A caesarean section cuts through seven layers of skin, muscle, and tissue. Done properly, the person shouldn’t feel a thing.
***
The bright overhead lights pull me back to the past, of staring at the ceiling and waiting for an answer. The fluorescent tubes covered in a patterned plastic cover seems to be the universal lighting of hospitals and doctor’s offices. I wonder if there is a discount, or does the invasive light discourage longer visits? It’s the unasked questions that draw me back in time, but I push off those unwanted memories. I don’t want to go there so I contemplate the overhead lights instead. The opposite of serene. I need to be in the hospital, but can’t they embrace some aspects of a birthing centre or home birth? At least dim the damn lights.
The pale blue gown feels stiff from sterilization and too much time in a hot dryer, but it is better than my wet skirt and underwear soaked through from my water breaking: there was a comedy-show giant uddle on our hardwood floor before we left for the hospital.
I rub my extended belly trying to feel movement. The hospital wrist band loose on my pale, almost translucent skin revealing small purple veins that I know a nurse will battle with at some point when it is time for an IV. Baby has been quiet this morning, yet I don’t consider this vital information. I assume it’s normal during labour. The triage is alive with nurses moving in and out of curtained beds, the beeping of machines, and the sounds of others in labour. No screaming, this isn’t like the television show I just finished producing, where even in a sci-fi world, creatures scream in labour. But there is pain here. I put on headphones and block out the sounds of throwing up and swearing coming from another bay. Like trucks, we are parked here waiting to be unloaded of our cargo. My precious cargo.
I turn up the playlist on my husband’s iPhone, trying to block the sounds I don’t want to hear. He has made me three options for what he hopes covers every eventuality: playlist one is meditative and calming, playlist two is for the moments in between, and playlist three is the energetic push playlist complete with Joan Jett and other anthems. Classical music pours through the headphones as another contraction takes hold of my body. I rock gently, breathing through the pain like I was taught. I’m a studious person who read the books and took the classes, and thought a lot about this moment. I check the phone, wondering how long my husband has been gone. He needed to move our illegally parked car so he could get me into the hospital quickly.
Parking is always a nightmare.
Layer One – Skin:
Everything up to this point feels of the same genre – anticipatory joy mixed with comedy. It starts by waking twice in the night with what I think is indigestion, debating if the spicy Mexican food we had for lunch contained gluten. I’m celiac but pregnancy confuses my reactions – something to do with a suppressed immune system – a biological development so the body doesn’t attack the foreign cells. I consider how, in pregnancy, my body is programmed to shift into protection mode, already thinking of this baby more than my own health. The reactions still mess me up, and that’s what I think is sending my intestines into roiling agony at 2 am. And again at 4 am.
Tacos are my last meal choice; the food I would eat if I knew I was going to die, or if I was stuck on a deserted island and had to choose one meal to eat forever. My husband and I ask each other these questions about food and music often. The things we couldn’t give up. For him, it’s bread, ironic given my celiac diagnosis. We own two toasters to prevent cross-contamination, but we make it work. Fitting if tacos are the last meal that sends me into parenthood. Unplanned, yet perfect.
By 6 am, I think I peed myself – unlikely even at this late stage of pregnancy, though my body is unrecognizable and constantly feels out of my control. A few Kegel exercises on the toilet let me know it isn’t my bladder, so I waddle back down the claustrophobic narrow hallway that barely fits my extra forty-four-pound body and go to wake my husband.
His sleep breathing is regular, yet deep enough that I can hear it over the roaring AC that has kicked on with the heat wave hitting Toronto this week. We joke that pregnancy has turned me into him – always too warm, and a little snorty when I sleep. Another dichotomy of pregnancy, I have shifted away from sleeping naked, even with the rising temperatures, because my body always seems to be leaking. Preparation for labour and breastfeeding, sure, but I didn’t expect the nose leaks, and the snoring.
