a new soul was brimming on the horizon, about to enter the world.

When we got back we met Jen, Aya’s midwife. The first glimpse I saw of her was her wrapping her arms around Aya who was completely limp and leaning into her during a surge. When it was over, the midwife stood back and beamed at us. She hugged us in greeting, asked us our names. She exclaimed, “I’m so excited for Aya! This is going to be such an amazing night!” I loved her attitude. Birthing professionals see babies born every single day, but she was right, for Aya this was special, it was going to be an amazing night.

Laurel had come back by that time and right away things I could tell that things were a lot more intense for Aya. Where before she had been "coming up" between surges, smiling and talking normally to us, now she was staying down in that quiet place where you don’t have the energy to do anything but breathe in that tiny space between surges. She asked to get in the tub so we filled it up and she climbed in. I really feel that a birthing woman is holy, and Aya looked so beautiful and holy as she hummed and sighed and worked to bring her baby closer. She was steady and full of determination as the surges started coming harder. Her face was so relaxed and gentle, but we could tell that her body was demanding more of her. She had a new vulnerability with being caught in a place between peril and power. 

We were all of us crowded in the bathroom, getting our knees wet, rubbing her back and pouring hot water over her shoulders, the nurse darting in every once in awhile to check the heart rate. Aya began to moan through the surges and we were all making the noise with her, humming low and drawing out the breath as if we could take some of the edge off. Since the bathroom was small, we took turns sitting on the edge of the tub. I remember once Garrett came in and kneeled by the tub; he wrapped his arms around his wife and she just clung to him as he murmured to her in Japanese. All of Aya’s interactions with Garrett were so sweet to witness…her need for him was so acute while she was birthing, there was a raw, open love between them. Eventually Aya wanted to leave the tub and she stood up cold and shivering. She had been checked in the tub and was at a 5.

We helped her dry off and she crouched and kneeled on the bed for the next surges. By this time she was visibly wearier, her eyes were tired and the surges kept hitting her harder. Jen came in and encouraged her, we dimmed the lights and Garrett played some of Aya’s favorite music on the ipad and song to her softly. At this point as labor progressed and got even more intense, Aya got a little sharper and was quick to tell us what she did and did not want (no more singing, quick rubbing instead of counter-pressure on her back). She stood at the side of the bed and swayed her hips. I have a clear memory of Laurel kneeling on the other side of the bed holding onto Aya’s hands, smoothly telling her how beautifully she was doing. (“Really? Are you sure?” Aya slurred. “Oh, thank you so much!”)

We were suspended in a zone that seemed separate from time. We had been at the hospital about 3 hours now. Jen checked Aya again and she was still at a 5. (Really wish they didn't have mandatory cervical checks in the hospital, they really are an inaccurate gauge of how long labor will be--as you will see--and they can be SO discouraging!~) Aya groaned when she heard that, a little desperation seeping into her voice. “A FIVE? Really? Still?” she pleaded before she slid into another surge and she was falling back on the bed, my brother was holding her. When she came out of it, Jen said (I am including this quote because I feel she handled it so respectfully) “You know, Aya, I can tell you’ve been working really hard and we haven’t made a ton of progress, so we have the option now to break your water and see if that gets your contractions going a little stronger. It will make things more intense, but it can also possibly hurry things along. I don’t think it’s the right choice for everyone, and it’s totally up to you to decide, but we’re at a point where it might be the right choice for you now. I’ll let you and Garrett talk about it and you can let me know what you would like to do.” Aya and Garrett quickly conferred and right as the next surge was beginning, Aya gasped, “I want to—I think you should do it—“ and then she fell back into the surge. Jen broke her water and Aya cried out, “It’s warm!” We all laughed and said “Yes, yes it is,” and Aya exclaimed, almost tearfully, “Oh, I’m so glad she was in a warm place! I don’t want her to be cold!” It was so sweet to see how her thoughts were with her baby even while her body was experiencing something so huge and all-consuming that took all her strength.

Around midnight, Laurel had to leave to take care of her nearly newborn baby. She was disappointed to have to leave before the baby was born and she spent her last minute just holding Aya during a surge. When she said goodbye, Aya said “Okay—I love you” and continued moaning and rocking her hips through a surge. They seemed to be getting bigger and bigger. Her back was turning red from where she constantly asked us to rub her skin—if we stopped, she flung back her hand and did it herself—and her energy was dipping. She finished a surge and told me, “Rachel, I don’t want to do another one. I don’t want it to come back.” We kept telling her that she was doing beautifully.

Diana arrived at the hospital just as Jen came back in and asked Aya if she wanted to be checked. She did and got up on the bed, with Garrett huddled up near her head. As she was checking Aya, Jen met my eyes and very slightly shook her head. My heart sank—at that point Aya had been hearing that she was a 5 for nearly five hours. Her horrified face when Jen gave her the news broke my heart. Jen slowly and calmly explained that she didn’t want to mention this, because she knew it was against what Aya had been hoping to do, but that an epidural would allow Aya to rest and have some relief. Jen finished by saying, “I just want you to know it’s an option, and it is completely up to you. I won’t mention it again, so you’ll have to let me know if that’s what you want.” Aya told us that she was feeling tired and discouraged and was considering getting the epidural. We all voiced our support of whatever decision she made. I told her that at this point in my labor I had already had my baby and had no idea what it was like to go that long—trying to ease the pressure she seemed to feel. We also mentioned the possibility that, if she wanted, she could get an epidural to rest and then have it wear off before she pushed the baby out. She said “Really?” and then moments later she said in a heart wrenching squeak, “Yes, please, I choose the epidural.” As soon as she said the words, another surge slammed into her and we saw her tense up against it. I remember saying to Jen, as nurses started rushing in the room with plastic bags and an IV pole, that I wished I could do it for her, so she could have a break. Jen said she would gladly take a few hours of Aya’s labor, too, and that she often wishes that when she attends births, that she could take the place of the birthing mother and share some of the labor. But everyone has to cross through it on their own—not alone, certainly loved and comforted and supported through it—but no one can do it for you. 

