Part iii: Love and Labor

“Pooja, you are reading a story book!” “No pain?” The duty doctor , with the name of a bollywood actress, seemed surprised. I was reading Zadie Smith’s On Beauty. Induction of labor pain was initiated 6 hours ago.

July 21, Monday. I woke up in the morning feeling not very different from any other day. Lower back pain, yes. That and the muscle cramps have become part of my daily life that I no longer remembered days without them. It was 48 hours since my doctor did a preocedure known as stripping. Stripping can be mildly painful, the doctor uses her hand to physically strip some tissue in order to speed up/ start effacement of the uterine sac. I was surprised by the strenght of my little doctor, and the dexterity and ease with which she finished the procedure. She predicted that I would be back in the hospital with pain in 48 hours.

Nothing much happened that weekend. Every trip to the loo to pee was also a quick check for any new developments. I spotted something like a brownish mucal discharge which I announced as the mucal plug. But that was it. I phoned the doctor and she asked me to meet her on monday.

Unni and I went for a long walk in the park. His paternity leave had started that day. We got our camera, shot pictures of the street dogs in the neighbourhood and a fully pregnant me and my belly.

I liked my belly. I had made a deep connection with it. I touched it and talked to it. Contrary to common fears, I had lost weight during this pregnancy, those ugly fat deposits under my chin and around the mid rib were sucked clean, and destroyed by this tummy. I owe it.

I counted the stretch marks. They formed waves of a little ocean. One day, Unni drew a whale on it.

It looked like a nice day to have a baby. The morning walk was refreshing. It had rained the night before. Water peeled off the packed layers of dust from the blades of grass. I asked Unni if he can imagine a baby in our hands tomorrow. He couldn’t. Neither could I. It was impossible to imagine its physical existence or put a face to the form. We walked back. I wondered if Unni will change after the baby.

My grandmother called, like she does, everyday. She felt nervous about me being too chilled out and wanted me to go see the doctor immediately. I promised her that I’ll go in the evening during her consultation hours.

Afternoon. I took a shower. Involuntary discharge. A small trickle of what felt like water. Did my water break?

I finished lunch and quietly asked my folks if we could go to the hospital then, instead of waiting till the evening. I was almost sure that this was a false alarm and that I would have to come back. “ Don’t be angry with me if this is not it”, I said. Both mothers said they were fine and they’d rather see me go to the doctor than wait at home. We went to the hospital in the afternoon.

2pm. I climbed the stairs and reached the labor room. I described my symptoms apologetically and warned them that this could be a false alarm. I was asked to lie down in the labor room cot. Dr. Madhuri did an internal examination. “ So Pooja, clearly your water has broken. You will have to be admitted. Let me talk to your consultant obstetrician” . The nurses gave me two pills( cannot remember the name) to induce pain.

Alright, so my water has broken. I texted my mother who was waiting outside. Unni meanwhile was asked to initiate admission procedures down at the hospital reception.

Both mothers began to panic , I suppose. Unni’s mom was the first one to come into the labor room to see me. I’m at a loss of words to describe the magnitude of the warmth she exuded at that point. This was perhaps the first time I’ve seen her transform into what I could only describe as an incarnation of empathy . She touched my forehead and put some rogue strands of hair behind my ears. She helped me get into the hospital gown.

I got out of the bed and stood upright. A gush. A swell of amniotic fluid surged down my legs and wet the whole floor. There it was, as dramatic as they show in movies. I felt really awkward about it and my immediate response was to try to cover it up. The nurses gave me surgical napkins but they would be wet in a short while and we had to keep changing it. Of course in such situations, you find that they speak to you with the casualness that only comes with seeing this everyday at their work.

My mother, a casual observer would conclude, acted rather strange.She came in and pointed out the difference in time between the big digital clock on the instrument panel and the analog wall clock. We had a conversation of about the delivery suite, the labor cot and other medical paraphernalia. I know her very well to assure you, this is her way of coping with stress. She, and very often I, go into a ‘matter of fact’ mode when we are under stress. This was her way of telling me, ‘look, there are things around the room and they are rather interesting. Daily lives continue as effortless as the clock ticking away on the wall’. “DON’T PANIC”’. Like you have seen mothers’ do to distract their babies from crying. If there is one thing in the world that can break me, that is to see my mother cry. She wouldn’t. She has been a rock, sans melodrama, in the critical turns of our lives. Where as my father is the fragile one, his heart and soul out and open for everyone to see.

