The sun rises four times while I'm in the hospital. I'm not conscious for any of these. Within minutes of arriving at OB triage, I'm diagnosed with severe preeclampsia and hooked up to a magnesium drip and given labetalol. A nurse named Martha explains everything to me as it happens. I tell her about my anxiety, how this might all be my anxiety at play. I dress in a hospital gown and give my clothes to Carl. He tucks them away in my backpack. I won’t need them again for a while.
A week earlier, I’d been at a routine prenatal visit when my blood pressure kept reading high, higher than it had my whole pregnancy. I’d gone to OB triage and was watched over in a hospital bed as my blood pressure was monitored, blood taken, urine checked for protein. I was told that if the numbers didn’t go down, I’d be admitted. I was told I might deliver that day at thirty-six weeks.
But my blood pressure did stabilize and I got to go home. Carl and I drove from the hospital to Panera where we had tuna sandwiches and iced tea. I’d folded up the piece of paper with my induction date for the following week, a precaution to get the baby out safely. I was scheduled for March 30th at midnight. I had a week and a day to prepare.
Over the next week, things escalated. I was so swollen: my hands, my face, my feet. When I was barefoot, it looked like I was wearing shoes. Nothing fit me anymore. Everything was uncomfortable in a way that felt extreme compared to the expected discomfort of the third trimester. It was hard to breathe, hard to get out of bed without getting winded. In other words, I knew she’d be early.
And at my next prenatal appointment, blood pressure once again high, but this time to a more alarming degree, I'm advised to go back to the hospital. But I don’t want to go. I don’t feel ready. It’s Tuesday, the 28th, and I still have two more days until my induction. I’d planned on doing one more grocery run before then, one last mani-pedi, even though my hands were going numb and my calves were so big I was embarrassed. It was only two more days, but those two days felt pillars holding up my sanity. They felt sure and secure despite how easily they were now coming down, knocking into dust. We went home and grabbed the hospital bag. Carl ate a hard-boiled egg. I took a quick shower and got quiet. It was the beginning of what I came to understand as surrender.
I’d sobbed into the sink back in the examining room. You’ve gained eleven pounds since last week, my doctor’s voice rang in my head. I’d been walking onto the scale backwards for the last nine months, and now I knew how much weight I’d gained in a single week. It’s water weight that you’re retaining from the gestational hypertension, my doctor assured me, but still, that number, in one week, I couldn’t fathom it.
34 y.o. female with IUP at 36w6d by 7 week US who presents to triage for Pre-eclampsia. Her pregnancy has been complicated by bipolar, anxiety, IBS, and a hx of an eating disorder. Sent from the office for elevated blood pressure. Denies HA, vision changes, nausea, vomiting, or RUQ pain. No SOB or chest pain. Good FM. Denies ctxs, LOF, or vaginal bleeding. Has never been diagnosed with hypertension but has had elevated BPs during medical visits even before she got pregnant.
The labor and delivery room is beautiful. Carl and I had already seen it on our hospital tour, and part of me is relieved when we enter the room and put our bags down and get settled. The room has three big windows that face north toward downtown. We have a private bathroom with a shower, one that I’ll never get to use because of the mag drip, and a couch that turns into a bed for Carl, which he does use for the next two nights.
I get into bed right away and meet my first nurse, Logan. She’s young and wears a pink Lululemon belt bag. She has thick, wavy hair that she wears in a high ponytail. Periodically throughout the night, she takes it down and puts it back up. It relaxes me to watch it fall and rise again, the dirty blonde waves like an ocean’s ebb and flow. I meet a whole medical team, everyone who’s on the night shift. The hospital runs in twelve-hour shifts of 7am-7pm and 7pm-7am. It’s 7:15pm when the fetal monitor is wrapped around my belly and the baby’s heartbeat appears on a screen. I hear the whoosh of her heart. It sounds like an echo from far, far away even though I know it’s coming from inside my body.
There’s a resident obstetrician, a midwife, anesthesiologist, a random medical student named Jean, even though I said no when I was asked if student observation was okay. These people cycle in and out of the room at intervals I can’t keep track of. The magnesium drip makes me feel like I have the flu, weak and achy, tired, out of it.
The first step of labor is to get a catheter since I can’t leave the hospital bed. I'm unhooked from the IV so I can pee one last time in a toilet. I push out every last drop, scared of what the catheter will feel like, what not having an urge to pee will feel like. I stare at myself in the bathroom mirror. You can do this, I force myself to say. This is the last time I see myself, the self that carries my baby, the self that is not one but two.