“My water broke.” He startles awake, barely able to process my words. “Or I peed myself, but I’m pretty sure it is my water.” I wonder if I look ghostly, or monstrous, standing in the doorway, backlit from the hallway.
“Do I have time to shower?” he asks. I nod and grab my phone off my nightstand, with some difficulty as it is low to the ground, and waddle back to the bathroom to see if any more water is coming. Sitting on the toilet listening to the soft drips that continue underneath me, I dial the hospital number to inform them, knowing the twenty-four-hour clock has begun by when the baby needs to arrive to avoid a risk of infection.
“I’m a patient of Doctor Seaward,” I tell the nurse that answers. Every time I say or read his name, I hold back a giggle. He must know it’s funny, the profession he’s chosen with that name. The nurse asks what colour the liquid is, so I hoist myself up to check. To my utter disappointment, it is a greenish yellow – a sign of meconium – or in laymen’s (and immature) terms, my baby has pooped inside me. I know from the labour classes that this development changes the next steps of my labour.
“Head on in,” the nurse tells me.
My husband is already in the shower, so I tell him to hurry up. Neither of us is panicked. I twist my long hair – half my natural brown, and the bottom with a hint of red from the last dye job before I found out I was pregnant – into a bun and brush my teeth. I don’t bother with any makeup. My due date is in five days, but I only packed my hospital bag the day before. I move it to the top of the stairs and leave it for my husband to bring down. The sciatic nerve pain that has been plaguing my body for the past eight weeks means my balance is off, and I don’t trust myself to carry anything down our narrow stairs. Everything in our old semi-detached Toronto house is narrow, and I don’t feel like I fit anywhere right now.
It is a sweltering August morning, so I sit on an exercise ball in our living room with the door wide open to our tiny backyard and the first hints of morning light.
I bounce.
What a mistake.
My water gushes out in a comedic splash of a puddle, scaring our golden retriever and sending her running out to the backyard. Liquid is everywhere, the very thing happening that I had been told, “Only happens in movies.”
My husband brings me a towel, and I wrap myself in it like a giant adult diaper and go wait in the car while he cleans the floor. The dog avoids the mess, overwhelmed by the early morning activity and likely the smell. It smells off, like old eggs, yet not as pungent. I wonder what it’s supposed to smell like.
Thankfully, there is no traffic on a summer Sunday morning at 7 am as we cross town to hospital row – the nickname for the Toronto area lined with hospitals of all types. I shift in my hot seat, sweat dripping down my legs from the humidity. I complain of discomfort at every red light, and we hit them all.
“You’re having contractions that close together?” My husband’s voice betrays his worry. I look at him, surprised; contractions, I hadn’t considered that.
Layer Two – Subcutaneous Fat:
Deep breathing while I wait for my husband to return. My mind races to memories I try to push down. Two miscarriages before this pregnancy, I know the all too familiar refrain of “at least you can get pregnant,” “it will work out,” or the most aggravating, “things happen for a reason.” I just want to be sad. I want it to be okay that I’m worried about this pregnancy even as I sit here in labour. Even as I’ve made it this far.
The first miscarriage was the night before our seven-week ultrasound, where you get to hear the heartbeat. I woke up with spotting and called the clinic; “Go to the ER” is all they told me. My husband and I spent the day getting tests and ultrasounds, wheeled from one room to the next, finally moved to the quiet area of triage, meant for small children, grief, or both. In hindsight, a strange combination, but it was empty, and I was thankful for the privacy. It was hours spent on beds staring at the ceiling as pelvic exams were completed. The tiny ultrasound room was dark, it hid the tears that fell from my eyes during the scan. The room too small for my husband to accompany me. The silence of the machine, the lack of eye contact with the technician, left my mind to race with all the terrible what ifs.
Later, my husband held my hand and gently told me, “It doesn’t mean it is the end.” I understood his desire to comfort, and we didn’t know officially. But it’s my body, and I knew it wasn’t carrying anything alive.
Hours later, the doctor confirmed it.