6. 30 p.m. The sweetest surprise was the visit of my friend Ann. Darling she was, jumped security and walked right into the delivery suite with a big baby bag. She had carefully put together a set of clothes and essentials for the baby. She wanted to know if I got an enema, a rather embarrassing procedure that expels all excrement from your system. I hadn’t. She found out from the nurse that I will be given one, later. By then I had begun to feel a little pain. And I thought, well, if this is it, it’s not bad. Ann, gave me a kiss on my forehead and wished me luck for she knew what I felt at the time was hardly it.

At this point let me also tell you that I was feeling extremely cold and Ann covered me with her wrap.

So you see, all the women who have experienced the pain, seemed to reassure me, and asked me not to be afraid. There is a circle of love that you are going to be initiated into, with this pain. Women who have given birth told me the kindest things, assured me that I’ll live to tell the tale, and show me by example the best things about being a mother.

I wasn't afraid. And I didn’t understand why they said “don’t be afraid”. I simply didn’t know how to imagine that kind of pain. The advantage of the ignorance was that I was ready to face anything. Now that I know, trust me, you don't need to panic. I was pretty relaxed and that really helped.

Meanwhile my doctor came for an internal examination. “ Pooja, I heard you sprung a leak. What else?” . I said, “errr, back pain…” . I had a dull but perceivable pain in the lower back. She examined me and said, “ Alright, you are fine. I'll see you tomorrow morning or if needed I'll come back in the night”. “Cool”, I said. She got the nurses to change the surgical napkin yet again and spread out what looked like a large plastic sheet with a pouch under me, on the bed. This helped hold the leaking fluid for some time.

7 p.m. Another dose of the same two pills. The nurses set up an IV line and attached the CTG probes to my belly. CTG, cardiotocography is like an ECG for the baby. The sound of my baby’s heartbeat can be heard loud in the room. The room resonated with her heart. It varied between 150 beats per minute to 180.

A note about the nurses in the labor room. They were kind and very efficient. They were prompt on action. Most of them were Malayalees. And I tell you, Malayali nurses are a blessing. So we joked about the IV line and the blasting air conditioning in Malayalam. Happy time.

The peace was broken when a consultant practically forced us to opt for stem cell storage. I wanted to donate stem cells to a public bank but this was a private party with a very expensive package. Unni and I had a tough time taking a call and finally we opted to take the package based on just this one reason, “ What if our child needs it at some point of time in her life?”. I wish we had the time and freedom to make an informed decision.

8 p.m The nurse ordered dinner for me. Unni fed me rice, rasam and curd while we watched Seinfeld on the laptop. Unni had managed to go home and bring my bag packed for this day. Both of us fell asleep watching the show. I woke up some time later and found Unni asleep. I picked up my book and started reading.

9 p.m The duty doctor finished another check up. She asked me if I could tolerate this kind of pain. I said, very bravely, YES.

Let me describe the nature of the pain. At that time what I got was a dull, often numb, lower back pain. It is similar to the kind some of you may get during menstruation, but some what more intense. I had tried in vain to find out more about the pain so that I can picture myself with it. Nothing will get you prepared for it. It is not the kind you get when you cut yourself or bleed. That feels more raw. This pain is visceral, the kind you have no control over. It is persistent and growing. But at the same time it is generous too, for it begins gently and then as you are able to tolerate, it rises to the next level. The body complies. Here, the mind has no say. Mind is like a little child, rebuked, ordered to stand in a corner while the body takes over.

I was put on antibiotics through the IV. The risk of the baby catching an infection leading to septicemia were high as my water had already broken. I made a couple of trips to the loo with my bum exposed in the hospital gown. I could feel the pressure on my bladders building up.

11. p.m. I was given 1 instead of 2 of the same mystery pill. By now the pain was some what intense. The dull pain down the back has transformed into piercing sharp jabs. I felt faint. I was still in bed and tried to relax as much as possible.

