Birth Story

My 12-year-old daughter Maeve was a full day old before I met her.

I had suffered an amniotic fluid embolism before she was born by emergency Caesarean section, and spent the night of her birth, and the following day, in the intensive-care unit at Northwestern Memorial Hospital in Chicago.

My obstetrician promised me Jello if I would walk across the skybridge back to Prentice Women's Hospital, the NMH facility where Maeve was born. The real incentive, though, was the chance to see Maeve and hold her. She was quite a little beauty, with bounteous dark hair.

I don't remember much of our early experience of breast-feeding but it progressed slowly. Maeve, who was just shy of seven pounds at birth, had had several bottles of formula before we met, and the formula kept coming, along with breast-feeding.

No one told me this at the time, but the fact that I had hemorrhaged during Maeve's birth raised the question of whether I would be able to breast-feed at all. Severe blood loss can cause a condition called Sheehan's Syndrome, in which the pituitary gland, starved for oxygen, is damaged to the point where it cannot produce the hormones necessary for lactation. The damage can be partial or total, and can cause other problems as well.

Before Maeve and I went home five days after her birth, a couple of her pediatricians went through the drill with me: Every two hours, around the clock, I was to breast-feed, and then "top her off" with formula.

Now, remember, I had nearly died. I had undergone two emergency surgeries, a Caesarean section and a hysterectomy. I had lost a colossal amount of blood and had been pumped so full of fluid that I weighed thirty pounds more walking out of the hospital with a baby in my arms than I had walking in with her in my belly. I had several oozing sores from a reaction to the tape that had held in the needles attached to various drips. I was a wreck.

At home, we had a major learning curve to address. I had been planning to breast-feed Maeve exclusively, as I had done with her sister, Nora, and we knew nothing about bottle-feeding a newborn. My husband, Ben, who had taken several weeks off work, had to buy some bottles. We had to learn on the fly how to sterilize them. (No one in the hospital had addressed the need to sterilize bottles. Maybe they thought everybody owned a dishwasher. We didn't.) In the short-term, we bought prepared formula.

Then there was the every-two-hour feeding protocol. As if. It worked to a degree during the day, when Ben could help me, but our exhausted family slept through most nights, and Maeve regularly went for eight hours without food. She lost a full pound in her first month of life — a dangerous trend for a developing baby.

We had no help. I don't recall anyone from the hospital calling to see how things were going. We were so depleted that we stumbled from task to task, day to day, though we were in contact with Maeve's pediatrician. But I did persist with breast-feeding, and with time, my milk came in. By the time I went in for my six-week check-up, Maeve was gaining weight and thriving.

Perhaps because it was so hard in the beginning, I cherished breast-feeding Maeve. For the two of us, who had shared a near-death experience, it was a daily chance to refresh our bond. We continued on for three years, encountering more and more raised eyebrows as the months passed. One of my doctors in particular, a specialist I saw a couple of times a year, began to grow shrill after a year about the psychological damage I was doing Maeve by tethering her to me by the breast. I ignored him because breast-feeding had made him nervous from the get-go.

I finally stopped because Maeve was in pre-school and the principal, a woman I liked and trusted, told me I was holding back Maeve's social development by continuing to breast-feed her, by that time usually only at bedtime. I think now that the principal was wrong, but we did have to stop some time. I guess.

My children are 10 years apart in age, and one thing that has struck me since Maeve's birth almost 13 years ago is how much more complicated the world grows as they get older.

When children are small, you can see clearly how their perfect lives will roll out. You can see them graduating from Harvard — or perhaps Yale; you devote serious time to considering which would be better — going into law or medicine, gliding along until they finish up as President of the United States. Along the way, of course, there will be sports trophies, prom dresses, all the trimmings.

Reality sets in gradually. It turns out the kids have learning disabilities, or strange hair, or no interest in sports — whatever, and likely in multiples. Ten years or so after spinning all those perfect dreams, you might find yourself praying they'll finish high school. Or even, please, God, let them stay alive through high school.

When Maeve was in preschool, I remember sitting in a group listening to moms in the Harvard vs. Yale stage, while my mind was on the then-exotic sensation some teen-aged boys in Nora's vast social network had created by sending nude pictures of girls they had probably known since kindergarten out across the Internet. I remember thinking that perhaps I had seen some of those boys, and those girls, on swings in the park or at a library reading hour when they too were small.

