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How we survived: The birth of Jackson C-Section

How we survived: The birth of Jackson

"They explained they were starting some sort of procedure. My doctor was there, telling me I was being transferred out."

What I remember, I remember in flashes. They are bright and distinct and some are so visceral they rend open my heart. Even now, I lie in bed and unspool the memories like so much thread: how close we came to death, how we were snatched from the brink … and how it all started with a pang.

Ryen Family Pic 1

The night it happened, I was 34 weeks pregnant and sliding into bed when suddenly it felt like a knife struck my belly. I grasped for my husband and cried out, “Chris! It hurts!” I breathed through the pain, and although it faded, the next wave came harder, and only three minutes later. I knew something was wrong, and scrambled to text my doctor. But the medicine he told me to take didn’t help, and soon my husband was heaving our two slumbering sons from their beds.

I tried to make it to the garage but managed only as far as the half-bath. I’ll feel better after, I thought, deciding I just needed to relieve myself. I started wrestling with the doorknob encased in childproof plastic, when I projectile vomited everywhere—on the floor, on the walls, in the hall, all over myself. My husband returned from buckling our sobbing children into their car seats, surveyed the situation, and said, “We have to go.”

We thundered to the hospital at midnight, all of us in a state of panic. My husband, a resident doctor, white-knuckled the steering wheel while our sons wailed and barfed in the backseat.

We seemed to hit every red light in the Western hemisphere. I tried to calm my body, but the cramps were coming closer together. I hoped—prayed—that they were only cramps, somehow related to my previous kidney stones. Just please, please not contractions.

We pulled in front of the hospital, bypassing the ER located far from Labor and Delivery. “They’ll just triage you, and I want you in as soon as possible,” my husband explained. He sped away to park as I waddled to the front entrance, nearly colliding into the double doors that I’d instinctively expected to open. There was no one in the brightly lit lobby, and I tried prying apart the doors with my fingers. Then I saw the white-stenciled lettering: DOORS CLOSE AFTER 9 P.M. GO TO THE ER.

My heart sank and I turned around. Our car, of course, was gone. And I was alone in an empty parking lot. I speed-dialed my husband, but it went straight to voicemail. Two more attempts, and I realized he’d turned off his phone.

Please, I thought. No, no, no …

Seized by another massive cramp, I fell to my knees. It was then that I noticed my hands were between my legs. I was cupping myself, as if holding something up, and in. That’s when I understood: my baby would be there within minutes because these cramps—these contractions—were happening less than 30 seconds apart.

There I was, squatting five feet from the hospital, feeling the very primal urge to push. But I knew with my complicated medical history that the baby and I might not survive. I’d lose my uterus, I’d hemorrhage, I’d bleed to death, and the baby would die on the cord. My only choice was another C-section.

I looked up into an empty night sky, its stars cold and distant. I felt utterly alone. And the window to act was closing within seconds.

That’s when I envisioned my mother’s face, and her words poured through me. Run, she ordered. Run! Do it NOW!

When the contraction let up, I stood, one hand clasping the strap of my purse, the other shoved between my legs. Though weak from bed rest, I sprinted down the curve of the pavement past dozens of empty vehicles. I turned toward the lower level of the parking deck, which I remembered had an after-hours entrance.

Then I saw it: a security vehicle with its bright orange lights spinning in lazy circles. Yes! I thought with great relief. They can help me! I waved frantically and cried out.

But the car and its shadowy figure passed me by.

I dropped my hands and jogged to a stop, watching the car disappear behind a column. Tears pounded behind my eyes. Another contraction started building from my stomach into my neck, and I took a breath and ran again.

As I rounded the corner, I spotted my husband shoving our children into the double stroller. I howled for him, and together we tore to the elevator and down the various corridors. I was seized with contraction after contraction, but I pushed through the pain, forcing myself onward despite the urge to squat at every vacant tile.

Katherine and Jackson Hospital 2When the double doors to Labor and Delivery opened, I limped forward as another contraction drove me to my knees. I grasped for the edge of the front desk.

The receptionist leaned over and patted my hand. “Oh, honey,” she said with a click of her tongue. “Do you think you’re in labor?”

