Life among the pagodas
Elisabeth’s Birth Story
I only had time for one pre-natal appointment with my Chiang Mai OB before giving birth to Elise. At the appointment my doctor echoed the words of my Myanmar OB and mentioned that I was measuring small and that the baby seemed small. I wasn’t overly concerned, as they said the same thing about Lena, and she was 6.5 pounds at birth (She was born at 38.5 weeks). I was nearly 37 weeks at this appointment, so I expected that I had some time for the baby to pack on some more weight before birth. My doctor said the baby was positioned quite low, and exhorted me to rest a lot so the baby would not come early. I wanted to keep this child inside as long as possible, and I find late pregnancy to be a huge energy drain, so I was happy to take more rest on the doctor’s orders.
“I’m gone all of next week, so try not to have the baby then, okay?” My doctor said as I left.
I hope not! I want this one to be an August baby. I thought. That was Thursday, July 13th.
The next week arrived. Friday, July 21st rolled around, and I woke up feeling odd, but chalked it up to having stayed up too late the night before. Jim was going out to a coffee shop to work for a few hours, and I was going to join him and leave Lena with the babysitter, but changed my mind at the last minute, feeling like I needed more rest. I fell asleep briefly, but my sleep was interrupted intermittently by some fierce little kicks.
[The baby had been quite active throughout the pregnancy, such that the ultrasound technicians in Yangon had struggled to get images and heart rate measurements. During the last few months I would often be awakened from a dead sleep by a series of kicks. This baby seemed to be able to reach places I didn’t think a child in utero could reach—how it is that a baby can tickle the inside of a hip so effectively? I didn’t know the uterus could reach that far! When I told people this, they often speculated that I was having a boy. Deep down I still had the hunch that this was a girl; who says baby boys get a corner on the market when it comes to being strong and spunky?]
I woke with a start around 11 am. The baby had moved and suddenly I felt a popping sensation. For a split second I was impressed, thinking that it was the biggest kick yet from this child. My awe quickly turned to dismay as I realized that my water had broken and had gushed all over the place. I was now on the clock—I would be meeting my baby this weekend, one way or another. As challenging as late pregnancy is, I was not ready for it to be over, and I laid back down, feeling sad and resigned, and trying to savor the last few times I would get to feel this little person inside of me.
There is something odd about knowing you’ll be having your baby soon, but not even being in labor. I called Lori, a community health nurse who helps pregnant expats in Chiang Mai, and asked for her advice. She briefed me on the hospital’s standard procedure for spontaneous rupture of the membranes. I should go in to the hospital sometime around 6 hours after the water had broken; if I was not in active labor after 12 hours, the labor & delivery staff would give drugs to augment labor, in order to prevent infection. As far as I knew, my OB was still out of town and I would need to deliver with another doctor.
Jim came back from working, we tidied the house and packed our bags for the hospital and restocked a few things for when we would return. I laid down and tried to nap. In retrospect I would have gone and gotten a foot massage or something, but I was too keyed up wondering how things would go—would labor start spontaneously, or would I need to receive Pitocin?
(One last photo before Lena’s sister joined the outside world.)
We left for the hospital around 5 pm. Checking in was surreal; the last time I had checked into this delivery ward, they barely had time to get my vital signs because I was fully dilated and the Lena was already crowning. I still can’t even remember how I got from the exam room to the delivery room—everything had happened so fast. This time, I leisurely waited while the staff examined me; Lena ran around in the hallway while Jim made arrangements regarding our insurance. One nurse even offered to remove the old nail polish from my toes for me—I was happy to take her up on that offer! The labor and delivery floor of Sripat Hospital always has such a calm atmosphere, which is surprising considering the intense nature of what goes on there. I suppose it is a testament to the quality of the nursing staff at the hospital.
I was only dilated 3 cm, and my contractions, though slightly painful, were sporadic, as they had been for the past four weeks. No sign of active labor yet. They brought me into one of the available labor rooms and we all settled in. Well, Lena didn’t exactly settle in; she quickly realized that the door handles were within reach and took off at top speed several times. I couldn’t keep up with her, so Jim had to corral her in order to prevent her from running into someone else’s labor room. We managed to divert her for a while with snacks and movies. At 10:30 pm she was still wide awake and I was not yet in labor.
(Lena was pretty excited about the birthing ball in the labor room. Here we are singing a song from Winnie the Pooh: “When I Up-Down, touch the ground, it puts me in the mood…in the mood for food.”)
Close to 11 pm, my doctor popped in. I was pleased to see her, as I had assumed she was still out of town and would miss the birth. She told me that if this baby was not born by 5 am, they would need to start me on antibiotics; since I was not yet in labor, I would need to start receiving Pitocin if I wanted to deliver the baby before then and avoid infection. We agreed that would be best, and the nurses began setting up the IV drip. Jim decided to start strolling the halls with Lena, in hopes that she would fall asleep before my labor picked up pace. (She can be relentlessly wakeful when she wants to be.)