12. p.m The pain is severe. I wanted to go to the loo again, this time to pee and poop. By now I can begin to feel the contractions. The pain radiates from the hip. Imagine a stone thrown into a calm pool of water. The pain is like the radiating ripples originating at the hip and causing convulsions of the whole body. I decided to walk a little bit to ease pain. We still had our humour sense intact. Unni and I planned to surprise the mothers by going out to talk to them. I looked through the glass and they were fast asleep on those uncomfortable chairs of the waiting area. We dropped the plan. So we walked around and snuck a peek at the other rooms. A couple of other delivery suites were occupied with women in various stages of labour.

1 p.m. The pain is in its extremes. The contractions were 3 minutes apart and lasted 30 seconds each. I began to wreathe. I was determined not to cry and I didn't feel like crying either. Instead, I swore, like a pirate. I cursed and promised I was not going to do this ever again. I began to sweat buckets in the same room which was too cold earlier that we had to ask the nurses to turn the air conditioner down.

Let me digress a little to marvel the human body. The contractions were like clockwork. You could set your watch to it. The pain begins, reaches the peak and then subsides. I would twist and turn towards a side while Unni tried his best to hold my hand or massage or whatever he tried to do.

I began to feel faster contractions which were a minute apart. The hip bones were moving apart and I was able to feel their grinding. I was taught, I was being stretched.

Now the plan was to induce labor with medication and at 4 a.m start me on the pitocin IV. By then I couldn't tolerate the pain any more and knew I could not go on like that for another 2 hours. I asked Unni to call the duty doctor again. When she came, this time I begged for an epidural.

An epidural is an anesthetic injection administered on a negative space just before the spinal cord on your spine. Many people advised me against it because they say it causes a persistent back pain throughout life. However a couple of doctors I asked seemed to say it is perfectly safe and the only side effect is a headache that would last for sometime incase the spinal cord is pierced and that there are safe procedures to seal the puncture. My own obgyn’s advice was this, “sometimes some very long labours could be endured both by the doctor and the patient with the help of the epidural. The mother begins to appreciate the birth instead of struggling and often disrupting procedures”. I totally understand this. I believe I have a high pain threshold and can withstand pain to a large extend. I hardly felt any of the TT shots and the pricks to draw blood. And I was determined to see this through without the epidural. Nevertheless, here I was, begging for one.

So the duty doctor did another examination. She looked at me and smiled. “You’ve already dilated 8 centimeters. How long have you been feeling this pain?” I was upset. Epidurals are given when you’ve dilated 3 cms and are pointless after 5 cms. This means that I will not get one and have to endure the pain. I asked if they could give me a local anesthesia or any goddam elephant tranquilizer for that matter to take me out. She said none of that is possible as I’m too close and any anesthesia would cause fetal distress and remembrance. ( jumping to a postpartum scene here- the girl in the same room as me, had a c- section, her baby wouldn’t drink milk because of some anesthetic stress). The doctor said she will call for my doctor.

On the positive side, active labour starts when you have dilated to about 10 cms. I was almost ready to push the baby out. Meanwhile I was given an injection to hasten the dilation and another IV of fluids.

The delivery suite very quickly, began to transform. They knew I was ready to deliver. Trolleys were brought in, which contained every instrument and equipment essential for the procedure. Nurses started setting up the labour room for all emergencies. Several monitors rolled in. People started changing into their gloves and scrubs.

I was still wreathing. They sat me up. Duty doctor was constantly checking for the head of the baby by feel. She asked me if I felt like going to the loo. I said yes. She told me that was because of the head of the baby pressing against my uterus and that I’m ready to push. I was in and out of sanity, an intoxication induced by limitless pain.

Meanwhile, I saw my doctor’s head over the busy room. Dr. Vijaya Sherbet. I’ve never been happier to see her. She is in what looked like pyjamas, yellow, swinging her car keys. She quickly put her gloves on, sat by the side of my bed, put my right leg on her shoulder and did an exam. Yes, I’m ready to push. The baby’s head is already in position and right there, ready to come out.

Since detail is the key style I wish to use in this narrative, let me paint the scene for you. I’m sitting up, with my legs apart, knees bent. Unni is holding one leg and the nurse the other. I was asked to clench my teeth, hold my thighs tight and push hard whenever I felt the contraction.

