Becoming Mother

A book and a blog for first-time mothers

Tag: death

Why are American Women Dying in Childbirth?

 

American women are more likely to die from complications in pregnancy and childbirth compared to women in any other developed country.

It’s true.

But why?

***

At 1:27 p.m. on February 2, 2017, I gave birth to an 8 lb. 10 oz. boy.

Because there was meconium in my amniotic fluid, a NICU team was paged to be present at the birth to make sure that the baby’s lungs were clear.

Those first minutes after birth were very blurry. There was just too much going on to fully appreciate everything that was happening. From my perspective as the birthing mother, I remember my son turning his head upward and looking me in the eyes (that really happened). I remember seeing that he was a boy. (A boy!?! Really!?! What?!?!)

I remember dropping my head back against the bed and crying in relief that it was over. I remember thinking, “Well, that’s the last time I’m doing that.”

I was euphoric and so, so grateful. We had made it. We had survived that. Both of us. That was what I was thinking.

I did not know that I was hemorrhaging. 

This is the thing about hemorrhaging: It happens so fast.

It happens while mothers are crying from happiness that their baby is alive and breathing. It happens while they’re trying to get a good look at their baby’s face. It happens silently as the room’s atmosphere turns from the intensity and suspense of the pushing phase into joy and excitement of the delivery phase.

No woman wants to believe that it’s going to happen to her. I had none of the risk factors associated with postpartum hemorrhage.

But it still happened to me.

While we were celebrating and crying and basking in the joy of the birth, my midwife was tracking my blood loss. I remember looking down and seeing her furrowed brow every time more blood poured out of me. But I didn’t think anything terrible was happening. I was flooded with joy and gratitude that labor was over.

But in the first ten minutes after birth, more and more nurses entered the room and the treatments started. My midwife told me each treatment that she was doing to stop the bleeding. By this time, I had lost about 1200 mL of blood, about 2.5 pints of blood. In other words, I had lost about 25% of the blood in my entire pregnant body.

Surviving postpartum hemorrhage requires a medical professional who quickly realizes what is happening and starts treatment immediately.

In my case, the midwife tried a shot of Pitocin. When that didn’t work, she gave me Cytotec. When that didn’t work, she gave me IV Pitocin. She kept massaging my uterus. She was on her last treatment before starting a blood transfusion: a shot of methergine.

That’s how close we were to a true emergency.

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My heart rate during labor. You can see exactly when the hemorrhage begins and how my body responded.

 

Hemorrhage is one of the leading causes of death in childbirth.

Causes of Death in Childbirth

Still.

Let me be clear: postpartum hemorrhage isn’t caused by a lack of care. This would probably have happened to me if I had given birth anywhere else.

But women die from hemorrhage when doctors and nurses don’t quickly recognize the amount of blood loss and begin treatment. Some states, like California, have codified and implemented standardized procedures and training for nurses and doctors so that teams can quickly and efficiently follow protocol to prevent postpartum hemorrhages from killing mothers. Instead of “eye-balling” how much blood a mother loses during delivery, nurses were taught how to collect and measure postpartum blood loss to help them quickly identify hemorrhage.

“Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction.”

But not all states have such standardized protocol.

***

A joint investigation by NPR and ProPublica found that more women are dying of complications related to pregnancy and childbirth compared to any other developed country.

In every 100,000 births in the United States, 26 women die. In other developed countries, the numbers range between 5 and 9 births. And those numbers have climbed from 17 to 26 deaths from 2000-2015.

Seriously.

Seriously.

It seems unimaginable. Really? In the United States? But we have so much technology. We have some of the best hospitals in the world.

Maternal Mortality

What the hell is going on?!?

There were several major findings from this investigation.