What I mean to say is that many of the things that seem critical when children are little get put firmly in perspective as they grow.

Poking around Lisa Belkin's Motherlode blog on the New York Times website this week, I landed on a post called "A Breast-Feeding Guru Who Uses Formula," which attracted me because I have been writing about breast-feeding. Through Belkin, I discovered Katie Allison Granju and her mamapundit blog. (I know, where have I been?)

Granju is a writer and digital-media expert who has become an authority on breast-feeding. Nevertheless, she found with her fifth child, Georgia, now seven weeks old, that she was unable to breast-feed. "I did have colostrum for the first week or two, but I never got the full enchilada," she writes in a post on Babble.com.

She tried "pumping, herbs, supplemental nursing system, plenty of skin to skin with baby, nursing on demand, nipple shields," all to no avail.

She is "resigned" now to the fact that Georgia is a bottle-fed baby, and she does what she can to inject warmth and meaning into an experience she never expected a child of hers to have.

But Granju believes that a horrific recent event in her life has contributed to her inability to breast-feed.

"I suspect that the biggest factor in my inability to produce milk at the moment is that my oldest child died in my arms only a few weeks before G was born. God only knows what the shock of that experience did to my body and its normal functioning," she wrote.

The death of Granju's son Henry from a drug overdose is about as terrible as this world gets. We dream for our children but they live the lives we give them. My heart goes out to the Granjus.

The science writer Douglas Starr has made something of a specialty of blood.

His book, Blood: The Epic History of Medicine and Commerce, and the PBS documentary series it inspired, Red Gold, cover the waterfront on this vital component of life, and our relationship to it.

The PBS website has a great discussion guide that sums up the topic impressively, and includes a timeline of important developments in our evolving relationship with blood.

Even before we understood its function, humans invested blood with value and meaning. As Starr writes in an essay in the guide:

Blood: It’s strange that this most familiar of substances has always been so laden with feeling, so heavily freighted with mystery and symbolism. Consider the vocabulary: blood of our fathers; blood of Christ; the nation’s blood; lifeblood; blood brothers, blood sacrament, blood libel.…The history of blood involves not only medicine, but also culture and religion. It is a story of change — how a mysterious liquid became a global commodity and reflected the soul of each society that used it.

This is my 75th post, something of a milestone for me, especially as it coincides with roughly six months of blogging — and a change of status.

I was part of a group laid off last week from the Chicago Sun-Times, where I had loved, loved, loved being a features reporter. The economics of print journalism caught up with me, as they have with so many others.

Where do I go from here? This is no idle question for me, and I'm just beginning to work out the answer.

Over the course of the past couple of years, I have enjoyed learning about new media, and now here I am, with both feet in the 21st century. I blog three times a week, I tweet, I even built my own website (with lots of help).

At the same time, I believe in the values of old media — checking facts, maintaining a certain distance from sources, and allowing both sides to have their say in a civil discourse.

Even while I find myself slipping into the conventions of the new, I hang onto my belief that the best journalism serves the reader's need to know about, and understand, the society she lives in.

I think I have picked a great topic to write about, because it seems to me that birth is on the cusp, just like me. Modern medicine knows how to make birth safe, and yet the maternal mortality rate appears to be going up.

Not only that, but I can't help but notice that while 99 percent of American women have their babies in hospitals, most of the voices making themselves heard in books and blogs belong to women who are dissatisfied with and critical of the hospital experience.

And with Caesarean-section rates rising out of all proportion to any statistical need for their use, those voices are gaining an intelligent and often passionate following.

Where do we go from here? I believe that one thing that will help us answer that question is an understanding of how far we have come.

Cartoon by Shel Silverstein

There is more than one way of looking at this, I know, but I believe I cheated death when I survived an amniotic fluid embolism during my younger daughter's birth in 1997. These extra 13 years, and counting, seem like a stupendous lagniappe tacked onto the lifetime I was meant to have.

That might be why, every so often, an event comes along that reduces me to a heap of gratitude for the medical advances, the professional competence, the technology — and the luck — that saved me. My older daughter's college graduation last week was one of those events.

