What happens when the birth of your child nearly kills you?

How a near-death experience during childbirth brought home the reality of soaring maternal mortality rates in the US.

Surviving childbirth - Hannah Selinger
[Jawahir Al-Naimi/Al Jazeera]

I want to tell a story about the birth of my second son, but I do not know how to tell it.

I could start by recounting the irrefutable details: October 15, 2018, was temperate. The day was sunny. It was a Monday.

I could tell you that I was feeling done with my pregnancy, in the predictable way that women at 40 weeks feel. Moving through the world had become difficult. Getting dressed required assistance. Sleep was impossible. The exhaustion of carrying another person peaks at some point, and I had hit my peak.

I could tell you that, at home, 40 minutes away, a new sitter was caring for my 22-month-old son, who likely did not understand, despite my insistence on repeating it, that a baby lived in my protruding belly.

He was a funny, spirited toddler, who was still learning language but who already understood what he liked and disliked. In the afternoons, while I sat at the table in our sunny kitchen, writing for a living, he rolled toy cars up and down my legs, humming to himself in that insatiable, delicious way that young children do.

That son had arrived two weeks early, when, felled by the life-threatening condition of preeclampsia, I was induced into labour. Ten hours later, when his heart rate slowed, doctors shuffled me into an anteroom, where an anaesthesiologist poked at my back with a needle, missing my spinal cord five consecutive times. When he finally succeeded in numbing me, two surgeons opened me up. My curious husband looked beyond the curtain to see my intestines on the table, as they searched for this new life.

Surviving childbirth - Hannah Selinger
[Jawahir Al-Naimi/Al Jazeera]

Unlikely battle scars

I want to talk about the badge of the caesarean, an unlikely battle scar.

I had always envisioned myself as a natural birth mother, opening my maw to pain as proof, maybe, of my fortitude. During my labour, I refused the gentle offer of an epidural, riding through the waves of the contractions by cursing the God I did not believe in. Who was I proving this strength of constitution to? Myself? The doctors? The C-section stole that role from me, and in the murky first days of motherhood, when I stumbled, sleepless, from room to room of a house I did not own, the lines between day and night blurring, I felt every single stitch.

I want to tell you about my reluctance when it came to a second surgery. I did not wish to repeat that part of motherhood. I resolved, in my second pregnancy, to eat less salt, to walk more, to preempt the ailments that forced my doctors’ hands during my first.

The procedure of delivering vaginally after a C-section – a VBAC – is actively discouraged by risk-averse obstetricians. Those same obstetricians have favoured the sure thing of invasive surgery over the unpredictability of birth at an alarming rate. But my doctors were kind enough. The option, they said, was on the table. Would I be?

Even as I prepared for a natural birth, I had my doubts that I would be able to make it a reality. The Centers for Disease Control and Prevention (CDC) says 32 percent of all births in the US are caesareans, but the World Health Organization recommends an ideal rate of 10-15 percent. It is a slice-and-dice solution to the fairly common act of bringing human beings into the world.

Between life and death

I want to talk about the problems with the birth of my second child. They began with a labour check, with cords and alarms and a room so small it could accommodate just me, my bag and a nurse.

Hooked up to a monitor, I could hear the swoosh of my baby’s heart, which sounded no different than it had on other occasions. But my hulking doctor, who shoved a meaty claw into my birth canal and concluded that I had not dilated at all, expressed concern. “Hon, it’s time,” he told me. “Call your husband.”

With a caesarean, you are awake, in that woozy, dizzy space between life and death.

A powerful wave of nausea, amplified by fluorescent surgical lights, caused me to retch and vomit into a pan. A blue curtain separated me from the corporeal reality of my entrails, taken out and placed on a surgical table for the world to see, exposing that thing that made me a woman: my womb.

Time, fluid anyway, is even more fluid on the table. I felt the slice, just not the pain, and then pulling and tugging. I heard the murmur of voices and the clang of metal instruments. My purple baby, suddenly before me, eyes open, began to cry. Introduced to me, he was then ferried away, left with professionals.

