Perpetual Twilight, Part 1

“House (Ar)rest”

Having a child in the NICU is like living in perpetual twilight.  The windowless rooms.  The heavy curtain dividers.  The lights in your child’s room—dimmed for optimal “family rest”—that make you blink violently when you walk out into the bright hallway.  The nurses, always looking hurried, yet trained to be silent even as they quickly thud past in their thick-soled black shoes, trained to not disturb the sleeping, the resting, the grieving, the hopeful.  The continuous, 24-hour schedule, skewing any sense of time you may have been able to retain in the artificial environment.  The clocks that dutifully tell you times that mean nothing.  Is it two in the morning?  Or is it afternoon? What does it mean that the clock reads 2?  What does it matter?  Either way, it’s time for another feeding.  Another tube inserted into her.  Another moment, another minute, when you get to fold down the plexiglass divider and touch her.

Thursday, August 14^th: I was clutching my husband’s arm, my eyes squeezed shut, as the pressure steadily mounted and peaked.  He was lying next to me, calm but alert, one eye on his phone, timing the contraction.

“Don’t forget to breathe, baby.”

His low, still voice reminded me that I was, indeed, holding my breath.  I slowly exhaled and opened my eyes as the pain subsided.  One minute long.  Twenty minutes after the last one.

“She’s coming.  She’s coming out of me.  I can feel it.  This isn’t normal.  I can feel her head pushing against me.  She’s coming.”

On Saturday I would be 35 weeks pregnant (I believed, though I would later learn that my calculations were off a day).  For the last two nights I had been experiencing contractions that were increasingly regular and painful.  I was being woken up throughout the night from the pain.  I tried to “drink a glass of water and lay down” (the usual advice for stopping preterm contractions), but it didn’t seem to be very effective.  I was told that the contractions were likely “false” labor, Braxton Hicks contractions, that helped to prepare my uterus for the task of childbirth, but didn’t actively advance labor, didn’t affect my cervix.  But these contractions didn’t feel like a general tightening in my midsection.  It felt like a downward push, hard, and insistent, and slowly rhythmic.

The next morning I called my OB, and was told to come to the office right away.  After a quick exam, it was easy to see that I wasn’t having “false” labor, or “unproductive” contractions.  I was in pre-term labor, 2 centimeters dilated, 70% effaced, and contracting every 15 minutes.  My OB put me on Procardia. (A blood pressure medication that some studies have shown helps to slow down contractions, though its efficacy for pre-term labor has really only been recorded for the first 24-72 hours after starting it.  It buys you a couple of days.  But, luckily, I was far enough along that all we really needed was a couple of days.)  Then he told me, “Your job for the weekend is to sit on your couch and time your contractions.”

“Like bed rest?”

He balked.  “I’m not going to tell you you can’t do things.  I’m not going to put you on bed rest.  Let’s call it couch rest.  House rest.  Just, don’t leave your house.  And don’t do much while you’re in it.”

“So, activity-wise…?”

“As close to nothing as you can manage.”

“For how long?”

“For as long as it takes.”

For two weeks, I slowly fused into my couch.  I dropped my daughter off with her grandparents.  I downloaded a contraction timing app to my tablet.  I ate everything out of a microwave.  I obsessed about every twitch, flicker, and tightening in my belly.  I watched my house succumb to the rapid entropy that comes when you have both a husband who works too many hours and a toddler whose idea of “helping” usually includes pulling all of the Kleenexes out of the box while laughing maniacally.  I watched way too many hours of “Criminal Minds” and “Law and Order” (because apparently marathons of violent TV dramas are the only things on in the middle of the day when you have basic cable. Who knew?).  I did nothing, except slowly, slowly, agonizingly slowly went insane.

I took the Procardia for five days.  After two, my “breakthrough” contractions had ramped up enough that the on-call physician told me to double my dose.  After two more days, I developed an allergy to the medication, and had to stop taking it immediately.  Without any medicinal intervention keeping my uterus from contracting, my “house rest” had morphed into house arrest.  I was told to stay hydrated, and keep my feet elevated.  No laundry.  No picking up my daughter.  No walking to the park.  No nesting.  I sat on my couch, thirty feet away from my newborn’s incomplete nursery, and was adamantly forbidden from working on it.

I was miserable.

