I had heard a lot about birth plans over the last few years. Particularly in this past year as I (finally) became successfully pregnant with my daughter, Raffi. If you count breathing exercises and maybe an ambient playlist on Spotify, it’s safe to say I didn’t get very far in the pursuit of any customized birth experience. What I did know was that a birth plan was something to design — to dream about, to prep for and aspire to. Like, hey, let’s Dream Board our Birth Plan, or Birth Plan our Dream Board (depending on how you look at it). As if, all you really need to do to have a baby the natural way — you know, the right way, as popular opinion would lead you to believe — is enough yoga, acupuncture, kegels, fancy teas, doula services, etc. All of that is truly admirable, but the truth is this: Birth is unpredictable.
But first, some back-story.
Last year, in January, my husband and I took a quick trip out West to see his brother and his family. Just a few months earlier, their father Bill had passed away, rather suddenly after a routine toe surgery led to a steady decline in his health. Within two months of his being admitted to the hospital, he was gone.
We flew out to Arizona to mourn with his family — Bill was sweet and a bit of a sentimental mush beneath his oftentimes macho Southern veneer. When we confided in him over the years of our dream to have a baby, he never hid his hope for us, which made him weepy whenever he asked how it was all coming along, despite how hard he knew it had been, especially for me.
We went to Arizona to pay our respects to Bill, but also to drive further out into the open desert, between Arizona and New Mexico, to get some space and to brace ourselves for what was on the horizon: A second round of IVF. The losses that had piled up over the past decade were still hard to fathom: My own father, then Kevin’s mother four months later, multiple miscarriages, the sudden death of a close friend, and then Kevin’s dad. Throw in a breast cancer scare at the end of 2018 and we were really on a roll. It was a lot. And so, much of diffusing all that disappointment was riding on this embryo transfer — a procedure that would take no more than a few minutes to administer. We’d wrestled with loss and death… became familiar with it, and, for me, occasionally lingered a little too long beneath that warm blanket of self-hatred and isolation. But, finally, I was tired of it all. As if a switch in me had been flipped, and I could feel my desire to begin again coming back to life. And so we went to the desert. To welcome what we hoped would be coming and maybe even sowing the early seeds of a birth experience I had hoped, someday, to be living out.
About six months later, I finally mustered the courage to share the news that I was pregnant. Our baby was growing beautifully, even if I held my breath throughout every single weekly sonogram, praying my body would continue to cooperate. Despite the nagging apprehension of getting genuinely attached, I felt strong. It was strange, after believing for nearly a decade that all of me, not just my uterus, was irreparably broken and unable to do what we’re taught from the earliest age is the most basic of natural things… that here I was… pregnant! With a belly and swollen feet and that glow I never dreamed was even real, let alone something I would experience.
Yes. I glowed.
But still, no amount of physical or medical reassurance could make me feel safe in my new skin after so many miscarriages. Every few days there were those familiar waves of panic that things would go off the rails, and, if the worst actually happened, maybe this time I wouldn’t be able to recover. With practice though (and a handful of people on speed dial for the particularly dicey moments) I managed to retrain my brain and, to a degree, my body to listen to my daughter’s repeated message to me: I’m good. Really. Don’t worry so much. Let’s keep going.
As far as pregnancies go, at least from what I’ve read and what good friends with children have shared with me, my first seven months were pretty status quo. Yes, I had persistent insomnia and occasional crippling bouts of nausea (potato salad was always the cure), but considering all that had come before, it was all going remarkably well.
Until it wasn’t.
My husband and close workmates did a pretty poor job of trying not to notice my swollen feet, you know, at first looking shocked, but then feeling bad for looking shocked. My husband made a nightly ritual of massaging them to move the fluid somewhere else, usually my knees which occasionally, looked and felt even worse. My doctor assured me the swelling was normal, if not unsightly, and that unless my blood pressure was high or protein started showing up in my weekly urine tests, I was good. I always knew that I was high risk due to my age and history but my doctor assured me that once I got to 34 weeks, I could start to breathe easier. At 34 weeks, my pregnancy would be far enough along to (hopefully) avoid any serious complications. At 34 weeks, he told me “to pop the mediocre champagne.”
But one morning, when I was around 32 weeks pregnant, I awoke and noticed that the swelling had crept significantly up my legs, almost to my hips. I was immediately worried. I made an appointment to see my doctor later that day, but on the way, my acupuncturist agreed to sneak me in for a session to see if she could get the swelling down. She took one look at my cartoon legs and ran to get her blood pressure gage. For the first time in my entire life it was high: 160/90. We did a short session to see if the therapy might bring it down, but 40 minutes later, it was even higher. We called my doctor from her table, at which point he told me to meet him at the hospital.
All I could think was: It’s too soon. Too soon. Too soon. It went on and on like a loop in my head. I called my husband, who met me at the hospital… no fancy face creams, silk kimono or anything else everyone urged me to bring to ensure being ready for that first “beautiful” birthing moment. Instead we grabbed a toothbrush at the nearby CVS and that was it.