As the nurses flipped on the lights and started unwinding the cord on the IV, somehow these desperate words burst out of mouth—“Is there any way you could just check her one more time?” (This was really none of my business and probably not cool, and I own that.) Jen turned to Aya and asked if she wanted to check once more just to make sure she still had not progressed, and Aya agreed. We held our breath as she slid on the glove. I don’t know why I asked—it was completely impulsive, I think I just wanted to make sure she was still at a 5 before she gave up her hope of birthing without drugs—and then I saw the look of wonder on Jen’s face and heard her say, “Aya—you are at an 8 and a half!” It felt as though the whole room took a fresh new breath of air. Jen leaned close to her as Aya’s face was screwed up in concentration and told her, “If you want the epidural, we can do it right now, but Aya, I really think you can do this. You are strong enough to do this—you don’t have to, but you are strong enough. If you want this, it is yours.” It felt huge. Aya’s eyes were shut tight: “I can do it. I will do it.” She wanted to go on. We helped her kneel at the side of the bed again and she met the next few surges with dogged strength and determination. “I can do it!” she chanted between every contraction. “I can do it, I can do it!” We were all cheering her on, chiming in with her words of affirmation. She threw herself back into it with new resolve, kneeling and resting her face and arms on the side of the bed. She was exhausted but determined.

She got back in the tub and sat upright, moaning through the surges. Diana calmly sat on the edge of the tub, pouring water over her back. Aya was gone by this point, to the same primitive zone all birthing mothers get to since the beginning of time. It really felt like she was not in the room with us, she was completely inside her own body. She wasted no energy; her eyes were closed, she was silent between surges. She no longer responded to anything spoken in English, which I found hilarious, so we kept asking Garrett to translate for us. Even in Japanese it took a couple of tries to get a response. If Diana was too slow with the water, Aya would begin frantically splashing her own back. 

This went on for maybe 30 minutes or so, the last slow, thick moments of transition. Then suddenly everything changed. The eleventh hour arrived. Aya’s back arched and she suddenly flung back her head and bellowed “PUUUUUSH! I want to PUSH!” I scrambled, fled to get Jen and we ran back to the room where she slipped on another pair of gloves and asked Aya if she “felt like going to the bathroom.” Aya snapped “No, I’m not going! I already went!” Jen tried to clarify what she’d meant, but Aya shouted again that she wanted to push, and in an instant Jen declared her complete and said “Let’s have a baby, Aya, I think we’re ready to do some serious pushing.” She squatted by the side of the bed while Garrett perched above her, arms wrapped around her, and the twins, Jen and I crouched underneath (VIP seating) while Aya started to bear down. She cried out and within minutes we could see the baby’s head crowning.

I have never seen a live birth before and I could never find words adequate to describe this moment (I’m tearing up right now just recalling it). A first-time mother finding the strength inside her to push her baby out into the world is the most heartbreaking, magnificent, moment that exists. There’s a sense of dismay as she realizes what this is going to take, more than she ever could have imagined, and some ancient, mighty instinct that kicks in and fills your whole being with a sense of you must do this, it belongs to you. Watching that happen is like despair and glory. It must be symbolic of every other part of motherhood. It is pure power. It made me feel awe, reverence, almost a sense of worship. The prayer in my heart was Please have mercy on her! Please let her be done soon, she has worked so hard. And mixed in with that was a fervent Bless her! 

The twins and I squeezed each other’s hands as Jen reached up and placed her hands around the baby’s purplish emerging head. “Good, Aya,” she called. “You’re doing it!” The feeling in the room was glowing, dizzying intensity. Once the head was out they shouted at Aya to straighten up, and hefted her on the bed and then my little niece Akane just slithered out into the world and her 20 hour journey of labor was over. Mommy and baby were together at last on the outside.

“Oh!” Aya exclaimed over and over again. “My baby! My baby!” Akane was on her chest, a floppy squishy fish child, being vigorously rubbed by Jen and the nurse. They instructed Aya to talk to her, and when she did, she let out her first squeaky cry. Aya was crying, too. “She’s so beautiful! I am so glad she’s not bald!” We were all laughing. Within a few seconds the oxytocin kicked in and Aya became drunkenly obsessed with everyone in the room. “I love you Jen, I love you forever! I love you Garrett!” Jen told Aya, “I do this for a living, and you impressed me today. I don’t say that often. But you really went above and beyond!” Aya was beaming so brightly as tears slid down her face. I touched her arm and told her I was proud of her. She said “I AM PROUD OF MYSELF!” I hope she always remembers that. My favorite moment after the birth was when she proudly cut the cord herself. I remember her face before we left that night; exhausted but peaceful. Aya is a birthing warrior. She was a hero that night, to her baby and to me. I hope she is happy with her birth, and it was an honor to be there and witness my niece coming into the world!
Akane weighed 7'13 and screamed while she was being weighed and bathed, then fell right to sleep when she came back to her mommy.