Even though I kept telling myself that I was lucky (we had made it to 34 weeks with no complications, and if my daughter had been born at this point, the chances of her having long-term problems from being born preterm would be truly miniscule).  Even though I knew that it was temporary (I only had to wait until 37 weeks to be considered truly “full term” and therefore out of danger).  Even though I kept telling myself to be thankful for the outpouring of help I received (My good friends sent me flowers.  My parents drove 500 miles to be with me.  My sister visited from Chicago. My daughter essentially lived with her grandparents, enjoying way too much junk food, way too few rules, and bedtimes that were way too late, for almost the entire time.  I missed her until I ached, but I knew that she was happier being with people who could get down on the floor with her, instead of trapped in the living room with her mother, watching Cars and Up again).  In spite of knowing all of these things, I found myself crumbling every day.  Two o’clock would roll around, and I would sob, knowing that I had already sat like stagnant pond water for the majority of the day, but also knowing that I still had hours—long, long hours—before my husband would come home, before I could move off the couch and into the passenger seat of our minivan and enjoy fifteen minutes of bliss and freedom as he drove us to a local fast food restaurant for dinner.  I watched the clock, timed my contractions, played hundreds of hands of solitaire, and sobbed.

Sunday, August 25^th-Monday, August 26^th: I was 36 weeks pregnant.  I was 4 centimeters dilated.  Once again, I grabbed my husband’s arm in bed as he timed my contractions. Every 10 minutes.  I was certain that I was going to be having my baby.  “It’s happening.  It’s really happening.”  We dropped our sleeping daughter off with my mother-in-law, and drove to the hospital, getting there around eleven at night.

The nurses hooked me up to the monitors.  We all watched the needle swing wildly and regularly, showing my contractions.  I was effaced.  My baby had dropped.  One of the nurses, after checking me, exclaimed, “Your cervix is READY for birth!”  I was uncomfortable, but smiling.  It was over.  I was done.  I would no longer have to sit in misery.  I was going to have my baby.  She was a little early, but it’s okay.  She’d be fine.  She was measuring big, her heart rate looked great, and, being a girl, the odds of her having problems would be low.  The nursery wasn’t finished.  The laundry wasn’t done.  Nothing was ready.  But it didn’t matter.  She would be here.  Finally.  I breathed more easily, knowing that it was all over.

Then, the OB made the decision to stop my labor.  It was her medical opinion that we wait.  I was just 36 weeks.  It was cutting it too close.  She confessed to being overly cautious on such matters, but told me that being conservative would be a good thing for my baby.  Really.  I was given two doses of terbutaline to stop my contractions, spent 9 hours at the hospital, slept 20 minutes, and was sent back home early enough for my husband to go back to work after just a few hours’ nap.  I was left alone, pregnant, and in labor.  Again.

I couldn’t believe it.  I was told that after 36 weeks my labor would be allowed to progress.  That it was standard procedure to allow a woman that far along to give birth.  But I was still pregnant.  Still sitting on the couch.  Still crying at 2pm after realizing that I may have to deal with an entire month more of labor.  Still guilty for wanting my baby to arrive, not for her sake, but for mine.  I was being a horrible mother.  Selfish and whiny, I just wanted my discomfort to end, even though the possibility that my unborn child would have complications was very real.  I didn’t care.  I wanted my baby.  For me.  I wanted to feel better.  I wanted it to end.  I was angry at the OB.  I was angry at my body, which didn’t seem capable of holding on to her any longer.  I was even angry at my child, not because it was her fault, but because I knew that I couldn’t blame her.  I was angry at her, and I hated myself for being angry at her.  Because I knew that I had to sacrifice my comfort for her safety.  Because I knew that I’d always have to sacrifice my comfort for her safety.  Because it wasn’t fair.

So I cried.

Saturday, August 31^st: I believed that I had made it.  According to my calculations, I was 37 weeks.  Full term.  Out of danger.  If my preterm labor ramped up again, my OB would not try to stop it.  I was freed from house arrest.

To celebrate, my husband and I decided to wander around the Fourth Street Festival, an art fair held every Labor Day Weekend in our hometown.  I was going to look at the handmade art, enjoy some people watching, maybe even have an ice cream cone.  I wasn’t going to be alone anymore.  After two weeks on my couch, it would be Heaven.

