Home Birth
Ivy is beautiful. Soft flawless skin and straight chestnut brown hair. Thin veins lace translucent eyelids and fall into the delicate fan of her eyelashes. Through the double door, just outside the room, her father waits, sheathed in a white Tyvek suit, a surgical hat, and mask.
Outside the cool, bright, windowless operating room, the summer night is dark and humid. Only moments ago, the emergency medical technicians arrived like a squall, rushing the mother on the gurney down the hallway; one kneeling, riding the gurney as she attempted to push the baby’s head up, away from the prolapsed umbilical cord. Then a cacophony of raised voices and moving bodies as the anesthesiologist put the mother under general anesthesia, the nurses and scrub techs readied the surgical field, and minutes later, the obstetrician pulled the baby into the world.
Six syringes of epinephrine, an open umbilical line kit, a 4.0 endotracheal tube and disposable laryngoscope blade wait on the steel table beside her. Amniotic fluid glistens on her skin as the nurse rocks her sternum, squeezing out 90 compressions per minute. A thin rivulet of blood seeps around the umbilical line as epinephrine and then normal saline funnel into her vein. We work in synch, each person with a specific job, and there is a quietness over us because each time I listen to her chest there is silence.
Later, after she awakes from anesthesia, I sit at the mother’s bedside. Her husband holds her hand while his shoulders shake; she blots her tear-wet face with the crumpled tissues in her hand. She already knows what I am going to say, and when I start to talk my words feel sluggish and slack in my mouth, as if I’m underwater. While I struggle under the weight, her nurse puts her hand on the mother’s shoulder.
After I sit with the parents, I walk in a daze past the nurse’s station and stop for a few minutes to gather myself before going upstairs. At the desk, one of the nurses tells me the back story. A birth attendant was there, at the house. When the umbilical cord slipped out, she instructed the father to call 911 and then fled before EMS arrived. At first, I feel nothing, but anger swamps me in the stairwell, just before I push open the door to the intensive care unit. I see the baby’s chestnut brown hair and steel blue lips.
It happens again, four days later.
Nurses rush a laboring mother from the labor and delivery floor to the OR, a nurse kneeling on the gurney pushing the baby’s head away from the pulsing umbilical cord. It’s the same thing all over again. The baby is delivered within minutes, limp and lifeless. His heartbeat is faint, forty times a minute at most. We squeeze in breaths from the ambubag. His skin is a dusky blue and he is unmoving. But as the air fills his lungs, his heartbeat soars, buoyed as his wet alveoli expand. Color seeps into him, first over his face and chest and abdomen, then it spreads to his arms and legs. After two minutes of the ambubag, he takes his first breath, then lets out a cry so loud and shrill we laugh with relief. By five minutes of age, he is crying and pink, his muscle tone is normal, and when we place him on his father’s chest he nuzzles hungrily.
As I walk down the hallway, my thoughts vacillate between euphoric relief and a lingering heaviness from the events four days prior. I imagine that chaotic home scene: blood and amniotic fluid on the bed, the sudden presence of the gelatinous cord in front of the attendant, and the father fumbling for the phone to call 911. They couldn’t see the baby’s boney head against the soft cord as the arteries and vein collapsed and the flow of oxygen molecules slowed, but they knew time had turned enemy. Minutes stacked upon minutes. Minutes to dispatch the ambulance, minutes to drive to the house, minutes on scene, minutes driving through the summer night and minutes to unload the gurney and ascend in the elevator to the OR. In those minutes their baby died.
Decisions and choices, like people, are complicated. Each day we make decisions without knowing how they will shape our future—decisions modulated by emotion and reason, promises of pain or pleasure, perceived risks and benefits. Often, the imperceptible subcurrents of past trauma, mistrust, scarcity, conflicting advice, hopes, dreams, and tribal and community ideology hold sway over our decisions.
This is the story I tried not to write. This is the night I try not to think about—of leading the father into the operating room or sitting with the parents in recovery after Ivy’s mother awoke from anesthesia to tell her Ivy was dead.
Sometimes, when I’m driving home in evening traffic, I think of Ivy. As the cars thread the lanes, I rewrite the story. It starts the same. The same bedroom: her mother steeped in sweat, the ceiling fan spins, and the father holds his wife’s hand, reeling in anticipation. Suddenly, he strides across the room, lifts the phone, and calls for an ambulance. The birth attendant tries to reassure him, she soothes him with calming words and puts her hand on his shoulder, but he shrugs it off. Call it premonition or a sudden coming to his senses.
Minutes later they load the mother into the mouth of the ambulance and trundle down the street as contractions wash over her. In my story the prolapse doesn’t happen until she is in labor and delivery room 4. Fifteen minutes after arrival, the cord slips out and they rush her to the operating room. Six minutes later, Ivy is pulled out of the sanguineous water of the womb, floppy and unbreathing. Under the hot lights we give her breaths and after a minute and a half, she cries. We dry her chestnut brown air and bundle her in a receiving blanket and hand her to her father.
In my story she delivers in the hospital, and we have time to save her. I’ve told myself this story so many times I almost believe it.