The catheter isn’t as bad as I thought, just uncomfortable, but then the OB says it’s time to start misoprostol, small tablets that are placed directly against the cervix. This is called cervix ripening. Each round takes around two hours to work. I try to catch up on text messages, emails. I try to sleep and get some rest, as encouraged. After two rounds of the tablets, I'm 1cm dilated. The next step is to insert a foley bulb, more informally known as a balloon, into my cervix, which will inflate and then be left in for a few hours until I reach 4cm dilation. It’s a guaranteed thing, so I want to give it a try, but I ask if there’s a possibility of getting an epidural first. Logan and the OB say that I’ve been doing so well with pain tolerance that they think I should hold off on the epidural until it’s absolutely necessary. But the idea of a balloon inflating in my body while I have complete feeling of my lower half doesn’t sound great to me. Logan says if at any time it’s too painful, the OB can stop right away and take it out. I'm reluctant, but I say okay, let’s try it.
I brace myself as the doctor inserts the foley bulb. I grip the handrails on both sides of the hospital bed so tightly my fingers turn white. I had tried my best not to look online and Google much about the induction process. I wanted to be open, to not scare myself shitless before going in. I knew about Pitocin and epidurals, about contractions and pushing, but knew nothing about tablets and balloons and how every hour a different nurse or OB will come in and put their fist inside of my body and do a “check” on my dilation status.
When the balloon goes in, a gush of hot liquid streams out of me. At first I think the catheter came out and I'm peeing everywhere. Then maybe I think it could be blood.
“What was that?” I yell.
“Your water broke,” the OB says and continues to maneuver the balloon inside of me.
“I want to stop,” I say. “Take it out.”
The OB pulls out the balloon and I feel relief, but there is another rush of water. I feel it pool underneath me in the bed, soaking through the pad Logan put down hours ago. There’s a clock on the wall, large enough for me to read from bed, but time stopped making sense the moment I stepped into the room. It must be well into the night. It’s dark outside the window. Lights blink in the distance without sound.
Feeling increase cramping, otherwise overall uncomfortable.
Recommended foley balloon placement to patient given exam unchanged. She initially was amenable. Foley balloon placed in cervix with ROM in process. Before foley balloon inflated, patient requested removal of balloon as she was feeling increased pain. She would like to get an epidural placed now. Will plan for patient to get epidural and recheck in around 4h (around 830am) or earlier if needed. Plan to start pitocin after epidural placed. If exam unchanged at next check, she will be amenable to foley balloon placement.
What I know about epidurals is that they require a very long needle and that you have to be very still to receive one. I'm already having contractions when the anesthesia team comes into the room. The progress notes say I receive the epidural around 5:53AM on Wednesday morning. I remember holding onto Logan’s forearms as an anesthesiologist named Alice inserted the needle. I remember sitting on the edge of the bed, all the wires, the catheter bag full of urine being swung to my left side and out of Alice’s way. I remember Alice’s jet-black hair tied back in a braid. I remember reading her nametag and thinking it was ironic; Alice, like Alice in Wonderland, sending me down the rabbit hole. “This will feel like a bee sting,” Alice says, and I recall being stung by a wasp on my right shoulder blade when we still lived in Los Angeles. My favorite hike, the Fryman Canyon trail, and how the pain of the sting throbbed for days. The needle goes into my lower back and it burns briefly then stops. “From here on out, you won’t feel anything,” Alice assures me, and she’s right.
Epidural placed and patient feeling more comfortable. Had episode of chest pressure in the setting of anxiety, now resolved.
The balloon is successfully inserted but only stays in for an hour. It works, and now I'm 4cm dilated. Once the first dose of Pitocin starts, I receive a small grey clicker that flashes green every fifteen to twenty minutes. When it starts to blink, I can push the center button and release more medication through my IV to ease the pain. If I don’t push the button, medication will enter my system every forty minutes automatically. I have a new nurse now named Cricket. Cricket encourages me to push the button every time it lights up.
Cricket is a little too talkative for my taste, but she and Carl have friendly conversation. Carl stands at my bedside and rubs my legs, careful not to mess with the tangle of wires. He leaves periodically to get snacks and meals. I'm in and out of sleep until I feel contractions and push the green flashing button in a frenzy. Everything feels urgent yet slow, like time is a thick guitar string that’s been plucked and I'm waiting for the vibration to reach me, for the sound to emerge and break the silence.
There’s another remote at my bedside with various of functions to control the TV, the height and position of the bed, the nurse call button, which is a big red asterisk. Cricket wears her hair down with a headband. When she takes down her mask to sip water, I see that she’s wearing berry-colored lipstick. I call her often. I start to have an immense pain in my lower back that worsens with each contraction. She says she’s glad I'm communicating with her. “Don’t be shy,” she says. “This is why I'm here.” But there’s only so much she can do.