We were sent home with appointments for a week later to confirm the miscarriage was complete and told to use protection for three months so my body could recover, and upcoming menstrual cycles could clean me out.
A disgusting visual.
We drove home in silence. At home, sitting on our brown leather couch with our dog curled beside me in her well-worn spot, I called my parents to tell them that I had a miscarriage. They hadn’t known I was pregnant. It was the same call and email to my closest friends – sharing the news we had finally gotten pregnant after almost two years.
And it was already over.
Layer Three – Fascia:
I sit in early labour, the gown now itchy, the flimsy layer of privacy behind translucent curtains, with staff and strangers coming and going. The bright lights make sense. This is the machinery of birth in a Euro-Western setting. Medical survival over communal experience of life, birth, death, grief.
A petite Asian nurse checks the machines connected to my stomach, before her demeanor completely changes and she yells to my husband, “Grab her things and follow us”. My triage bed is surrounded by the rush of nurses and staff, and I’m wheeled down the large hallway, other staff moving out of our way.
“What’s happening?” I whisper to no one in particular, but no one is listening to me, all focused on their roles.
An older male doctor tells my husband, “The baby’s heartbeat is crashing, and an emergency c-section should be performed right away.”
I’m suddenly wide awake.
My heart races, a sheen of sweat covers my face and chest as fear rips through me. “What’s happening?” I say louder, finally finding my voice. I look awkwardly behind me, searching for my husband, who follows dishevelled, carrying our bags, my wet skirt, and his phone with dangling headphones.
The steady beeping of the heart rate machine strapped to my stomach returns, and the doctor comes to the side of the bed as we enter the OR. He watches the machine in silence for what feels like minutes, but is probably only seconds, “The baby’s heart rate is dropping at times, but it seems to be stabilized, so we are not going to operate now and move you to a room to labour.”
I’m told to lie on one side because it seems to keep the heart rate steady, as I’m wheeled out of the OR, down another hallway. The hospital feels like a maze that I’m stuck in and could never find my way out of. I have no sense of where I’m going, or where I came from.
“I’m going to throw up,” I whisper to the nurse beside me, and she grabs a clean bedpan for me as we roll past the nurses’ station. It is impossible to aim while lying sideways.
“Your patient threw up on the floor,” I hear a desk nurse call to our fast-moving group. I don’t know who cleans it up. There is no dignity in birth, yet I’m surprised by my lack of embarrassment. I can’t stop worrying that this birth will end with no baby to take home and move into the bright yellow room I’ve carefully decorated over the past few months.
Layer Four – Muscle:
The second miscarriage came four months after the first one. I pushed off the dating ultrasound to eight weeks, fearing the results. I wanted to feel pregnant, but beyond the two pink lines and increased hormonal acne, I felt the same.
The appointment came with more blinding overhead lights as I waited for the ultrasound. There was no heartbeat. A doctor, or nurse, I don’t remember who, came in to say they will do another scan in a week. Perhaps I didn’t have the correct date of my last period.
But I did. I have an app for that.
I didn’t tell them this, though.
A week later was the same news. No heartbeat and the baby measured five weeks. I was told to wait for the miscarriage to happen naturally – “natural,” there’s that word again – and that I should go to the ER if there is excessive bleeding.
I find out the meaning of excessive three weeks later when I bleed through a giant maxi pad, my underwear, and my jeans in a matter of minutes. The jeans – my favourites – never recover. Yes, for three weeks I carry a dead embryo in my body, unable to drink out of fear everyone is wrong, and the baby will grow, unable to grieve, and for the first time since getting my period at thirteen, worried that blood will come when I least expect it.
I cancel a work trip so I can stay close to home, and the miscarriage finally begins when I would have been away. It is a lot. The blood in the toilet, nothing visible as human, is a funeral of my own making. After the flush, I drop to the floor, finally allowing myself to break down.
