A Dark Day

Yesterday afternoon, my doctor gave me the news I’d been dreading.

I am miscarrying.

Our baby is dead.

I expected that. I started spotting on Tuesday and the bleeding and cramping has intensified over the last couple of days. The ultrasound and first blood test were inconclusive. We needed a second blood test for a trend. But my doctor and I both suspected what we would find.

Our baby is dead.

I grieve the loss of our fourth child. I grieve my children’s loss of a sibling. I grieve for baby hands I will never hold, for baby smiles I will never see.

But I do not grieve as those who have no hope.

I need not question whether or not God is for me.

His Son died.

That is answer enough. He is for me.

His Son rose.

That is answer enough. I have hope.

Please pray for us as we grieve.

Rupture happens

Select at random from the massive group of women who’ve had c-sections in the past twenty years, and ask them about rupture.

Chances are they’ll tell you that uterine rupture is common and life-threatening for those who choose to VBAC (have a vaginal delivery after a c-section.)

They’ve gotten this impression from doctors, hospitals, and insurance companies who, after a ACOG (American Congress of Obstetricians and Gynecologists) position paper in 1998 decided that VBAC was too risky to support.

On the other hand, talk to a bona fide crunchy-granola homebirth mama and you might get the impression that uterine rupture doesn’t actually happen – at least, not with any frequency.

Neither are quite true.

Rupture happens.

Some degree of separation along a former uterine scar occurs in up to 3% of VBAC attempts. In less than 1% of VBAC attempts, a complete separation of the scar occurs, requiring an emergency c-section to avoid life-threatening complications (in other words, a TRUE emergency c-section, as opposed to the much more common “failure-to-wait” section.) In the remaining 1-2% of VBAC attempts that result in rupture, the separation is small and/or partial and requires no treatment other than monitoring hemoglobin levels. (Data from VBAC.com.)

Generally, these incomplete ruptures are caught by manual examination after a VBAC. The attending physician sticks his hand inside the newly delivered mother’s uterus and palpates the incision scar to see if there are any holes or weak spots. Yes, it really is as awful as it sounds (It was more painful for me than the previous 42 hours of unmedicated childbirth.)

My rupture wasn’t identified in that manual sweep. It was discovered by ultrasound a week later when I went back to the hospital with intense abdominal pain. That we know of, the pain wasn’t caused by the rupture – the pain resolved on its own before I left the ER.

My hemoglobin had dropped, but it had stabilized at the next check, a couple of days later at my doctor’s office.

I never required any treatment for it.

It won’t prevent me from getting pregnant again or having another VBAC, although it does mean that I would be wise to give my uterus plenty of time to heal before I subject it to more contractions (in other words, I should try to avoid labor until Beth-Ellen is at least 18 months old.)

Moral of the story?

Rupture happens. It can be life-threatening, but it isn’t necessarily so. Those considering a VBAC (or who have been talked out of a VBAC) deserve to hear the whole story – instead of only hearing worst-case scenarios or empty reassurances.

What did you do?

If I’ve been asked once, I’ve been asked a dozen times.

“What did you do differently this time around?”

What they’re really asking is, “Why didn’t you get preeclampsia this time?”

The answer to the question as asked is that I didn’t do anything I “should” have. I ate what sounded good (precious little) instead of eating careful balanced meals like I did with the other two. I barely exercised instead of exercising diligently like I did with the other two. I didn’t plan for or expect a normal birth. If preeclampsia were a matter of human control, I would have been more likely to have gotten it with Beth-Ellen than with the other two.

(Incidentally, the one preventative action with any good evidence behind it is taking a baby aspirin during pregnancy – and I did that with both Louis and Beth-Ellen, with vastly different outcomes.)

The answer to the real question is simple.

God willed it.

It was God’s grace that gave me preeclampsia with Tirzah Mae and Louis – and God’s grace that gave me a normal pregnancy with Beth-Ellen.

What did I do?


God did everything, in His inscrutable wisdom.

The Very Best Part (Beth-Ellen’s birth story, part 9)

A rush of water and blood, spilling onto the floor, soaking my socks. Did he really break my waters while I was leaning over the side of the bed? That’s how I remember it. The blood, the water, and absolutely overwhelming intensity.