It was brutally hot.  We stopped and looked at the booths set up by local artisans and craftsmen, chatted with a few of them whose work caught our eye, and tried to turn our faces to the hot breeze that worked its way lazily down the street in between the crowds of people.  We spent most of the afternoon sitting under a tent, listening to Americana, sipping lemonade sold by the high school orchestra.  I began to really notice my labor. Whenever I had another painful contraction, I would grip my husband’s arm.  I seemed to be clutching him every song.

As we walked back to the car, I had to stop frequently and wait through another minute-long contraction.

“These are getting closer together.”  Once again, his voice was calm, but he was watching me intensely.

“No, no,” I gasped.  “It’s just the heat.”  Suddenly, I was aware that my newly acquired freedom was at risk.  It was my first day out of the house in weeks.  It might turn out to be my last.

We went back to my mother-in-law’s house to pick up our daughter.  There, in the cool of the air conditioning, my husband quietly timed my contractions while we sat around and chatted, trying to ignore the elephant of my impending delivery.  Every five minutes.  I somehow convinced him to take me home.  Somehow decided that my labor would stop if I was in my own bed, resting and watching cartoons with my daughter.  An hour later, they were four minutes apart.  I called my OB.

“Rachel, are you in labor?”

Gasping, “Yeah.  Yes.  I’m pretty sure I am.”

“Then get here.  Now.”

At 7:23 my OB checked my cervix.  “You’re 6 centimeters dilated.  Your baby is coming whether we do anything or not.  Within the half-hour, you will be having a c-section.  Okay?”

Joy, nerves, excitement, fear.  I had no time to truly feel any of them.  I called my family.  Everyone was at a barbeque at my aunt’s house.  They immediately started laughing and making guesses about the baby’s weight and the time of birth.  They started a friendly bet around the table.  I heard their overlapping conversations, their joy, as chaos and noise.  I was smiling and laughing.  I was still smiling and laughing, even when I was being wheeled, alone, into the OR.  I was still smiling and laughing, even when I started to tremble, shaking uncontrollably.  Am I cold?  I must be cold.  Maybe I should ask for a blanket. The nurses joked and smiled at me as they wrapped me in warmed blankets and tested my belly for numbness.  My husband came in, then, wearing blue scrubs.  I was still trembling.  Still smiling and laughing.  It was 8pm.

Ultimately the c-section was a wonderful experience.  It was fast, efficient, and without any complications.  I felt nothing but a slight tugging sensation, then I heard the roar of congratulations as the nursing staff and my OB welcomed my little girl into the world.  My husband, smiling behind his mask, was holding her in a tiny bundle.  It was 8:33pm.  She was born at 36 weeks, 6 days.  I had been one day off in my calculations.  She was the oldest a “premature” baby can be, though her size belied her early delivery.  6 pounds, 15 ounces.  We all laughed.  The OB joked, “If she waited three more weeks, she would’ve been HUGE!”  My husband placed her face next to mine, and I began to cry as I kissed her, the tears rolling back into my ears.  She was red and swollen, puffy from the strain of the birth, but I could see how she looked like her sister, her father.  Her eyes were closed, and her lips were pursed.  A frown was working its way across her forehead.

And she was quiet.

She wasn’t crying.  It wasn’t a cry.  More of a grunt.  A gasp.  One of the nurses appeared, hovering over my head and haloed in the bright spotlights above me.  “Rachel, she seems to be having a little trouble breathing.  We’re just going to send her to the special care nursery.  Just to get her some help.  She just needs a little help.”

I couldn’t look away from her, from my daughter.  I couldn’t stop kissing her.  My husband was looking up at the nurse.  Quiet and calm as always, but alert.  I didn’t notice him tensing up.  I was looking at my daughter’s chipmunk cheeks. Just a little help?  Just a little? I nodded.  “Okay.  Yeah, I understand.”

The nurse looked kind, but she wasn’t smiling and laughing anymore.  “What’s her name?”

“Madeline.  Madeline Louise.  Maddie.”

“You’ll be able to see Maddie soon, okay?  Daddy’s going to take Maddie the whole way.  He’ll be with her the whole time, okay?”  She looked down, “Maddie, give Mommy a kiss.”  The nurse put her hand on my husband’s arm, and he stood up, pulling Maddie away from me.

I twisted my head around, trying to watch her from where I was strapped to the operating table.  The last thing that I remember was my husband’s shoulder, in blue scrubs, hunched over our new daughter, as he turned away from me and walked out the door.