  1. The U.S. is spending more money on research, equipment, and training for improving infant outcomes. Think of how much progress we have made in helping premature babies and treating newborns born with previously fatal deformities and diseases.
  2. Decreased education and training about caring for birthing mothers, for both doctors and nurses. This leads to a lack of knowledge that is passed on to the mother when she is discharged from the hospital.
  3. Lack of standardized best practices for caring for birthing mothers among the states. Unlike other developed countries, there is no nationwide effort for reducing the maternal death rate in the United States. Responsibility has been left to individual states to decide if and how they investigate maternal deaths.

America has not conquered maternal mortality. We like to think that because we have advanced technology and highly trained medical professionals that tragedies like a woman dying in childbirth just simply don’t happen anymore.

At least not nearly as much as it used to.

It’s a kind of hubris, really. To think that we have mastered childbirth. We have tamed it and told it who’s boss. In fact, we’re so good at childbirth that we should just focus most of our attention on the infants. They’re the ones that are the most vulnerable, right?

But the truth is…

“In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.”

~Nina Martin & Renee Montagne, “The Last Person You’d Expect to Die in Childbirth”

***

If there was one major takeaway from this report that I want to share with everyone it’s this:

Women still die in childbirth. 

Giving birth in the United States does not guarantee that both mother and baby make it out alive.

I completely agree with the report’s observations that labor and birth put women in the most vulnerable position in their entire lives. They don’t know what’s going on. They’re immersed in the pain and process of labor. Birthing women depend on everyone around them, doctors and nurses alike, to notice the signs that an emergency is unfolding.

If you or someone you know will be giving birth in the United States in the near future, I strongly encourage you to read ProPublica’s full investigative report on this topic.

This is not a political issue. ProPublica is an independent organization that is not funded by political donations.

This is a human issue.

American women are not immune to maternal mortality.

For the women who die every year from pregnancy and childbirth from preventable or treatable conditions, let’s raise our awareness of this problem and insist that we study this at the national level, not just the state level.

We can do better than this.

The death of a new mother is not like any other sudden death. It blasts a hole in the universe.

~Nina Martin and Renee Montagne, “The Last Person You’d Expect to Die in Childbirth

The Thing We Hope Never Happens (a call to help a hurting mother)

My absolute worst fear is suffering the death of one of my children.

I can imagine coming to grips with the death of anyone in my life.

Except my children.

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***

Last Friday, I was reading my Facebook feed and read a horrific post from a member of my church.

Her daughter-in-law, Britney, was driving on a two-lane road with her five-year-old daughter, Jocelyn, and two-month-old son, Jonah, in the backseat.

You already know how this story ends.

An oncoming car illegally crossed the center to pass a car.

It hit them head on.

crash

It killed the little girl.

The mother and baby boy survived.

In the picture, Jocelyn was balancing on one foot, as if in the midst of dancing. She was posed proudly with her baby brother. Smiling. Blond and smiling. Happy. Just like my daughter.

Jocelyn 2Jocelyn and JonahJocelyn

There at my desk, I cried.

Britney was me. Her kids were my kids.

And my heart was broken for her.

All of this happened just days before Mother’s Day.

***

It was too cruel and unfair for one person to bear.

How could Britney face life and the world, now knowing, now feeling every day, that horrific things like that can happen?

Just like that.

How?

How could she keep going?

But of course I know how.

We all know how.

She’s a mother.

Britney

This is stuff that mothers are made of.

Loving through pain.

Living while part of you is dying.

Believing through despair and doubt.

Resiliency beyond measure.

Pure grit and strength.

***

Britney has already undergone several surgeries to repair her broken bones, including her pelvis. She has been moved out of the ICU and into the trauma unit. (And let’s not forget the fact that she’s just three months postpartum.)

Her newborn son also suffered extensive injuries. Two broken femurs and a broken arm.

Noah

He is currently being cared for around the clock by his grandmother, Lanae, who works as a surgical nurse. He couldn’t be in better hands while his mother is recovering.

***

I made myself imagine what I would do if I were living Britney’s reality.

What would I do?