There would be no laboring down, no rest for me.

Are you feeling lost? Maybe you’d like to read part 1, part 2, part 3, part 4, part 5, part 6, part 7, and part 8 of Beth-Ellen’s birth story

Two, maybe three contractions and I was pushing.

The room buzzed full of people, not that I was paying any attention.

Someone was frantic. “She’s pushing. Somebody get Dr. Jensen in here.”

Another person remarked that my OB slept in his office (or something like that) when he had a woman in labor – so he should be able to get here soon. Even so, they were convinced that delivery was imminent.

And it was.

I don’t know how long I pushed, but it wasn’t terribly long.

I pooped. I know because I did not at all like the dry washcloth they used to wipe it away.

Baby was crowning and someone encouraged me to feel the head. I reached down and found that it was not at all what I expected – it felt like the rough edge of an almond. In the rare moments between contractions, I contemplated that what I had felt must have been the edge of her head’s plates.

A giant push. Her head was out.

And then she was out.

A girl. Beth-Ellen Irene, I announced.

Someone helped me into bed so I could place Beth-Ellen on my chest. They covered us with a blanket – necessary since I’d shed all my clothing somewhere along the line. All my clothing except those now-bloody socks. Someone took them off now, asked if I wanted to keep them or just toss them. My brain wasn’t working just then, so I delayed the decision. Keep them. (Once we were home from the hospital, I threw them away, still sealed in the biohazard bag they’d been placed in.)

Beth-Ellen lay between my breasts. I was just so delighted to have her. To have her vaginally. To have her naturally. To have defied the odds.

I was also exhausted and unprepared for the “clean up.”

People talk of how the hormones flood a woman’s system, making her barely notice the third stage. And maybe they’re right. I have no memory of expelling the placenta. I barely took note when Doctor Jensen said the cord was no longer needed (In retrospect, why? Was it because it had stopped pulsating? Was it because the placenta had been delivered by then?) Someone asked Daniel if he wanted to cut the cord. He’d always been ambivalent when we’d discussed it, so I was a little surprised when he assented and did it.

But even if hormones blunted my experience of the third stage, they did little to save me from what was to come.

Beth-Ellen on my chest meant I needed to stay on the bed, couldn’t jump out of it at the extreme discomfort that was a manual inspection of my uterine scars. It was necessary to check that I hadn’t ruptured. It’s better to find out about that sort of thing sooner rather than later. But boy, that was not fun.

And then came the stitches. I had lidocaine for them, but that doesn’t mean it was pleasant. I only had superficial tears, but there were several, so the stitching took a long time.

I handed Beth-Ellen over to be bathed and weighed. I put on a clean hospital gown. The nurse returned Beth-Ellen to me and we went to our postpartum room together.

And here’s the very best part – we’ve been together ever since.

Keeping Things Moving (Beth-Ellen’s birth story, part 8)

How long did we labor like that? I don’t know. I lived from contraction to contraction. Mary offered sips of water in between, reminded me to switch positions every half hour or so.

Whatever position we tried, I ended up the same. On all fours on the bed, facing the foot of the bed. On my knees on the bed with my upper body draped over the elevated head of the bed. Standing or kneeling on the floor with my upper body over the side of the bed. Always with my legs and back at right angles to one another. Always with Daniel providing counterpressure. Liv tried the double hip squeeze at some point in there and found it effective, so Daniel switched to that.

Are you feeling lost? Maybe you’d like to read part 1, part 2, part 3, part 4, part 5, part 6, and part 7 of Beth-Ellen’s birth story

On and on. Contraction after contraction. I started to feel desperate, but all I could articulate beyond my moos was “Oh, God, help me.” Mary picked up where I left off, praying a prayer I don’t remember now but that was exactly the trust-filled prayer I wanted to say if I could have spoken.

It must have been about then that someone wondered if I wouldn’t like to be checked. I acquiesced. I’d been wondering, but was afraid to ask lest I discover I wasn’t progressing and end up deeply discouraged. But now that someone else had suggested it, I gave myself permission to want to know.