By midnight, I was starting to have regular contractions—thanks to the Pitocin—though they were still coming about 10 minutes apart. Nurses came and checked on me every 30 minutes or so, and had me lie down so they could time my contractions (this was rather painful by the way—I don’t know many people who prefer to lie down during contractions). Every time one of the nurses came in, she would time me, then look at me sweetly and tell me that my dosage needed to be increased so that labor would speed up. She would press the “up” arrow on the IV, then leave me to labor on my own again. The first few times this happened, I took it quite amiably. But about 1.5 hours into labor, I started feeling resentful that I had to experience so much discomfort at the push of a button. But at the same time I was grateful that there was an end in sight: this baby needed to be out by 5 am, and the nurses were doing their job well. I just hated the lonely feeling of being in pain all by myself; no matter how many people are around, there is something lonesome about being in labor.
(The most well-rested one of all…)
Sometime after 1 am, Lena had finally given up the fight and fallen asleep, and Jim returned with her and plopped her on the couch in the labor room. Labor was starting to intensify, thanks to the IV drip, and I was glad for his company. By 2 am, I was starting to experience chills and I was vomiting a bit, which I am assuming was my body’s response to the Pitocin.
As 3 am drew close, the contractions were painful and felt relentless, and I was wishing that pain relief was an option. I started feeling feverish and suddenly was overwhelmed with the thought, “I am done—this is too painful and I can’t do it anymore.” Right on the heels of that thought, my body started pushing, Jim dialed the nurse’s station, and within moments the room was filled with scrubbed up nursing staff and a sterile birth pack was being unwrapped and laid out.
I was pushing and things were noisy enough that Lena woke up from her sleep and started crying. Jim held her and held my hand during a contraction. I was told to slow down on the pushing, and that the baby was crowning. The pushing phase of labor feels like a mystery to me. On one hand, it is so intense that it is hard to recall some parts of it, on the other, it is filled with moments of absolute calm and painlessness, even casual chatter, while the body takes a breath before continuing. It is a well-designed process.
“Does the baby have hair?” I asked Jim during a pause in contractions. “Yep,” was the answer. Lena was still upset, so he left the room to help calm her down. Another contraction came and went, and my doctor told me that the head was already born and the baby would be born on the next push. “Can you get my husband back in here?” I begged the nursing staff. Jim and a slightly mollified Lena returned just in time. He held her in one arm and got a few photos with the other. And just like that, on the next push our second daughter emerged into the breathing world, wiggling her limbs and registering an Apgar score of 9-10. Jim left Lena on the couch with a can of Pringles while he accompanied Elise to the nursery for her first shots. (The next morning when Lena woke, she seemed to have forgotten everything about the previous night, except for the Pringles, and she continued to chow down until we interrupted her breakfasting to introduce her to Elise.)
I was shocked to discover that Elisabeth was only 5 lbs, and I felt guilty about it for the first few days, like I had perhaps done something wrong and failed to nourish her. But other than being small, she was and is in every way a wiry, active little baby with a great appetite. Now at 4 weeks old, she is already over 7 pounds and gaining well. Being born small doesn’t seem to have had an adverse effect on her so far, and I am just so grateful for medical technology such as Pitocin, that allowed her to enter the world without the risk of infection, or the strain/trauma of having to be treated for an infection as a tiny newborn.
(30 minutes old!)
When I hear North American women sharing teary stories of traumatic births, I feel incredibly grateful for the wonderful experiences I’ve been able to have here in Chiang Mai. Never once have I felt manhandled or disrespected by the doctors or nursing staff. They have always been incredibly kind and courteous. Seeing the Sirpat hospital building from afar when we drive through town gets me feeling sentimental. I get the warm fuzzies whenever I get to be back at there, and, silly as it may sound, I kinda leap at any little chance to visit the hospital and relive the memories of welcoming my daughters into the world there.
(At first she was lost in nearly everything we put on her, including newborn diapers. Now at 4 weeks she is fitting into newborn sized clothes.)
I live in a part of the world where giving birth is an act of bravery for the average woman. I have visited maternity wards that are a breeding ground for malaria, where there are 50 new mothers and babies packed in one room, laying inches from one another. Nursing staff is known to be corrupt, and the doctors barely have more than a few moments for each patient, and in some places will only give extra care if they are bribed. Sick or stillborn babies are often taken away from their mothers before they can even hold or see them. The last Myanmar hospital I visited was filled with women and their families bedding down in the open air hallways of the hospital—they are not permitted to leave the hospital for the first three days after birth, even if they wish to, so they are forced to stay in a place where they are exposed to more disease than they’d encounter if they rested at home. And this is in the most medically advanced city in the nation. If I were a Myanmar woman, my postpartum infection after Lena’s birth might have ended my life; if I were a Myanmar woman, the circumstances of Elise’s birth might have put her in grave danger.
I am so thankful that my birth stories are happy ones, but this thankfulness is definitely tinged with the awareness that so many do not share my privilege: good access to healthcare, insurance, extra resources in case of emergency, and a passport that allows me to travel to places that offer better care. Giving birth is an intimidating experience even in the best of situations; my own birthing experiences have impressed upon me the courage of many women throughout the world who do not have the same access. Myanmar has the second highest maternal mortality rate in this region, many of the deaths resulting from easily preventable issues. I hope that new health programs will come along to aid a decrease in that death rate. I hope that someday soon women in Myanmar who can only afford public healthcare will not have to fear their caregivers, or dread a visit to the hospital to give birth; and that someday soon maybe, just maybe, women in Myanmar might get the warm fuzzies too when they think of the place where they gave birth, and of the people who helped.
(Lena is somewhat fascinated by the “Teeny Baby”)
(Four days old)
(Four weeks never went by so fast!)