I gasped up at her. “I need a bathroom! A bathroom!” I was in such a panic that I thought if I just relieved myself a little bit, that this awful feeling would go away.

A nurse took my elbow and guided me to the nearest toilet, where I collapsed and at once felt slightly better. “Maybe I’m OK!” I said, a tenor of hope threading my voice.

The nurse eyed me skeptically. “Mind if I check your cervix to see if you’re dilated?”

“Fine.” I groaned. “Do whatever you need to do…” At that point I vomited again: on her, on myself, on the floor and the walls.

“It’s OK,” she said, waving away my apology as she snapped on new gloves. She moved between my legs and eased her hand inside—only to snatch it out again with eyes suddenly the size of dinner plates. “That’s the head!” she said, her voice pitched. “You’re having the baby!”

“No!” I cried out, unbelieving. “I can’t have the baby! I need a C-section!”

“We need to get you into a bed,” she said, ignoring me.

“But not with my history,” I blubbered, in tears again. “My baby will die! I can’t have a VBAC! I can’t!”

But she was equally adamant. “We have to get you into a bed right now!”

I grasped the handrail by the sink. “I can’t move. I can’t…” And the urge to push came again and I struggled with my breath and the pain.

The nurse shouted for help. Two nurses lifted me in the air and pushed me into a bed: a position that felt all shades of wrong. I wanted to squat, to push right there in the middle of the room, not caring who saw me. But when I resisted, they picked up my ankles and pressed me flat. “The baby!” I gasped as my husband appeared. “Oh, Chris! I’m having the baby!”

We kept looking for my doctor until an older OB/GYN appeared and asked if this was my first baby. I moaned out my medical history. “No. First baby—gasp!—miscarriage. Breech second baby and C-section.” Another contraction hit. “Next baby—gasp!—placental rupture and C-section at 27-weeks—gasp! gasp!—I almost died …” But the pain was too much, the contractions coming too fast for me to catch my breath, and I couldn’t tell him about the corrective hysteroscopy and laparoscopic surgeries and progesterone shots I’d taken throughout this pregnancy. I felt my baby writhing and flashed to every medical professional warning a vaginal birth could kill me, the baby or both. All I managed was, “I’m high risk!”

He nodded and said, “I need you to pick up your legs.”

My legs? I thought, uncomprehending, but hands were already pressing me down. All the pain shot through my back. He positioned my husband on one side and a nurse on the other, driving my knees against the sides of my waist. “You’re going to have to push …”

“No!” I struggled to see him over the mound of my stomach. “You have to do a C-section—”

He shook his head. “There’s no time.”

“What about an epidural?”

He shook his head. “There’s no time. Just breathe and …”

“No!” I glanced at my husband in shock. “My husband’s a doctor, and he says that’s a lie. That they only say that in the movies for dramatic effect. That there’s always time!”

The doctor managed a chuckle. “In this case, it’s actually true. Now push!”

And then that very urge wrapped me in a vice, and I pushed as hard as I ever have. But just as the burn focalized, my muscles went slack.

“Good,” the doctor said. “Try to push again. You’re almost there …”

I tried, flexing my stomach, but there was nothing. “I can’t,” I said. “I’m sorry.” I took in a breath and rolled my head on the sopping pillow. “Why on Earth would anyone do this naturally?”

He chuckled again. “Honey, I’ve been wondering that for 35 years.”

And then another wave hit. Giant hands wrung my body out like a wet cloth. I clasped my husband’s hand as my knees pinned my waist. Everyone yelled for me to push when I noticed the nurse in charge of finding the baby’s heartbeat was still scrambling for a signal. When the rapid thump thump thump filled the room, the doctor barked that she’d mistaken his heartbeat for mine.

Now three people worked frantically to find the heartbeat as others told me to push. I pushed harder and harder, through a ring of fire, and then the doctor announced he was making a cut. Then everything released. There was a wet slithering, and I was stunned.

Because there he was. Jackson. My son.Jackson 8 Months Old

His eyes were open and bright blue. And he was crying, his mouth wide like a baby bird, and he was flailing his little arms and legs. I couldn’t believe I was looking at a tuft of strawberry blonde hair and … he was alive?! He was alive!

They took him away to suction his mouth, and I looked to Chris in astonishment. “I did it.”