Once under surveillance, I was told I was beginning to show signs of preeclampsia, a condition that can lead to placental abruption and other serious health concerns. Rest is recommended to treat it, but the only real cure is delivery. I never dreamed something like this could happen, even though I probably should have. I just assumed, like most people who have uncomplicated pregnancies (up until that point), that everything would likely turn out fine. Not the case. Preeclampsia affects about 5-8% of U.S. pregnancies, and is the leading cause of maternal and infant illness and mortality. It can also be more prevalent in mothers over 40, very young mothers, and for women who’ve undergone fertility treatments, such as myself.
In an attempt to hold out on delivery just a little longer, the team performed blood tests every morning at 6 a.m. and blood pressure checks every three hours to monitor me and the baby. The plan was to stretch out my hospitalization as long as we could. The closer we got to my due date, the better. And after holding steady for three days (and getting the essential steroid shots that are customary if you can get them in time to speed up a preterm infant’s lung development), it seemed like we might even get another week under the belt before my condition escalated. But one morning, the day before my late-father’s birthday, my doctor tapped on my door and said what I had feared.
“Well, today’s the day,” he said, placing his hand on my shoulder. I immediately began to cry. Sobbing into my hospital gown, my doctor sat beside me and assured me it was going to be okay. We were nearly at 33 weeks, a triumph, considering the journey it was for me and my husband to even get here. And now, it was happening, yet another thing I couldn’t have prepared myself for — an emergency C-section.
I remember calling Amy Emmerich, our CCO, who was in an executive meeting at that moment to give them an update. I’ll admit, it’s an interesting and maybe peculiar phenomenon to some to hold such a level of intimacy with colleagues. But, at that point, that degree of honesty wasn’t anything new, and I am grateful for it. Traveling a long and complicated fertility path — and all that goes along with it — doesn’t just require trust; it demands time — time at doctors, time waiting for test results, time at home because you feel like garbage. Lots and lots of time, very often away from your work. And it’s hard to hide that. Anyone who’s been there, and who has a job with people that rely on them, knows that sharing comes with the territory, no matter how private you’d like to be in such a personal situation. And, so, when I told Amy the news I’d been admitted to the hospital, I remember her voice didn’t waver. She relayed the message to the team, and I heard everyone around the table cheer. I cried. And while I couldn’t see it in that moment, I knew there were some people there in that conference room crying, too. Because, that’s what you do when everyone’s rooting for you and you have know idea what’s going to happen or how things will turn out. You cry. Because you can’t bear to disappoint one more person on the way to the finish line. Not one more person.
Just two hours later, I was being wheeled into the operating room, a day shy of seven weeks before my due date, with a blood pressure count that had tipped 190/100.
It’s hard to explain the fear, even at moments, terror, that I felt in the hour leading up to the actual birth. In reality, I felt as though I had been pregnant with the idea of my kid for nearly a decade. It’s such a long time to wait to become a parent, and I know from all the many stories I’ve read that compared to some other parents’ journeys, that might not even seem that long. But it was so hard to imagine and remember a time before I was wishing for her. Before I wrote and prayed and went to every conceivable mental and physical measure to crack the code of motherhood. I had come this far, after so long, and instead of feeling ready and prepared I felt like I was being shot out of a canon. Because even surrounded by accredited professionals, no less than 10 nurses, drugs, sterile instruments, a loving partner as advocate, I knew I had no control over what was about to happen.
Giving birth can be beautiful and miraculous in theory, but it can also be frightening, and in many parts of the world, particularly where women lack health care, it can be deadly. With all your preparation and perceived birthing “tools” it really doesn’t feel as though you have control over anything at all. Because the truth is, you don’t. Between the mystery of birth itself and the multitude of medical conditions that can appear near the end (breech, transverse, umbilical cord prolapse, low amniotic fluid, placenta previa... the list goes on). In those moments, when you just want everyone to be okay, there’s barely enough time to tread water let alone pull out your journal to amend your birth plan. If you have one. Which, as we know at this point.... I really didn’t. I did however, have a doula that I had hoped to coach me in my birth experience, and upon hearing I was very early, agreed (and was miraculously free) to meet us for the surgery.
Instead, our actual birth plan, came dressed up as the head of the Mount Sinai NICU (Neonatal Intensive Care Unit). A lovely young doctor who came to see my husband and I and tell us, moment by moment, what was going to happen since our baby was coming early. Our plan would be him, there in the delivery room with us, waiting in the wings with his own nurses and an incubator. He told me not to immediately worry if our baby didn’t cry when she first came out. It didn’t mean anything necessarily. He and my doctor would allow me and my husband to see her and kiss her only momentarily, after which she would then be taken immediately to the NICU to be examined and hooked up to fluids, monitors, and oxygen. I cried. He told me not to worry; 33 weeks wasn’t too early. I cried some more. He told me not to worry. I worried anyway.