Nora had just turned 10 when Maeve was born. She had not enjoyed being an only child, and was thrilled about the prospect of welcoming a new baby into our family. I had spent 4 1/2 months on bedrest, punctuated by a couple of terrifying bleeding incidents, which Nora had suffered through along with her dad and me. We were all relieved when the pregnancy reached term, and I went into Prentice Women's Hospital for a scheduled induction.

That fall Friday was a holiday from school, and Nora was off picking apples with friends in a far suburb, hoping that when she came home she would meet her new sister or brother.

She came back instead to a phone call from her dad, telling her about Maeve, who by that time was swaddled up in Prentice's high-risk nursery. Nora wanted to talk with me, but her dad said I had had a rough time and couldn't come to the phone. At the time he was talking with her, he still didn't know if I would live or die.

What if I hadn't survived? Both my girls would have been motherless, but Maeve wouldn't have known anything else. Nora would have suffered a devastating loss.

That didn't happen, of course. Because I have been there these 13 years, I know the scrapes Nora has been through, the joys, the disappointments, the accomplishments. Success in school never came easily to her, but last week, she graduated cum laude from DePaul University in Chicago.

I don't want to take credit for Nora's successes, but I do believe that mothers make a difference in their children's lives. I am proud of the wonderful young woman my daughter has become, and I am grateful that I have been there to see it.

Amber Strocel is one of my favorite bloggers. A Vancouver, B.C. "crunchy granola mom" (and engineer), Strocel writes with equal aplomb about the pleasures of domesticity and more serious issues like Internet privacy.

Strocel also writes a good bit about childbirth, and one recent post got me thinking. In “Scare Tactics,” Strocel considers which kinds of stories about birth and breastfeeding women should share, in particular with pregnant women.

As anyone who has ever been pregnant knows, that bump is a powerful magnet for women who had a 78-hour labor, or whatever, and believe you need to hear a blow-by-blow description, complete with sound effects.

“I don’t see much value in sharing horror stories,” Strocel wrote, adding that during a discussion she shared on Twitter, others had disagreed, saying they thought “negative stories can prepare women” for the possibility of problems with birth or breastfeeding.

Strocel relates that during the birth of her first child, precipitated at 34 weeks by an infection, she experienced severe hemorrhaging, which required surgery and a blood transfusion.

“I was actually not all that afraid of labour when I was pregnant the first time around… Being armed with someone else’s story of severe blood loss wouldn’t have changed anything for me,” she writes. “Thinking about it, I believe there’s a difference between sharing a horror story that scares someone out of her pants, and useful information that you can use to avoid problems.”

Strocel offers an example of the latter: "If I had a very negative experience with a health care provider, I might share that with someone who was considering seeing the provider."

I agree that would be useful information, but the key would be to catch a woman before she had committed to that provider. By the time other people know a woman is pregnant, she has usually settled on a birth attendant.

In fact, I’m not sure any birth stories have utility for a pregnant woman. Let's think about a really positive one. Would hearing about supermodel Gisele Bundchen’s painless water birth really be encouraging to the average mortal? No pressure, girlfriend, but Gisele had zero pain.

I suspect one reason why people deluge pregnant women with birth stories is that we assume they have some interest in a topic we don't actually get to talk about that much.

The birth story occupies a place very near the heart of the narrative of most mothers’ lives. I have two birth stories myself. One tells of a vaginal delivery in a hospital that required foiling an obnoxious resident itching to perform a Caesarean-section; the other is a near-miraculous survival story.

I hardly ever tell these stories out loud. They are great stories, full of colorful characters, conflict and drama but, practically speaking, who can I press them on? The people who are willing to listen to me use words like “vagina” and “transfusion” do not include, for example, my brother-in-law.

As I think about these stories, though, it occurs to me that even though the near-death experience is more dramatic, the birth of my first daughter is more satisfying, more reassuring, more the kind of narrative prospective parents are looking for: A family overcomes obstacles to have the experience it was hoping for (more or less). It was certainly more pleasant to live through.

I'm not sure it is the more helpful of the two stories. Knowing what it takes to live through a calamity — in our case, speedy access to a competent surgeon and anesthesiologist, and plenty of blood — seems to me to be extremely useful information.