9 centimeters. 90% effaced. With a bulging bag of waters.

Relief. I had been making progress. I would be able to deliver this baby. I started dreaming of “laboring down”, of the plateau some women experience when they’re fully dilated and before they feel like pushing. Some describe it as restful after the work of transition.

But even as my mind was dreaming of a break, my labor companions were urging action.

Could I squat during some contractions? Even push if I had any desire whatsoever to do so? Once the waters broke, surely the process would go quickly.

I squatted through one excruciating contraction and wouldn’t do it again.

They started talking artificial rupture of membranes. “I know you didn’t want this,” Mary said, “but I think you should consider it. I’m worried that you might wear out with these contractions. AROM could speed things along.”

Our team left the room so Daniel and I could talk about it. We did so in the bathroom, where I tried to pee. But I thought maybe I was starting to feel pushy and it terrified me. I pulled the call light and the staff rushed back in.

I resisted the mild urge to push (likely to the chagrin of my birth team!) Liv and the resident asked if I had come to a conclusion about AROM. We hadn’t, but I was worried about starting a timer, about ending up with another operative delivery. The resident felt that I was far enough along and the “timer” long enough that my risk wouldn’t be increased. He described the risks and benefits of delivering en caul, with the amniotic sac still intact.

We consented to AROM.

Careful to follow my birth plan, which had detailed that I did NOT give blanket consent for any procedure and that I expected to give individual assent for any and all procedures, Liv asked me to affirm that I was indeed consenting to AROM. The resident did the same, asking for consent and then, right before performing the rupture confirming: “So I’m going to rupture your membranes right now. Is that what you want?”

I agreed.

I’m not waiting until New Year’s! (Beth-Ellen’s birth story, part 7)

The receptionist in the Emergency Department took one look at me, recognizing me from the previous night and called for OB admittance before she took my information.

Back behind the doors, an emergency room nurse exclaimed that she thought I was going to have this baby on the way upstairs. Another nurse told her that’s what she’d thought LAST NIGHT. I interjected: “This time it’s for real. Babies in my family are born on significant days – and I’m not waiting until the new year!”

Are you feeling lost? Maybe you’d like to read part 1, part 2, part 3, part 4, part 5, and part 6 of Beth-Ellen’s birth story

Like the night before, I elected to walk to labor and delivery. Unlike the night before, this time we had to stop for contractions. I leaned over the rail in the elevator, Daniel providing counterpressure with his fists while I mooed my way through a contraction. The nurse held the door for the contraction to end. This time was definitely different.

The triage nurse was quick and efficient. Get the important information. Pause while I contract, this time on hands and knees on the exam table. Somehow, between contractions, she got me checked (5 cm dilated, 70% effaced), got a hep lock in, and monitored baby.

The resident arrived, read my birth plan, said he was on board with it. He clarified that I didn’t want routine pitocin after birth. Would I be okay if they hung a bag in my room in case there was an emergency, only using it if I did start to hemorrhage? I affirmed that, yes, that would be okay.

My nurse introduced herself, reminded me that she’d taken care of me when I was hospitalized with Louis. Of course, I remembered Liv – and I was thrilled that she would be my nurse. She, too, clarified about the pitocin.

The anesthesiologist came in to do his education. He informed me that since I’d already had two c-sections, I was going to end up with another one. He’d do a spinal, just like with the other sections. I was so glad when the next contraction hit and I could moo right over the sound of his voice, so confidently informing me that everything I’d worked for would be for naught.

He told me that, from here on out, I was not to eat or drink anything. My contraction over, I informed that I was going to drink what I wanted to. I muttered out the phrase I’d been practicing: “Feel free to document noncompliance.” The anesthesiologist grimaced as he admitted that, yes, my doctor let his laboring women have Gatorade. It was obvious that the anesthesiologist did not agree with this course of action.

The anesthesiologist left and Mary, Liv, and the resident all rushed to reassure me. “Pay no attention to him,” they said. “He does this to everyone. You’re going to rock this labor and have this baby normally.”

And then we labored, much like we’d been laboring at home – except with Mary holding my hands and reminding me to keep my vocalizations low and Liv unobtrusively monitoring baby with a Doppler.