The corners of his lips pulled up in his first smile of the night. “You sure did, honey.”

My regular doctor appeared just as they started the placental massage, and I winced through this new pain. He sewed me up, smiling and looking greatly relieved that the night had ended with us healthy and in the hospital.

A few minutes passed before I shivered, as if someone had opened the door to the cold. Then a pause, and I trembled again. The trembling grew into a tremor until my body jerked as if receiving electric shocks.

Chris looked to the doctor in concern. “What’s happening?”

A nurse answered. “We see this all the time. People usually attribute shaking to the epidural, but many times its just the adrenaline and hormones leveling off after birth.”

Relieved, though still shaking, I asked, “So when’s the endorphin rush going to hit?” After two C-sections, I was now a contender for those elusive hormones.

My doctor patted my leg. “In a couple of hours.”

“A couple of hours?”

He nodded. “That’ll give us enough time to observe you and ensure you don’t hemorrhage.”

Distantly I realized I’d endured everything without even a Tylenol. “What about pain meds?”

“No pain medication yet since we don’t want to mask any problems. Just sit tight.” And he left the room, and I heard him announce down the hall, “Great night to have a baby, isn’t it?”

I faded in and out over the next few hours. And, to everyone’s relief, nothing happened.

They eased me into a wheelchair and rolled me to the NICU, where I gazed through the incubator window at my new son. While other mothers might be saddened to see their baby this way, I was used to this and more. Jackson only had a nasal cannula over his face, which was nothing compared to the ventilator and IV lines and everything else his micropreemie brother had endured after his own traumatic delivery.

I peered inside and watched his little chest lift and fall, his eyes flutter beneath the lids, his perfectly bowed lips purse and relax. It was as if fairy dust had been sprinkled down on me from above. Because in that moment, I fell absolutely, unequivocally and forever in love.

***

I was transferred to a recovery room, where I managed to pump a few syringes of colostrum, and was left to sleep for three hours. When Chris and the boys arrived the next morning, I was in good spirits. My previous C-sections had rendered me helpless for days. Back then, when I could stand, I’d been hunched over clutching my sutured belly with a pillow, managing only small, shuffling steps. Now there were no pressure cuffs on my calves to thwart deep vein thrombosis and no catheter to catch my urine. I could walk. The difference was astonishing.

My room bathed in sunlight, I traded my hospital garb for a polka dotted nightgown, washed my face and even brushed my teeth. I wanted to be refreshed after a night of sheer terror.

“But you’re still shaking,” Chris observed with a frown.

“It’s OK,” I insisted. “Listen, we’ve already been through the worst of it.”

He sighed and shook his head. “Oh, honey. You were amazing.”

But before I could reply, everything inside me tightened up in white-hot pain. I gasped and smashed the Red Cross button on my bedrail. “Send someone in!” I shouted over the intercom.

Chris jumped up. “What’s wrong?”

I clasped my stomach. “It hurts! It’s like a contraction!”

Now he was worried again, despite a new nurse’s reassurances. “It’s likely just a clot she needs to pass,” she said. “I’ll massage it out.”

The pain waning, I told Chris to take the boys to the cafeteria for breakfast. If there was blood, I didn’t want our children to see it. When they left, the nurse started probing my stomach and I whimpered. “It’s OK,” she said. “You’re going to be sore for awhile. Nursing and pumping will start contracting down your uterus, so that will contribute to the tenderness as well.” As she pinched and rolled my abdomen, I felt something wet slide out. She glanced down. “Well,” she said, after a pause, “it’s a little bigger than we like.”

“How big?”

“About the size of a golf ball.”

“And how big should they be?”

“Well, usually we like them about the size of a fingernail. But it varies. It should be fine.” She cleaned me up and started to leave when I felt another sharp jab. I must have made a noise because she spun around. “You OK?”

No.” My breathing was suddenly ragged. “The pain’s back.”

She massaged me again, and now something really wet slipped out. Her eyes widened.

“Is everything OK?” I asked, knowing it wasn’t.

“I’m going to get some help …” But before she reached the door, the pain was back. Another nurse appeared, a blonde this time, and together they kneaded my abdomen like bread dough. The shaking returned full force, and I couldn’t keep my joints from knocking the bed rails.