I end up in the ER with the diagnosis of incomplete miscarriage, but the ORs are full, and a senior male doctor that I never meet tells my ER doctor that fitting in a D&C isn’t possible that day. My doctor, a young South Asian woman, tells me to come back if the bleeding continues and tells me she’s so sorry. I think I’ll never see her again.
My body failed at the miscarriage, meaning I take multiple doses of misoprostol that lead to nothing. “Are you sure you don’t feel cramping?” I’m asked when the prescription is renewed. “Maybe a bit,” I finally lie like I don’t know the body I’ve occupied my whole life.
Three weeks later, while I started a brand-new job, another ultrasound confirms my miscarriage was complete. Unlike the first time, my parents and close friends knew I was pregnant, and knew it wasn’t viable.
Two weeks later, my sister tells me over Skype she’s pregnant, with twins. I burst into tears. It’s the most emotion I’ve shown in weeks, and I feel guilty I’m not able to hold in my reaction to celebrate with her. After that, I bury myself in work. My husband and I don’t talk about trying again. I don’t ask him about his grief. He knows I’m not ready to talk about mine.
Layer Five – Peritoneum:
This is not the birth experience I hoped for.
I’m stuck lying on my left side facing away from the door, my belly connected to monitors tracking the baby’s heartbeat. I’m vaguely aware of people coming and going, the only constant being the nurse assigned to me back in triage. I don’t remember her name either in the moment or afterwards – a regret I still carry. She becomes the calm within the storm, telling me to breathe with my husband, who crouches on my side of the bed. I look at him but don’t really see him through the pain.
Time blurs into something I no longer understand. The contractions grow in strength, seizing my body, making it hard to breathe. Later, exhausted from lying in one position, forced to take the pain without movement, I opt for an epidural. A doctor explains the process, and I’m asked to sign a waiver. It is the only time I think my husband should sign on my behalf, as my signature mid-contraction resembles that of a child, and not an adult about to have a child. He asks me to sign the C-section waiver at the same time, as more risks are explained to me that I don’t hear. I can’t process his words as I’m rocked over and over again with contractions. I see his mouth move and I nod along like I’m supposed to, but no information is absorbed. I hope my husband understands what we are being told.
In preparation, I sit up and look out the window over the morning. I glance at the clock, seeing it is after 10 am, both late and early in my hazy brain. I breathe through contractions as the needle is inserted. Pain is relative at this point, and the needle is less painful than the contractions.
As I lie back down, I try to convince myself I can’t feel the freezing ice pack being placed on my thigh. You’d think they’d have a more high-tech way of monitoring whether the epidural is working other than an ice pack. I want to be good at this birth thing, so I say, “Maybe I feel it a bit less.” But I do feel it. Is this all an epidural is supposed to do? I wonder, but don’t ask.
Someone senior comes in and explains that “We have to do the epidural again. You’re one of ten percent of people who needs the needle inserted higher up for it to work. As we explained before, there are risks – closer to the heart and lungs – but you should be fine.” The contractions are stronger now, and staying still as a giant needle goes in my spine a second time is excruciating. I lean my head to my husband’s, forehead to forehead – and breathe.
I think about my breath, no longer able to remember if I brushed my teeth this morning, or if that even matters given throwing up since then. Plus, my pregnancy books talked about labour inducing horrid breath. But that all leaves my mind as I look at my husband and breathe. He smiles warmly, thin lines crinkle around his eyes. The only hint of our age difference. We are opposites – one calm when the other is rattled – rarely bothered by the same thing. In this moment, I’m grateful for his calm. I need that balance. I think he tells me, “You’re doing amazing.”
I’m back in my body, in this spacious room with neutral colours, made for walking and moving as you labour. “Keep looking at me,” he whispers as another contraction hits. I follow his instructions, and for the first time in a while, I believe things will be okay.
The needle is in, and I lie back down. The nurse prods me back into the position that seems best for the baby. The ice pack is placed again on my thigh. I see it there, but I feel nothing. Relief. Without the pain, my mind returns, and I can understand the words being spoken around me. But a simmer of anger bubbles under the surface that, once again, someone told me what I felt instead of listening to me.