What I learned in those moments before Raffi was born made me think back to earlier in 2018 when my dear friend Aya regaled me in her own unexpected birth story. An easy pregnancy, a big baby, a plan for a natural birth, 26 hours of labouring, and then a C-section. She didn’t sugarcoat anything for me, and I am grateful for that. I feel lucky that she was honest about her fears. Because when I rolled into the ER, I knew it was okay for me to have those same fears, too. It didn’t make it any easier to bend over for the spinal tap, lay down on the table and spread my arms out crucifixion style while a nurse hooked up fluids, inserted a catheter, and prepped my abdomen for a six-inch incision that would become the doorway between then and now. It didn’t make it easier knowing any chance of a birth plan was blown to bits. Instead, I closed my eyes, and, with the help of my husband and our doula, just kept breathing as my doctor told me exactly what he was doing while he cut, wiggled, stretched, and tugged some more. Eventually, he pulled out my beautiful wailing daughter, her mouth agape and her tiny body the colour of ripe rhubarb.
Just as the NICU director had told me, I was able to give my sweet Rafaela a kiss on the forehead, her eyes tightly shut, before they whisked her out of the room in a gust of nurses. At the same time, my own doctor sewed me up and prepped me for a trip back to recovery where I would be placed on a Magnesium drip for 12 hours to prevent my high blood pressure from peaking and possibly causing a stroke or heart attack (once again...surprise!).
During those hours, I was alone, while my husband was with our daughter. I wasn’t able to get out of bed, vomited on and off from the miasmatic cocktail of meds, and felt myself emptying what seemed like gallons of blood, goo, and emotional runoff into a bedpan. Thank goodness I didn’t have a mirror, because at one point I was able to see my reflection in a strip of metal trimming on the wall beside me and I didn’t recognize myself. As if this stranger was saying: Welcome to the other side.
Our daughter was alive. She was early but she was okay. I was okay, even if I felt like I’d stepped in front of a transit bus. Because when I finally got clearance to see my daughter, and slipped my hand into her incubator and she curled her fingers around my own, it didn’t matter that she was tiny or that the CPAP breathing tube was too big for her face, that her eyes were sealed shut as if to say… give me some space, processing, please. We all were. I spent every day with her, and watched as she slowly awakened to the world. And each of those days, when every movement or sound she made could make my heart flutter.
I’ve discussed this a bit over the years, but I am not one of those people that dreamed since I was a kid about having kids. I was always pretty ambivalent about it. Until that moment when I decided it was an experience I wanted to have. Didn’t need to have. Wanted to have. That attitude and the lengths my husband and I went to bring Raffi into the world cost me old beliefs, and friendships, because the last thing you want as you’re recovering from your umpteenth miscarriage is someone who’s supposed to love you confiding about how babies born of science are just “not for me.”
Those comments, and every one of us who’s struggled to have a child has fielded these gems from people we love, are so hard to leave behind, but we are better and stronger and lighter when we do. Your path to having a baby, or not, is yours and yours alone. It’s not black or white, fertile or infertile. Possible or impossible. We all operate somewhere on that spectrum of hope and intention and biology and science. If you’re like me, and most women, your own journey will be highlighted by a panoply of twists and improvisations and, if you’re lucky, balls out comedy that will lift and drop and then lift you again to the next thing. And the next. When I imagine my NICU mate having a loud discussion with our mutual nurse, about her need for nipple extenders — in front of both our husbands and two other families — we locked eyes and nearly collapsed in a heap of belly laughs while simultaneously moaning in pain because of our stitches. Those are the moments you should remember, that I remember. Nipple extenders, the fantastic men’s style underwear and giant maxi pads, the view of Central Park from my hospital window, my deep purple scar that I hope never fades. None of it was perfect or planned, but perfect is overrated.
This month, Raffi turns seven months old. And this past week, I celebrated my first Mother’s Day. I have no idea how to feel about that. Joyous and like somebody should have a parade in my honour, or quiet and clingy with my baby and my husband, because they were my life raft through it all. I’m only here to have something to say because they came along on the journey, and showed me I could actually be a mother, too. That I might even like it… and I do. It requires a kind of brain power and physical tenacity that feels like you are in training for the Tour de France but with all the wrong gear. Your brain is constantly engaged, as are your thighs and lower back, which makes it seem like your lower body would look really firm and awesome but it really doesn’t. You just feel sore.
Sore… but also in love. Because the feeling I have in my heart when Raffi squeals in the morning with delight, when her father reads to her, when she grabbed my face and lips for the first time… when it seemed clear she knew I was her mother, I realized, I’m here. I’m actually here. We both are. Finding our life together. Whatever is to come. I never could have planned it.
And I wouldn’t change a thing.
DESIGN AND ART DIRECTION ANDREINA CARRILLO. ANIMATION BY MISHA TOWNSEND.