I felt another—bigger—clot pass moments before a rush of warmth between my legs. “Did I pee myself?” I asked, hopefully.

“No,” the first nurse said. “I’m going to page someone …”

There was another pain, hardest of all. The bed suddenly looked like a basin of bloody water had been sloshed forward. I looked to the nurses. “Am I OK?”

Their eyes were wide, and they simultaneously shook their heads. Another gut punch left me gasping. This time the blood ran to the sides of the bed, pocking the linoleum beneath.

“Stop massaging her!” the first nurse ordered.

Then the nurse supervisor came in, saw the state of the bed, and started barking questions. What had happened? Had they followed protocol? Yes, they answered. They had assessed my situation, massaged out the clots, had been at it for a few minutes and now here we were.

Bam. More cramps, more blood and more shaking. They paged a team and told me help was coming. New nurses arranged themselves on either side of my legs. They hiked up my nightgown, swabbed my thighs, and stabbed me with medicine to stop the bleeding. But still it came.

As we waited for help, my second nurse asked if I needed water.

“Yes,” I said, licking my cracked lips. “Please, yes. I’m so thirsty.”

As everyone exchanged information, the blonde approached with a Styrofoam cup. I put my lips to the straw, but the water went down wrong. After 5, 10, then 30 seconds passed without a breath, I started to panic. I can’t breathe, I thought with a naked urgency. I can’t breathe! I slapped the bed rails and my throat. I made small, inhuman sounds—little squawks. The nurses rushed to page Rapid Response.

The room flooded with people trying to reassure me, to help, but nothing worked. My hands smacked the bed, my chest, my legs—flailing as if electrocuted. My eyes flew about the room as everyone looked on horrified. I realized I was going to die right there in the bed, and no one there could save me.

I was still choking when two men appeared with an EKG machine and a tray of winking instruments. One of them took my chin and tipped my head back forcefully, so that the pillow came up around my ears, and I felt something cool rubbed against my neck. Not the betadine! I thought hysterically. Not a tracheotomy! Oh God they’re going to trach me right here in this room!

Then, suddenly, my lungs opened up. I sucked in a breath as if coming up from a dive. I had just that moment to squeak, “I’m OK! I’m OK!” as one of the men came at me with a scalpel. Everyone froze. The two men looked at me very seriously, both ready to continue, and watched as I drew in a few cautious breaths. That’s when I doubled over, and more blood soaked the bed. When I glanced at all the people looking at me, I realized not one face—not one—looked confident. Everyone just looked terrified.

One nurse spoke up, “I’ll order blood packs for the OR …” and fled the room.

“The OR?” I echoed. “I need an operation?”

There was a general consensus as everyone hurried to get me prepped. “We’ve called your doctor,” someone said.

“He’ll figure out what’s happening,” said another.

“Don’t worry,” said someone else. “You’ll be fine.”

“We’ve got to move her now!” I heard someone roar, just before the world faded.

Patches of memory: my husband’s stricken face, his hand squeezing mine; light slaps on my cheeks, voices telling me to stay awake. When someone ordered to prep for a hysterectomy, my eyes snapped open. “No hysterectomy!” I fairly shouted. “I want more children! You hear me? I want more children!” I pointed at a random woman in scrubs, as if declaring her a witness, and I passed out again.

Katherine and Jackson Hospital 1

I awoke long enough to be cognizant of Chris wiping the sweat from my brow. “They don’t know what’s happening,” he said to my unasked question. “You just keep bleeding …”

I felt disembodied. I had been so happy … when? It seemed like a decade ago. Was it just this morning? I thought. What’s happening to me?

“Cut off the dress!” someone shouted and a bright pair of scissors appeared. They held me down as my body convulsed. I felt the edge of the blade cut up my thighs, up my stomach, and then my head was steadied as it sawed at my collar. I saw a flash of bloodstained pink polka dots and thought, crazily, Not my dress! Not my pretty dress!

They explained they were starting some sort of procedure. My doctor was there, telling me I was being transferred out. I burned all over from the sundry IVs they’d connected, trying to infuse blood and fluids. One of the nurses, having never performed a balloon procedure, nervously inflated it … tearing through my episiotomy and beyond.