I do not know how to write about the unfamiliar parts of a familiar surgery.

While the doctors sewed me up, I felt pressing, over and over again, as if someone were leaning into my insides. Time bent. My first C-section had seemed so fast, so breezy. It is hard to make heads or tails of time when you are drugged and recumbent, but I recognised, in that white-lit room, that something had stalled, that something was wrong. Eventually, I was wheeled into a hallway, where I waited for my husband and baby to arrive.

After my first C-section, the nurses wheeled me into the same hallway, at the same hospital, and I held my newborn for the first time. He craned his neck up at me and l saw his navy eyes, shiny from the ilotycin that they use to stave off infection in newborns. I took a picture, with the baby on my breast, his face leaning into mine in some biological way that I was only beginning to understand.

That memory of my introduction to motherhood is burned into my brain, part of a reel that I replay when I am feeling nostalgic. It was here that I met him, I think. It was here that I knew the pulsing vein of instant love.

I want to tell you that I do not remember holding my second born in that hallway. I remember that he was there, of course, but I do not remember his face, or his glossy eyes, or his hands searching to connect.

I remember only my desperate, painful thirst. I begged the nurses for water, but they would not relent. They promised my thirst would fade. They palpated my wounds, my swollen and distended belly that had held a human – two humans, actually – and that now held scar tissue.

“It hurts,” I said, and the nurses nodded in solidarity. I had just had major surgery. Of course, it hurt. I was, to them, a wimp, incapable of suffering these common discomforts of early motherhood.

‘Call her family’

Was the portable ultrasound that revealed my ruptured uterine artery first? Or was it the tachycardia, a new word that I now know explains what happens when your heart rate goes from 60 to 160.

“We’re taking you into emergency surgery,” the same large doctor said, and I thought of the staples that had just been used, not an hour before, to hold my spilling guts in.

I remember nothing after that, not the cold bright light of the second operating room of that day, or the mask used to send me under, or the 20-odd doctors frantically called in to assist. My surgery, to repair the bleed, required four emergency blood transfusions and an entire vascular team.

I want to talk about my husband. Outside, in that same hallway, he held my newborn baby. A door to the doctor’s office was open and he could hear a doctor calling for backup.

“She doesn’t have that much time,” someone said. Another person likened my insides to a hamburger.

A nurse came out. “Does she have any family?” the nurse asked. My father was dead, but I still had a mother, a stepmother, a grandmother, three sisters, one brother, uncles, aunts, cousins, and, yes, a whole family.

“You should call them,” the nurse told my husband.

Exiled from the maternity ward

When I woke up, in Intensive Care, with a throat burning from intubation, I was exiled from the maternity ward and from my son. He spent the first night of his life without me, as I struggled to sit up, to drink the water I had so badly wanted.

In that first night, which folded into itself, hours stretching on through the beeping monitors and prickly IV and vital checks, I contracted pneumonia, the filthy bits of unused air sitting too long in my lungs.

I want to tell you about the very worst of it, a condition known as an ileus. Air trapped in my stomach from two consecutive abdominal surgeries bloated me until I looked nine months pregnant again. My insides writhed against gas that could not escape, and I stayed up all night, for three nights straight, vomiting neon green bile.

In those first days and nights, I did not hold my son, or nurse, or change a single nappy. My husband cradled our baby and fed him thimble-sized portions of formula, while I focused on learning to use the bathroom again.

I spent almost a week in the hospital, begging for narcotics to offset the incomparable pain of my intestines rebelling against me, the only cure for which was time.

A haunting

I want to tell you that a traumatic birth does not end when you come home.

Six weeks after my delivery, long after I had resumed my everyday life, I returned to my doctor. I was at risk, he said, for postpartum depression.

“Your experience,” my doctor said. Not near-death. He did not use those words. He left me alone to nurse my newborn baby, whom I had brought with me to my appointment. I was, after all, no longer pregnant, no longer the priority of the practice.