There are hours unaccounted for in the progress notes. This is normal. Not every hour can be documented. Only major changes made, essential updates on labor progression. Somewhere in this time I move from 4cm to 6cm to 7cm and then 8cm. The day rises and falls. The last time I ate solid food was around 8pm Tuesday night, a pack of three graham crackers that I dipped in peanut butter. From then on, I'm only allowed liquids. Water and juice; cranberry or apple. At some point, Cricket offers me an ice pop. “Cherry or citrus?” she asks and I tell her cherry. It’s a double popsicle that she breaks in two. I hold the wooden stick and eat slowly. It feels good to use my teeth, to bite down and chew and swallow.
When I finish the other half of the popsicle, I look over to the couch and Carl isn’t there. I look to my left and Cricket is gone too. I push the call button. I find my cellphone on the table to my right and unplug it. It’s been at 100% for days now but has remained plugged in. I call Carl and the phone rings and rings. The loneliness stretches out around me in waves. I feel so small all of a sudden, the labor and delivery room sinking with me at its center. I fear I might be here forever, or that I’ve always been here, my mind catching up to a body that’s been waiting to deliver this baby my entire life. This is the collision of my mind and body, a cosmic jump into self, a new self. I see the room bounce and level, the guitar string, a single note that wants to play into the infinite, but it’s stuck, stuck in my throat, in my legs, my back, my stomach, my whole being, my voice unable to match the tone, the feeling of all of time, the feeling of release.
Carl finally picks up and I hear his voice both on the phone and close to me. He exits the bathroom and comes to my bedside. “Sorry,” he says. “I'm here.” Cricket brings in a fresh jug of ice water and hands it to Carl. He brings the straw to my lips and I drink.
Patient feeling increased pressure, endorses back pain. Denies HA, CP, SOB.
And then along comes Amber. Amber is my favorite nurse. She looks like Michelle Pfeiffer when she had short hair in Scarface. Amber thinks my epidural placement might be off, hence the lower back pain that’s radiating on my left side. She calls in the anesthesia team and Alice comes back. I hadn’t expected to see her again, as I’d assumed there’d be someone new after a few shift changes, but it’s Alice. Alice says I shouldn’t feel pain, only pressure as she moves the piece of plastic around in my back. I'm sitting up again on the edge of the bed. This time Amber holds my arms and tells me to breathe.
After the new placement, the OB comes in again and does a check. Still 8cm. She talks with Amber and the game plan is to get me to change positions every half hour to encourage a stubborn part of my cervix to move out of the way. I hadn’t realized I’d need to do more than continue to dilate, that my cervix also played a part in readying my body for delivery.
The definition of labor in pregnancy is a series of continuous, progressive contractions of the uterus that help the cervix dilate and efface (thin out).
Amber has me use a peanut ball between my legs, an exercise ball with a slight dip in the middle creating the look of the number eight, or rather, a peanut. She’s an expert in placing me in all sorts of positions while making sure I'm still comfortable. But the back pain increases as time goes on. Amber has me get on my hands and knees with the peanut ball underneath my chest. She has me do hip circles and stretches, “Whatever feels right,” she tells me. She presses her knuckles into my lower back, into the exact spot that hurts. “It’s the baby,” she tells me. “She’s pressing against your spine. But I think we can get her to move.” She massages and kneads and I flow from child’s pose to cat-cows and I can’t see Amber’s face or Carl’s face but I know they are watching me. I know it’s a night shift, but the window to the outside world is pointless. I can’t go outside. I can’t feel fresh air. I have no idea what Carl’s been doing all these hours, but I know he’s been here. When was the last time he talked to his mom? When did I talk to my mom? Does anyone know how I'm doing besides these doctors and nurses? When will the midwife come back? When I'm ready to push? How will I know I'm ready to push? When will it be time?
Amber helps me return to my back and the pain is gone now. I thank her and fall back asleep.
Patient feeling increased pressure with contractions and less back pain. SVE 9.5/90/1. Pitocin at 30. FHR 130 moderate variability, accels, no decels, contracting q3-4 minutes. Has been doing various position changes including hands and knees and peanut ball. Not having SR blood pressures. UOP 75mL over last hour.
The patient's OB provider team reviewed her antepartum course thus far.