I screamed like I’ve never screamed in my life, bucking up against the bed. I saw the nurse’s eyes fill with tears seconds before I passed out again.

I remember the fleeting touch of my husband’s hand as they wheeled me away. The overly bright surgical lights heating my face. A nurse stroking my head and telling me everything was going to be OK. And then a mask covering my face as my doctor roared, “Hurry up, and knock her out!” Those words chased me into darkness.

How could I have known what was happening? Time didn’t exist for me. How could I know my husband was pacing the waiting room for more than nine hours, his heart catching every time a new order of blood or plasma or fluids was paged, that I had descended into rapid blood loss, surviving only by the blood of donors and the technical skill of my surgeons?

How could I know my friend was watching our children in a lobby the size of our living room, how those hours stretched endlessly for them, how they didn’t have a clue as to how I was doing? Or if they would ever see me again?

How could I know that the hospital called my father, and with only one seat on one plane taking off before midnight, that my parents had to make a terrible choice?

How could I have known? I existed in a place with no light and no dreams.

***

I awoke as if coming through a fog. Slowly I came aware of a pressure on my forehead. Rhythmic. And a familiar voice repeating these words: “You’re OK. Don’t panic. Everything’s fine.”

The room was dim, and when those words eased over me a third time I placed the voice to the face slowly fusing together. Daddy? What was my father doing there? Was I hallucinating?

But he was there, staring down at me. He looked so worried that I instinctively reached up to touch his face, when something clicked, and my hand froze in midair. I looked down and was shocked to see my hand cuffed to the bed. I tried the other one, only to hear the same click, and realized that side was shackled, too.

I’m tied down? I thought blearily. Why on Earth …?

“It’s OK,” my father said. “Don’t panic.”

Panic? I thought. But why would I …?

And then I felt it. This thing, like the face-sucker in Alien, was smashed against my face, and I felt my throat constricting against something massive. I struggled and tried to rip it off but a force held me down. My father explained I was on a ventilator and needed to stop panicking, but I couldn’t because everything felt so, so wrong.

I struggled against the harnesses like a madwoman and heard my father saying, “This is why you’re tied down. Your lungs failed. If you want to be extubated, you have to breathe, Katherine. For one hour, you have to breathe.” But his words fell through a haze. Every fiber in me wanted it out. Take it out!

“Calm down!” my father said. “Just try to breathe, honey. Try to breathe.”

I realized that the more I fought, the harder the machine fought back. In a series of whirls and clicks, it pumped oxygen down my trachea, hard. I was too weak to resist. And so I closed my eyes against the tears and tried to rein my terror.

“Good,” my father said. “Relax. Now try to breathe with it.”

I tried—and immediately vomited. I heard the emesis track up my throat and out through a tube past my head.

“Breathe,” my father said.

I tried and tried once more. Every few minutes the urge to vomit took over, and I was sick again and again. But I was breathing.

For one hour, my father coached me. The minutes ticked by interminably. He announced my O2 stats like the score at a Super Bowl game.

I had so many questions, but couldn’t voice the words. My father asked a nurse for a pad and pencil, but was told nothing I wrote would be legible. But I insisted—because a skill I possess is the ability to write blindfolded—and he diligently returned, holding the paper next to my bound right hand.

The first question I scrawled was “Surgery?” because I felt the telling burn across my stomach.

My father nodded. “Yes. It took nine hours. But they stopped the bleeding.”

I wrote again. “Hysterectomy?”

He shook his head. “They were able to save your uterus. They ligated several vessels, but it should be fine.”

I closed my eyes and wrote again. “What happened?” Because he would know. He was a surgeon. Like my husband, he spoke the language.

“They’re still not sure, honey. It looks like some sort of infection. From what your doctor said, it caused your rapid labor and led to you hemorrhaging.”

I struggled with the pencil. “Baby OK?”

“He’s fine. He’s still in the NICU. And before you ask, Chris is home with the boys resting. He made sure you were doing well out of surgery before getting me from the airport.”

And finally, “Breast pump?”

My father chuckled. “Only you would even consider pumping milk at a time like this.”

I tapped my words with the edge of my pencil, then scrawled, “Too much time. Need to pump.” My breasts should have been swollen against my hospital gown, but they weren’t. Why hadn’t my milk come in?