We tried using the rebozo around my hips. I waved it away and gestured that I needed the counterpressure again. We tried Mary’s massage tool. Nope, that wouldn’t do. Mary tried to give Daniel a break, but she was a hundred pounds too light to provide the pressure I needed. Daniel would only get a break when I did.

Deja vu all over again? (Beth-Ellen’s birth story, part 6)

For the third night in a row, contractions woke me up with a bang at 11 sharp.

Like the night before, they were long and hard and difficult to cope with.

This time, they were 4-7 minutes apart and almost two minutes long.

Are you feeling lost? Maybe you’d like to read part 1, part 2, part 3, part 4, and part 5 of Beth-Ellen’s birth story

It took about three contractions before Daniel asked what he should be doing. Should he be trying to sleep (as I’d been urging him all along – he needed to conserve his strength until I needed him) or was there something he should be doing for me?

This time, my answer was unequivocal. I needed his help. Desperately.

I was on all fours on the bed, rocking my hips side to side and back and forth. My back and buttocks hurt, oh so badly. I groaned, but it wasn’t groaning so much as bellowing – a deep moo that lasted so long I wondered how I could keep going with the relatively short gasps of air between each bellow.

I directed Daniel to find the tennis balls in a sock that I’d prepared for a pain relief measure. Press those into my back. No lower, lower. In those dimples, just above my bottom. More, more. Until his entire upper body weight was pressing the tennis balls into those dimples. When he was pressing there, I could at last feel a little relief.

He didn’t like the sock I’d put the tennis balls in, so he found some other socks from the closet and switched them out in between contractions – and into the next contraction while I begged him to be done and use them NOW.

I texted my doula, who asked if I wanted to go in and get checked. I replied that I was nervous about repeating the night before.

Mary suggested that I get in the bath, which is what I did.

I labored on all fours in the bathtub, with Daniel leaning over me to provide counterpressure during contractions. At first, Daniel timed the contractions on my phone, but as things continued with great intensity, I needed help between contractions too. Daniel had suggested a podcast to occupy the time between contractions (he was worried about getting bored, but quickly lost that worry!) I vetoed a podcast and suggested instead that Daniel read through the Scripture passages I’d put in my laboring notebook. Daniel read Psalm 139:1-18, various verses from Psalm 37, Psalm 34:1-10, Philippians 4:4-9, Isaiah 40:28-31, Psalm 57:7-11, Psalm 71:5-6 and 17-11. When I started mooing, he set aside the book to apply counterpressure again. He flipped back to the beginning of the book and started reading through again. Every so often, when the pressure between contractions became too intense, I opened the tub’s drain and turned on the water as hot as I could handle, backing up to direct the spout of water as close to my lower back as I could get it.

An hour passed. Contractions were 3 minutes apart, 30-60 seconds long and requiring total concentration.

I dictated a message for Daniel to send to Mary. She thought I should go in.

I dried off, sat on the toilet and checked my dilation. I’m no birth professional, but I could tell I’d made progress. This was no repeat of the night before.

We loaded up the car again and headed back to the hospital.

Stop talking to mama, baby (Beth-Ellen’s birth story, part 5)

It was Christmas Eve, and given that we’d labored 24 hours for two centimeters progress, I couldn’t put everything on hold just because I was in labor.

Then again, the contractions were continuing and were requiring my total focus. They were still a minute long and five minutes apart, but I couldn’t talk through them anymore. That was enough to rule out the morning worship service.

Are you feeling lost? Maybe you’d like to read part 1, part 2, part 3, and part 4 of Beth-Ellen’s birth story

We settled on preparing my family’s traditional Christmas Eve meal. Daniel transferred one soup from the container I’d frozen it in to the crockpot (because Daniel has tried oyster soup when we were engaged and had found it wanting). I prepared the oyster soup. I pulled out the platters and the dishes and directed Daniel and his mom as they set the table and arranged the veggies and dip, the crackers and cheese and summer sausage and cheese ball, and the relish tray with pickles and olives.