34 y.o. G1 female admitted at 36w6d, now 37.0 weeks, for pre-eclampsia with severe features by BP criteria requiring one dose of labetalol at admission. Her pregnancy has been complicated by bipolar, anxiety, IBS, and a hx of an eating disorder. She has had slow progress of her labor, was 6-7cm for 8 hours, and has now progressed to 9cm/90/0. She has had intervals of cat-2 EFM for minimal variability, now is cat-1.
Her vital signs are stable. The plan of care is continue oxytocin IOL. Continue magnesium and pitocin IOL.
Would watch closely for evidence of arrest of labor.
My mom had C-sections with both my brother and I. She never dilated. My mom was on bed rest with me because a few months into the pregnancy she started bleeding. My brother was five. I’ve never heard my mom’s labor story. I'm not sure why I never asked. I called and texted friends that are moms to hear their stories, but so many of them confessed they didn’t remember all the details, that it was all a blur. While there are small parts of the thirty-hours I labored that come up foggy, I remember how it all felt. I remember each progression of pain, each turn. I'm afraid I won’t be able to forget, and the progress notes help me to recollect the details even more clearly. The labor doesn’t feel like lost time, but like it happened outside of time, a block of space stacked on top of my life that resides over it like a tower. I can watch myself from this tower. But maybe it’s one of those things you just have to live through. You live through it and then it lives in you.
Patient comfortable with epidural, but having painful contractions with urge to push. SVE 9.5/100/1, still with a prominent anterior lip. 130, minimal to moderate variability, no accels, no decels. Given 4 hours since first called 9cm with pitocin at 30 and inadequate cervical change decision was made for cesarean delivery for arrest of dilation. Discussed this decision with patient and answered questions. Patient in agreement with plan. Pitocin turned off and will proceed to the OR. Mag gtt will continue until 24 hours postpartum.
My cervix still hasn’t thinned enough when I reach 9cm. The OB comes in and tells me to push while her hand tries to move the stubborn piece out of the way to make room for the baby’s head. The back pain has returned. She’s moved again. The urge to push isn’t painful, but it’s urgent. “I feel like this is happening,” I say to Amber, to the OB, to the midwife who has returned. I can’t remember her name, but she looks like a gymnastics coach I had when I was twelve and lived in Florida. Mrs. Cindy with her bangs and her cigarettes. The three women stand at the foot of my bed and go over the delivery plan for a C-section with me. I nod my head. I say okay. I look at Carl. I'm ready as I’ll ever be.
The anesthesia team returns and starts to numb me completely from the waist down. A surgical cap is placed over my head and Carl is given a full set of scrubs. He’s told that he’ll have to wait for me to be fully prepped in the operating room until he can come in. I can’t image his waiting, his walk from the labor and delivery room to the OR. I’d rather it be me than him going through this. If I could choose, I would choose myself every time. But still, I can’t process his not knowing what was next, his hope that me and the baby would be okay.
I'm wheeled to the OR and see the hallway of the hospital for the first time in days. It’s early Thursday morning now, and I'm so tired from the drugs that it’s hard to stay awake. Double doors open and close and I move through them. The OR is filled with the harshest blue and white light. I'm transferred from one gurney to another. All I have to do, all I can do, is slightly roll to one side. I'm introduced to the surgeon, to a few other OR nurses. I wonder if Jean is watching from the sidelines. I see Amber. There’s a new anesthesiologist named Dustin. Later, Carl and I will joke that he was so good looking; buff with his muscles bulging out of his scrubs. Dustin fills my IV with all sorts of things that put me in a deep haze. I turn to Carl and say, “I'm okay, I'm just tired. I'm okay.”
I know Carl is worried about me, about the baby. He leans in to kiss me and tells me he loves me. “I love you,” I say. My eyes flutter closed and I strain to open them, to let him know that I'm okay.
NICU Newborn Resuscitation: NICU Newborn Resuscitation Procedure Note
Date of birth: 3/30/2023
Time of birth: 4:12 AM
Labor complications: Failure to Progress in First Stage
Gestational Age: 37w1d
Reason for NICU team attendance: C-Section
Delivery type: C-Section, Low Transverse
Delayed cord clamping: Partial DCC, at least 60 seconds
Cord blood collected: Yes
Resuscitation course:
Baby emerged vigorous with a strong cry and was placed on a radiant warmer where resuscitation was performed using NRP guidelines including drying and stimulation and bulb suction. Initially with some breath holding but eventually had more regular respirations.
Infant was shown to parents after stabilization and offered a brief period of bonding.
In the postpartum room, Carl sits at my bedside as Amber hands me our baby. Amber pulls down my gown and the baby latches onto my left breast right away. For the first time, I notice a heart rate monitor on my left-hand ring finger. I'm still attached to all the IVs, all the wires. I'm still in a haze, but I know this is a moment that will be etched in my mind forever.