But it was not depression I was feeling, not exactly. I could not pinpoint what the problem was, but there was a problem. I kept an emotional distance from my baby, not because I did not love him, but because it was all very complicated.

His entrance into the world had nearly signalled my exit, and when I started to think too deeply about it, I was drawn into a pattern of fear and regret. What if I had died? What if I had left my not-yet-two-year-old motherless, because of a commitment I had made to having two children, to fulfilling some outrageous American dream? What if I had been too greedy in my quest for a good life, and what if I had nearly uprooted it all in the process? What if almost dying was actually my fault?

My mortality, before, had been a given. People in their thirties do not die for no reason. People in their thirties do not code on the surgical table.

Surviving childbirth - Hannah Selinger
[Jawahir Al-Naimi/Al Jazeera]

Around every corner, I began to see insidious danger. Privately, I catalogued how many ways a person can die. I could get hit by a car. I could fail to notice a changing mole. I could miss the signs and mistake a tumour for a migraine. I could choke on a piece of cheese while home alone with my kids.

The birth of my son became a haunting, a visceral reminder that any of us could succumb at any time. Life was only a game of risk.

I distanced myself from one of the great loves of my life, because I was scared of him, and scared of myself, and scared of what had happened, even though I had survived.

At night, when he sobbed the sobs of a person just learning to live, I left my husband to tend to him, sleeping through the weight of my milk. It is strange to live through trauma and to arrive at the conclusion that you are weaker – not stronger – than you were before. But that is how I felt: gutted, emptied, a shell holding on for dear life, even as the periwinkle eyes looked up for me, and only for me.

Dying of pregnancy

I want you to know that I am not alone, that, in 2017, ProPublica teamed up with NPR to conduct a six-month-long investigation into maternal mortality in the US. That investigation concluded that more women in the US are dying of pregnancy-related complications than in any other developed nation.

That rate – 26.4 deaths per every 100,000 live births – increased by 136 percent between 1990 and 2013.

Worse, the numbers disproportionately affect African American women, who experience 43.5 deaths for every 100,000 live births, as opposed to 12.7 for white women.

My experience was not an outlier; it was an example of a relative norm.

We women are not listened to, regardless of our wealth, of the colour of our skin. When we are attuned to our bodies, convinced of its failings, we are labelled hypochondriacs. Our concern is converted into hysteria, a word derived from the Ancient Greek word husterikós: suffering in the uterus.

Had my heart rate not raced to the point of near-oblivion, I am not sure that anyone would have believed that the pain I was experiencing was anything beyond that of an overly sensitive, post-surgical woman. The gravitas not given to my situation, and to the situations of women like me, is why women are dying. It is why women will continue to die.

All the ways a woman can die

I want to say that, a year after the birth of my son, I am not the same person. Before you have children, death feels like an inevitable bookend to life. After, it feels like some sort of hellscape you are imparting on the uninitiated. How will they survive without me? I ask myself. Who will cook them their dinners, or listen to their songs? Who will explain the depths of my love for them? How will they know how desperately I tried to stay alive, just for them?

Many days, assaulted with the reality of motherhood, I do not think about the darkness at all. I do not thank the heavens, or medical advancements, for my life. And I do not wonder too intently about the women who did not survive the operating room. Some days. But some days, as my coffee grows cold, I think of all the ways a woman can die. I catalogue my ailments and practise my self-advocacy.

I want to let you know that my son and I are OK now. In the mornings, when I hear his cries from the next room, before the sun has even come up, I go to his room alone, because I want the first moment of my day to be a baby in my arms, nuzzling into my neck because I am the person he needs most in the world.

I hope he does not remember, now or ever, that I kept him at arm’s length for so long, while I battled the demons that arrived along with him.

He is a sweet and needy baby, a difficult baby, and a baby that prefers his mother to anyone, and when I think back on the first year of his life, and how I struggled to be the thing he needed most, I hope that he forgives me.

Source: Al Jazeera