My father understood the question without me writing it. “Your body’s still in shock. You may need more transfusions to even begin producing milk.”

“Whatever it takes,” I wrote, then tapped my words for emphasis.

“OK,” my father said, knowing my mind was set. He paced to the door. “Nurse? My daughter needs a breast pump. Just as soon as she’s extubated.” It almost took an act of Congress to fulfill that request, as no new mother in ICU had ever asked for a breast pump.

After the hour, a respiratory team agreed I could be extubated. They pinched the sides of my face and ordered me to cough. I choked and gagged, and then I was staring up at what looked like a synthetic octopus, with the head that was pressed to my face and the slick tentacles that had wound down my throat.

When my consciousness cleared, I realized I was strung up like a marionette. I could hardly move from the PICC, arterial and central lines infusing my body. In total I’d had 11 blood and plasma transfusions, packets of Pitocin to contract my uterus, potassium and magnesium to increase my levels, and an endless series of saline to keep me hydrated. The first time I surveyed myself, I thought, My legs! Oh God, my legs! They were swollen to the size of tree trunks. The edema from so many infusions was expected, as was the pain exploding like stars all over my body.

“On what planet must I recover from an unmedicated childbirth and abdominal surgery?” I jokingly asked every one of my nurses.

I made light of my situation during the day, but in the quiet dark, it all seemed so unfair that I almost couldn’t breathe.

* * *

 

I was on Propofol, Dilaudid and finally Percocet to dull the pain. I struggled. In my lowest moments—when I couldn’t eat or drink, when I had to page someone to help me shift, so I wouldn’t develop bedsores, or when it took three nurses to pull me the two feet into an armchair—getting better seemed impossible. Encouraging smiles, flowers and gifts, even the publication of my third book couldn’t snap me out of my doldrums. The first time I could sit, I stayed for two hours. I stared at the machines connected to me and thought, How can I possibly go home and be a mother to three children? I can’t even take care of myself.

But then a card would arrive from the NICU with Jackson’s cherubic face and the words, “Catch up to me, Mommy! Get well soon!” Every time I saw him, my hope rekindled. I strapped on the breast pump, flexed my throbbing legs and strengthened my lungs with my breathing apparatus—anything I could do to get better. If my son could do it, then so could I.

On my third day in the surgical ICU, my first team of nurses visited me one by one. I was just coming down from a 103degree septic fever and still had the shakes, but their words startled me out of my stupor. None of them thought I’d pull through that first night. Not with losing so much blood. Their words haunted my dreams. On any other day, in any other hospital, with any other doctor, I would have died. I would only exist as a shadow in my oldest sons’ memories, and Jackson wouldn’t have known me at all.

It was later that a blood panel revealed I’d suffered from Strep-A, a rare, life-threatening condition, especially in pregnant women. Perhaps hitching a ride on a contaminated progesterone needle, its bacteria had infiltrated my uterus and the placental massage poisoned my bloodstream. Strep-A has a 50 percent mortality rate. Some heart attacks and cancers have better outcomes. Half a million people die from it every year. I was one of the lucky ones.

Despite my survival, a tremendous sense of sadness lingered. What finally pulled me through was my newborn son. That first time we tried non-nutritive nursing, he shocked the NICU staff by ignoring the tube down his throat and burrowing against my breast like a famished puppy. The warm pressure of his small body quelled my numbing ache. I held him, and nursed him, and counted the hours until we could both go home. And we did.

Every day I am thankful to be alive, to still be my sons’ mother, my husband’s wife, and my parents’ daughter. I never had an easy delivery, but I have my life and those that are in it. And so there it is. How much more lucky could I be?

Katherine Tirado-Ryen (katherinetiradoryen.com) is the author of three novels, including Forgetting Me. She lives in Ohio with her husband and three children, and is currently working on her next book.

Send us your birth story! Whether you had a home birth, hospital birth, 37-hour labor or emergency C-section, we’d love to read the tale of your little one’s grand entrance. Write up your birth story (click here for tips on getting started) and email it, along with a few photos, to birthstory@pnmag.com. We’ll share it on our Birth Day blog and may even print it in an upcoming issue!