But this baby is alive. The baby who danced in my belly whenever loud music played. The baby whom we chose not to find out the gender, but a few weeks earlier, a vivid dream of a four-year-old daughter stealing a cookie at a family event and holding her hand up high to avoid the dogs grabbing her treat has made this baby a person in my mind. A daughter. We have narrowed down to two girl names, but we have no boy name ideas.
Layer Six – Uterus:
The calm after the epidural doesn’t last.
The doctor I remember from the ER and my second miscarriage arrives. I don’t know if she remembers me, and she’s followed by another doctor. I assume the new doctor is senior as she is the only one who speaks, “You’re doing great, and you could likely do a vaginal delivery for your next baby, but this baby is in distress, and I don’t know if baby can wait the two to three hours you have left to likely fully dilate.”
It is all I need to hear, and the decision is made.
More calmly now, I’m rolled into the OR. On the route through the hospital, a new nurse asks my husband if we have music to play. “What playlist should we use?” he asks me. The unspoken realization that he didn’t make a c-section playlist. “The middle one,” I tell him, barely remembering what is on this playlist but knowing I need something calmer than Joan Jett. He hands over his phone to the nurse, and he’s led away to get suited up.
Even with multiple trips down the wide corridors of the delivery floor, I don’t notice any details. I couldn’t retrace my steps if I’m asked. I do remember it is quiet, like the rooms are soundproof, or perhaps no one is here.
In the OR, I’m so cold as I’m strapped down, arms out as if on a cross, so another IV can be put in my arm. My purple veins even harder to find after hours without water. My fear of needles almost completely gone after this pregnancy experience and all the poking and prodding it has entailed. I decide the anesthesiology resident is my person, only because he leans over and asks if I’m okay.
“I can’t stop shaking,” I tell him.
I’m swiftly covered in warm blankets, and I slowly stop shaking.
The bright lights. A song plays that I don’t remember, but later my husband tells me was Kate Bush’s This Woman’s Work. I remember a nurse saying she loves the song.
I feel pressure beyond the curtain that’s draped across my chest, blocking my view of the gore. It is the most surreal moment when weight is placed on my chest, and I imagine my insides are partially out. But there is no sound, until the doctor tells me, “A lot of people are about to run into this room. It is going to be okay.”
I burst into tears, looking to my husband sitting beside me, as his tears well up. We don’t know what this means, but hear the “Code Pink, OR 8” over the speaker system, and I know that is my room. I know something is wrong, but I don’t know what. I don’t ask. I just stare at my husband with all the history and fear of hospitals and pregnancies before. Even with his head and mouth covered with a surgical cap and mask, I can see the fear echoed in his eyes. He can’t hide it and holds my hand and kisses my forehead. I don’t think we speak.
Layer Seven – Amniotic Sac:
Seven layers to get her out. Pulled from my body with not enough care for how it fits back together. Figuring out years later that things aren’t back as they should be.
The rush of sound, the extra people, another layer pulled back, revealing the fresh grief from the earlier losses. Raw and unhealed. Another layer. I hear your cry. Finally, the anesthesiology resident leans down to tell me, “It’s a girl.” This time I cry with joy.
Seven layers of muscle, fat, tissue to find you. To pick you out of warmth, comfort, and darkness to this sterile, bright, and terrifying world. Clean and swaddled, you’re placed in my arms and I’m meeting you for the first time. You are not who I remember in my belly. You are quiet, pink, squirming. And breathing.
I don’t remember who I am without you.
I don’t tell anyone why, but I must hold you before anyone else does, but relent and let your dad carry you up the stairs. The trust in my body has not returned. I’m too scared to ask if he’s afraid of dropping you. I don’t want to know the answer. I need to think he’s invincible. One of us needs to be, and my body is still broken wide open.
But you’re here.
And I play you This Woman’s Work on your birthday every year as we dance under the bright August sunshine.