From here on, I began to enjoy my labor. That irritating pain of the grinding bones was no longer present. Pushing was not painful as I had imagined it to be. It is tough and drains you out of all energy. But at the same time, you are able to imagine an end to it and therefore much more tolerable. You will feel all your muscles working towards ejecting this being out, starting with your neck. This feels more like a task you are in control of in comparison to the relentless pain you endured before.

I pushed really hard. The baby slid further down and I could hear my doctor cheering for me.

Unni was called over for a sneak peak at the head of the baby. He saw, what looked like a head inside my vagina, which he thought was too small. After I finish pushing the doctor would use her two fingers to make a circular motion around the baby’s head in order to ease it out. An efficient ob gyn has a skilled pair of hands that she needs to use, sometimes more than her head.

The suite was still morphing. The bed was broken in half. And I, I have hardly any blood in my head to think and interpret. I was my body. It told me what to do. I did what it asked me to. My body wanted to expel this being out of its system and guided me into doing just that.

‘Fart, feces, fetus, foreign body- better out than in’. Dr. Thomas Stone in Cutting for Stone.

I could hear my doctor say, “ Sweetie, you are right there. Push hard. Push as though you are pushing out hard stool” . That’s what it felt like.

Push…. and I fell back, exhausted.

When the contraction stops, everybody relaxes. I can hear my doctor chat with the duty doctor . I looked at Unni. He smiled at me.

One more time….I pushed with all my might. I could feel the mass slide further down. More cheering. I didn’t scream. I was determined not to give the doctors’ a difficult time. And when my mouth opened, doctor Vijaya reminded me yet again to clench my teeth and scream. Since I was holding my own thighs, I could direct all the force into pushing.

Meanwhile, I got an episiotomy. No story here. I didn’t feel it. Unni was shocked.

In the lull, I looked up and saw a man in the room. My doctor told me that he was the neonatologist. I saw the mobile NICU on stand by with another nurse to assist the doctor.

“She will be done in another push”, said the doctor to the neonatologist.

Well, if that is so, let me give it all I can.

So I pushed, one mighty, giant, incredibly long pushed that left me breathless.

And the baby slid out. Crying.

Dr. Vijaya held her up and said, “parents, meet your daughter” .

I had no voice. “ We have a daughter!!”.

According to Unni, with that last push I shot the baby out with so much force that it practically fell off the half bed.

I was so happy. “ It wasn’t so bad. It just felt like pooping really hard”.

Meanwhile things got busy at the NICU station and Unni moved to that end. I could see the baby being wiped down and tubes being inserted into all orifices to clear them.

My doctor once again used hand movements, wriggled my lower abdomen and extracted the placenta. She started suturing the episiotomy. I asked her how many and she said, “just one outside”. The pricks hurt a bit, so she gave me an anesthetic injection.

I saw the battered placenta in a dish, drained off its life blood. I felt sorry for it. Such commitment it had to protect my baby. There it lies, dead.

What surprised me was that the umbilical cord is white in colour and fairly long.

Unni meanwhile was looking at his daughter in amazement.

The nurse brought the baby for me to see. I smelled her hair and asked her if she had all the fingers and toes. She had.

So there, I had a baby. We have a daughter. The tiny thing had big eyes and long fingers.

The mothers’ saw their granddaughter.

The trolleys, lights and monitors went out as fast as they came in. Finally there was just me, Unni and the baby in the room. As she slept under the warm lights in the NICU, Unni and I drifted off to sleep. And just as it came, the pain too disappeared.

Afterthought- as you can see, I was really happy that Unni was in the labor room. Contrary to what I have heard elsewhere, he told me that the experience has not dramatically changed him as it was not happening to him. Therefore he cannot really connect to it. He said he would have been too anxious waiting outside, not knowing what was happening to me. He appreciates me for being brave.

We are a team. I feed, he cleans poop.

Take your husbands to labor. There is no reason why they should shy away from the tough and gory tasks. Labor is a beautiful experience. It is not disgusting, neither it is to be banished from sight. I’m unhappy that it happens very often hidden behind the green curtains. I know several people who have been butchered by their less skilled doctors or mistreated in isolation. Ask for clarifications, assert your rights. And more importantly, keep a calm head and appreciate the pain. No matter how bad it is, this pain has an end and before you know it, a beautiful life will be born. There is no way you can deny its charm.

NEXT UP - And then the pain, the breasts’ story

Further - Life with Leela