Somewhere over the course of the morning, Tirzah Mae noticed her mother’s lack of responsiveness to her (during contractions). In between contractions, I explained: “Remember how mama said the baby would let mama know when it was time to be born? The baby would talk to mama by making her belly go” and then I squeezed my belly on either side, making it bulge further in front. “Well the baby has started talking to mama to tell her that it’s about time for the baby to be born.”

We sat down for our Christmas meal – Grandma and papa and the children in chairs, mama on her birthing ball. Every few minutes, I stood up, leaned over the wing back chair behind me (in the living room), rocked my hips and groaned a bit as the next contraction hit. Then I’d sit back down and eat a bit more.

If we were in a race to finish Christmas dinner, I’d have been dead last. Tirzah Mae would have been the winner. And, as is often the case when Tirzah Mae finishes her meal before me, she wanted to snuggle. But there was no way she was getting on that ball with me. It was hard enough trying to eat and manage contractions and balance on the ball and try to be pleasant at the table. I acquiesced to having her scoot her chair close to me so she could rest her head on my belly (when I wasn’t contracting, of course.)

She laid her head on my lap, patted my belly and said in the sweetest little voice: “Stop talking to mama, baby. It makes her crabby.”

The baby didn’t listen to Tirzah Mae’s advice (thank goodness!) Contractions continued, varying from five to fifteen minutes apart, but continuing to increase in intensity. Unable to concentrate on anything too focused (i.e. a book), I downloaded a Sudoku app on my phone and began methodically working through its puzzles between contractions. As the day wore on, the contractions started more abruptly, ramping up to seven or eight right away instead of slowly increasing to a peak.

Nevertheless, we went to bed yet another evening, still in latent labor.

Getting baby into position? (Beth-Ellen’s birth story, part 4)

We discussed the possibility of malpositioning as the allotted hour of walking came to a close. If baby were posterior, perhaps that could explain how I’d been laboring so long and hard with so little progress.

We knew with my history of severe preeclampsia that we didn’t want to do anything inverted, but my doula could do a side-lying release and we could see if that helped things out any.

Are you feeling lost? Maybe you’d like to read part 1, part 2 and part 3 of Beth-Ellen’s birth story

The doulas also wondered about nipple simulation, but I was unsure. I was still torn between the desire to get labor over with and the desire to have enough strength to bring it to completion.

The triage staff were busy when we returned after our hour of walking, so we began the side-lying release.

The resident came back to check me. No progress. No surprise there.

But I couldn’t leave yet. They needed to check the baby again. This time, I insisted on standing. I continued chatting with Daniel and Mary (my primary doula), pausing every three minutes to lean over the bedside table and sway my hips or lunge a bit as another contraction hit. These were at mid-day intensity now – but nothing I couldn’t manage by myself.

A twenty minute tracing stretched to thirty, forty minutes. Even longer. It must have been quite an emergency the other woman was having.

Mary mentioned that one of the nurses had recognized me, asked my name. She’d taken care of me with Louis and had requested to be my labor nurse if they kept me. My mind jumped to the two primary nurses who’d taken care of me with Louis. I felt sure it was one of them, and I felt a twinge of regret that I wouldn’t be staying. But I’d be crazy to stay when I was two centimeters dilated.

The triage nurse finally returned. She took a look at my tracing, at those every three minute contractions, and called the resident. She knew he’d been intending to send us home, but these contractions were pretty close together. Could he come back in and check me again? Or maybe she could just do the check if he was busy?

She got off the phone and I told her not to bother. These were the same contractions I’d been managing fine at home for a good part of the past twenty four hours. Contractions that had dilated me to a 2 in that time. I’d go back home and manage labor there until something changed.

Which is exactly what we did. We went home and went to bed. By this time, I was exhausted enough that I did something like sleep between contractions. I lay there in a left side-lying Sims’ position between contractions, drifting in and out of consciousness. And when the contractions came, I rose onto all fours, raising my bottom as high as I could and lowering my chest as close to the bed as I could manage. If malpositioning was our problem and I could get this baby into a better position through my own positioning, I was going to try.

I can’t have slept long, given that we didn’t get home until three or four – and the children generally wake up between six and seven.

But the rest felt delightful, and now it was Christmas Eve – when my family traditionally celebrates Christmas.