The following days are beyond challenging. A recovery room so small with only a chair and a small sink, a shared bathroom that locks from the inside like on an old cruise ship. Setting the temperature to 80 degrees because the baby is having trouble regulating her own body temperature. Only being allowed liquids for another 24 hours post surgery. My heart-rate monitor beeping every five minutes and the blood pressure cuff inflating and deflating every twenty making it impossible to sleep. The nurse in postpartum who couldn’t find a good vein and left me bruised from my knuckles to my wrist. It blooms blue-green on my skin.
There are things I'm leaving out, things I have yet to process, or things I’d rather just not say. Maybe someday I’ll be more ready to say them. I write this while I continue to heal, while the days postpartum accumulate into time I can feel as it builds up behind me. Days further away from the birth, days the baby sleeps and wakes, days we get to hold her, feed her, love her.
But I have flashbacks to that prenatal visit, back to the operating room, back to the labor and delivery room. If I close my eyes I'm still there searching the room for an escape, for a way to leave my body and come back when it’s all over, to come into now, the present moment in my own bed at home, the baby sleeping in her bassinet against the window with the shades drawn.
When we are finally cleared for discharge, Carl retrieves the car from the parking garage and comes back upstairs with the car seat. He straps our baby in and carries her down the hallway, into the elevator, down to the lobby. We drive home and I sit in the backseat, one hand over the baby’s body. She wears the swaddle that we weren’t supposed to take with us but did anyway. The hospital is only five minutes from home, but it seems as if we were much farther away. It feels like leaving the airport after a long flight, how you’re thirsty and tired and in need of a good meal. We walk through the door of our home and I almost can’t believe it. It’s around 7pm when we enter the space with this new human, this little darling being that we’ve made together. She coos and cries and we wonder whether to feed her, change her, or just hold her. “You’re home,” we tell her.
We get no sleep that night, but at least I can rise from my own bed in the morning and open the blinds. I hear birds chirping again, a sound I’d forgotten. The sound of life is the noise of leaving and returning. As each sound returns to me, I take it in and listen.
Obstetrics Post Partum Progress
Interval History:
POD #2 from pLTCS 2/to AO Dilation. Pain well controlled. Amb/eat/void s diff. Min rubra.
Denies dizziness or lightheadedness. Refused am labs. Breast & bottle. Desires d/c today.
SW was consulted by medical team to assist with psychosocial assessment. SW spoke with member of medical team who stated Patient "had a rough night". Per review of medical chart, Patient was admitted to hospital as "a 34 y.o. female with IUP at 36w6d by 7 week US... for Pre-eclampsia... pregnancy has been complicated by bipolar, anxiety, IBS, and hx of an eating disorder".
SW met with Patient in room and introduced self and role in medical team. Patient was sitting in bed accompanied by spouse and baby. Patient confirmed demographics and stated she lives with her husband at address in chart. Disclosed this is her first baby. Stated that she already sees a therapist and psychiatrist. Denied any needs/referrals/resources. Accepted information concerning PPD. Stated her midwife and PCP have also given her info on PPD. Denied any social work intervention at this time.
Condition of the patient: Stable
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I had the pleasure of interviewing Sarah Gerard for Write or Die on their new chapbook, The Butter House, available April 18th from Conium Review. We spoke about writing stories with no conflict, cats as metaphor, and place as character. This chapbook is a dreamy little wonder into the world of cats and gardening and what it means to find stability in a new place, in a committed relationship, and in the self.
Wisconsin Review recently published a short nonfiction piece of mine, “Bloomability,” in their latest print issue. the piece centers on a friendship that meant the world to me as a pre-teen and later as an adult, but also one that plagued me with so much hurt and doubt; my attempt to navigate how sometimes losing a person is more complicated than having feelings of only grief.
And…excerpts from my pregnancy diaries were published in Issue 79 of The Racket Journal (begins on p. 7). Thank you, Noah!!
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Thank you for reading, as this newsletter continues to challenge me to bring forth some of my most difficult moments and lay them bare, both as an outlet for myself and in hopes that something I say will resonate with a reader and ring true. I hope these letters connect us because some things in life are too impossible to hold alone.
Our daughter is here, safe and healthy, and we are so in love with her <3
Oh Brittany. I have tears from what you went through. It was so hard to hear about the difficulties you went through. Your little baby kept you going ! God intervened and you are all safe and secure now.
This is so beautifully written, Brittany! You are a strong mama <3.