But perhaps the stories we mothers like best are the ones where the fair damsel saves herself.

Humans aren’t the only ones who have the occasional difficult birth. Here’s a video from the University of Minnesota about Henry and William, a couple of little guys who beat the odds: Only 1 percent of twin births to horses end with two living foals.

(I can’t help wondering how any horses get born at all with those long pointy legs!)

There is no arguing with death, except through art.

Here is a poem I found through an Art of Medicine essay by physician-writer Caroline Wellbery MD in the Lancet. She uses it to talk about the value of medical uncertainty.

Dr. Wellbery's article is worth reading, and so is the commentary that went with it in the May 15, 2010 issue.

My Father's Autopsy
by David Gewanter

The one he did, that is, and took me to
when I was 13. I turned as white as
the old woman lying naked there;

but as he clanked out tools I inspected her
quickly, the dead cinder of her nipples,
the stiff tuft at her crotch (“Still black?

Wouldn't it turn gray?”). Dad took stock
of her length, weight, muscle tone, telling me
or the microphone how she lived,

what made her sick. “Like being a detective,”
he said, “except I answer my own questions.
Here; touch this.” But I wouldn't, and

I wanted her body to resist interrogation,
prayed weirdly she never said “aah” for a doctor.
Then he slit and sawed her down the middle –

she opened as easily as a yam, or a duffel
bag; dipping delicately in, Dad scooped
out a handful of stuff, all jumbly

like underwear from Mom's dresser. He
read her guts like a priest: proving
the tubes, slicing wafers from her heart,

so thin they would glow under lens-light –
at last she yielded him a brown pebble
which I felt between his finger and thumb;

then he put it back. Death's story, deduced from
facts hard as bone – as he talked me through it,
I could hear the joyful lift in his voice….

He had little patience for his house,
its prattling unready anatomies,
his wife's “incompetent housekeeping”;

at night he sat over journals and drinks,
compact, severe, inward as a microscope.
Now he's home all day waiting for the mail,

hasn't cut a corpse for years. He calls
every weekend, his news familiar
as a backache, and we talk without fear.

Once I thought my pen would open him here
like the corpse on its single pan of judgment;
but as I cover this pan with pages

he is alive on another one.

David Gewanter, In the Belly, University of Chicago Press.

Here's an old riddle. I am using the cognitive scientist and author Douglas Hofstadter's version, which appeared in Scientific American in 1982. If you find you can't solve it, contact me and I'll email you the answer.

A father and his son were driving to a ball game when their car stalled on the railroad tracks. In the distance a train whistle blew a warning. Frantically, the father tried to start the engine, but in his panic, he couldn’t turn the key, and the car was hit by the onrushing train. An ambulance sped to the scene and picked them up. On the way to the hospital, the father died. The son was still alive but his condition was very serious, and he needed immediate surgery. The moment they arrived at the hospital, he was wheeled into an emergency operating room, and the surgeon came in, expecting a routine case. However, on seeing the boy, the surgeon blanched and muttered, “I can’t operate on this boy — he’s my son.”

What's the explanation? As Hofstadter wrote, "You'll know when you've got it, don't worry."

One of the points Dr. Robert Wachter made in his speech at the ACOG meeting in May, 2009, was that everybody makes mistakes. True, people can wind up dead when doctors make mistakes, but everybody else makes mistakes, too.

To illustrate his point, Dr. Wachter showed a video from the BBC, "The Wrong Guy," the tale of two men named Guy who were waiting in reception areas in the BBC's London offices on the same day in 2006.

One was there to interview for a job.  The other, an expert on information technology, had been scheduled to hold forth on the network's News 24 program about a ruling in Apple Corp.'s suit against Apple Inc. The Beatles' music company and the computer firm had previously agreed to stick to their own businesses. But then came iTunes, and Apple Corp. sued Apple Inc. for alleged encroachment on its music brand.

A London judge ruled in Apple Inc.'s favor and the BBC invited tech expert Guy Kewney on to chat about the ruling. But it was Guy Goma, the unwitting job applicant, who was summoned from the waiting room for the interview.

The look on "the wrong Guy's" face when he catches on to who they think he is is priceless!