Thursday, January 08, 2009

William Orion: Part One

(Due to length and time constraints I am breaking up this story, this is the first part and goes only through the birth day, I will post the second part, which will cover his hospital stay (or that's the plan) as soon as I am able.) Name and birthdate have been changed for privacy.

I was on my hands and knees on the living room floor, which had not been the plan. The nice, warm birth tub sat within touching distance, but plans for a water birth were out the window. The head wasn't advancing as well as the midwives wanted so they had moved me in an attempt to open up my pelvis. I have bad hips, pretty much anyone who knows me knows that since my day's activities have been planned around my limited mobility for the last several years. My pelvic girdle is tipped, rotated a bit down and in. I'd talked to multiple doctors, OBGYNs, and midwives before going through with a home birth. They all assured me I had a low risk pregnancy and should have more than enough room for baby to be born, and, even if it was a bit tight, my joints were so loose that the rigors of labor would just move everything out of the way. The dangers, they all agreed, were towards me. We went into the labor with every expectation that I may dislocate a hip or separate my pelvis. It didn't concern me that much, after all, I dislocate things all the time and, while rotating something out of place the first time hurts like you'd expect, a non emergent trip to the ER to wrench something back into place (or maybe just with a chiropractor) seemed a lot nicer than arguing with doctors about a c-section whilst I was in labor.
I have Elhers-Danlos Hypermobility syndrome, a genetic, connective tissue disorder that causes, as suggested by the name, extreme mobility in my joints due to laxity in connective tissue (tendons, ligaments, and, to a lesser degree, skin and cartilage). It also causes other problems, wounds heal very slowly, scars are wide, fragile, thin, like rice paper, I don't respond to pain medications properly, and damage done to tendons, ligaments, muscles etc, never really fully heal. (I re injured the same muscle four years in a row in track and, even 12 years after the initial injury, still feel the strain on the muscle some days. The rib I put out of place about 16 years ago still rotates out of place almost weekly) So, while I realize there is a 3% chance that a c-section will be medically required, I did not want to put all the muscles in my abdomen, not to mention my womb itself, in the hands of doctors with a nearly 40% c-section rate (not to mention that there was a fairly high likelihood that an epidural would work poorly or not at all on me). Add to that the normal complications inherent in a hospital delivery (mortality/morbidity rates for hospital births for mother or child for a low risk pregnancy hover around .02%, for a low risk home birth, .01%. The risk for serious complications is also statistically higher for hospital birth than home birth) and the last thing I wanted was to be in a hospital. While the logical statistics is what ruled my decision I will admit that, if the statistics had been equal between them, I still would have chosen a home birth as the thought of being 'delivered' by a doctor is repugnant to me. Labor is not something either mother or baby need be delivered from. I wanted to birth my son and deliver him to the arms of his father, not have some doctor pull the proverbial rabbit from the hat in delivering the baby from me.
So we were at home, with myself and my husband, a birth tub, 1 nurse midwife, 2 direct entry midwives, 1 apprentice, my two parents, his mother on speaker phone, 1 cat who had judiciously hidden herself hours ago, and a partridge in a pear tree. Orion had been monitored the whole time by Doppler and, right up until the time they moved me from the birth tub, his heart beat had been steady and sure. But now something was wrong.
They had told me once the head was birthed we'd be able to pause, to have a bit of a breather, but the head was out and everyone was still calling for me to push. Someone called for oxygen, and I thought it was for me. When he was born, only 3 or 4 minutes after me being moved, they didn't hand him directly to me. I still didn't really realize anything was wrong. I knew enough about labor and delivery to know sometimes you have to bulb out babies, give them a bit of oxygen and stimulation to get them to start breathing. It's not a big deal and is relatively common. We'd been ready for something to happen to me, baby had been given a complete screening, genetic tests, diagnostic ultrasound, and the odds something would go wrong was so remote, the odds something would go wrong with me so much more likely, that none of us were really ready for the possibility. Then I heard something I'll remember for the rest of my life: "One, two, three" pause "one, two, three" pause. That measured beat that anyone who has ever taken a first aid course would immediately recognize.
William Orion was born at 6:45 pm on August 8th, 2008 without breath or pulse.
The midwives had an oxygen mask on him immediately and a heartbeat back within about 30 seconds. My husband was calling 911; he couldn't talk, and one of the midwives took the phone from him. For a moment I could see my baby, a bit of face and chest, and managed to reach back and stroke his cheek once. Then he was gone behind a wall of midwives working to keep his heart beating and trying to get him breathing.
We heard sirens literally seconds after we had called 911, and the paramedics were there within minutes. They didn't have a backboard for an infant, and Orion was carried out on a cookie sheet by the midwife. Benjamin and my father went with the midwife in the ambulance. My mother and I, along with the rest of the birth team, would follow as soon as we were able. It took a bit more than a half hour to get me out the door, and it took two people to get me down the stairs.
At the hospital we learned what was wrong. Orion had a hypoxic brain injury and a severe meconium aspiration. The doctor said on the scale of brain injuries he was a 'moderate' case. It was, as he said, worse than 'moderate' made it sound, but a lot better than it could be. He explained that they had very good outcomes with cooling to reduce brain injury by keeping swelling down. As far as his lungs were concerned he was on a respirator and oxygen. They were having difficulty keeping his oxygen saturation up but, for now, it was within reasonable ranges. The doctor was hesitantly optimistic but advised us he would be in the NICU for at least 10 days.
He was also a complete jerk, rude to both our midwife and my husband and myself, clearly looking down on us for having a home birth, and wanted to run urine tests on Orion because I was "a chronic narcotics user" (I was on prescription pain medication, under supervision of 3 doctors, while pregnant, but had been off them completely for the last full month of pregnancy so that Orion would be born without any chances for side effects of medication withdraw. My pain management doctor had told me I could safely stay on them throughout the pregnancy but that the baby would have to be checked into the hospital for a safe detox if I was still on the drugs when he was born. I didn't want that, so I was off all pain meds a full 4 weeks before his birth, just in case he came early).
When I went into the NICU Orion was shaking uncontrollably. I was in a wheel chair, unable to stand, so I couldn't really see him, just a bit of his side really. But I could reach up and touch him. He was so cold. 91 degrees sounds warm, but, in reference to normal body temperature, its very cold. My son was born, but there was no warm embrace, no soft lit room filled with loving family, no first suckle. Instead he was cold, shaking, hooked up to tubes and I.V.s out of my reach, out of my arms, the loving family was restricted to two at a time by his bedside in the NICU, and he was getting his nutrients from an I.V. while I was trying to use a breast pump. My husband and I sat there, 10 days, at least 10 days before we could have our baby back, but we were optimistic. We knew, either first or second hand, of many babies who had spent a few days in the NICU after birth, 2 for exactly the same problem, who had come home safe and sound after a few days of oxygen and care. We learn new things about those we love in times of stress. I responded to the overwhelming emotional stress in my customary way, by affecting a clinical detachment that allowed me to remain functional. Despite nearly 24 hours of labor I was awake and wheeled into the NICU several times that night to speak with the nurses and watch my newborn son tremble in his crib. Ben? He responded by a nearly coma-like sleep, trusting me to wake him if something happened. And thus ended the first day of our son's life.