I would sob and ache and grovel and resent and rage.

For a Long Time.

I would lash out and blame and despair.

I would be out for blood. I would crave Revenge. I would want to hurt and crush and obliterate. I would want to empty the life of the person who didn’t think first, who would rather take a risk, who thought the laws didn’t apply to him.

(Because I think first. Because I don’t want to take the risk. Because I don’t think the laws don’t apply to me.)

And while I would be going through this, I would still have to Get Back Up.

Although I would want to take time off from Life to mourn and process and make meaning, I would have to immediately Get Back Up.

For my son.

Because he would still need to eat and sleep and grow.

He would still need my arms to tell him that he is safe, even though I had just seen how unsafe the world can be.

I would need to decide every hour to keep on practicing the appearance of Love even though I’d be simultaneously steeling my heart from the possibility of Future Pain.

Because Love would have just killed off a part of me.

Love had created a trove of beautiful moments of my little girl — but now there would be no more. And the more time that would pass, the more those memories would lose their clarity. And if I forgot any part of those memories, it would be like losing her all over again.

All I really would want to do is climb into the ground with her so she wouldn’t be alone in the dark.

I would be like this for a Long Time.

***

But I also know that One Day, through the crisis and search to find meaning, I would finally choose Love again.

Because Love is the only path to Peace.

I would keep walking.

Still vulnerable.

Still hurting.

But alive.

And courageous.

***

I used to pray that Life Would Be Okay and Get Better. But I’ve stopped doing that.

Because that’s not what Life is for. The life worth living isn’t a life without pain because the pain is what shows us life’s worth.

When I say prayers now, it is in moments for others who are in pain.

And the prayer is that they keep moving

And keep walking through the pain

And that if they fall, that God will reach a Hand down to help them get back up.

***

Britney,

Our hearts ache with yours in your time of hurting and grieving. My prayer for you is that you keep walking through the pain. Keep moving. And keep believing that there is good in the world even though it is also so very bad at times. In fact, perhaps the world is good because it is bad.

Years from now, I hope that you can look back at these dark hours of your life and see all the light that people are shining on it. It’s always the people who have suffered and cried and walked the Path of Pain that will be the first to reach out their hands to you. Take those hands. Let them help you get back up. And don’t feel guilty about it. You are not a burden.

Because Some Day, it will be you who is the one reaching out and saving someone else.

You are not alone.

And you are Loved.

***

If you would like to help this family financially as they cope with medical and funeral expenses, you can contribute through their GoFundMe fundraiser here.

No gift is too small and you can give anonymously if you prefer.

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If you would like to provide financial assistance to Lanae as she takes care of Jonah full-time, you can donate here.

Lanae

 

Week 38: Paradoxes

Are you ready?!

This is the most likely comment that people will say to me in the next few weeks.

How do I honestly answer this?

Yes. I don’t want to be pregnant anymore.

No. I’m not ready for labor again.

Yes. I’m tired of all the fluid retention.

No. I’m not ready to breastfeed again.

Yes. I want to finally see this baby.

No. I don’t want to do all the night feedings.

Yes. I can’t stand carrying all this weight anymore.

No. The room still isn’t ready yet.

Yes. We’ll never be fully prepared anyway.

***

When I sleep at night on these bitterly cold days, I sweat. I throw the sheets off until I freeze. Then I pull them back over me. Repeat.

I have crazy dreams. Last night, I successfully managed to outsmart, outrun, and hide from a serial killer who had me trapped in an office building, much like the one in Mad Men (which, of course, I’ve been binge-watching lately).

At full term, a woman’s placenta generates as much estrogen as a non-pregnant woman will produce in three years.

Yeah.

Thus the sweating and crazy dreams.

In the weeks to come, the loss of these same hormones will cause me to shake with hot flashes and chills, to weep at the drop of a hat, and to constantly check to make sure the baby is sleeping.

Basically, their loss will make me feel completely undone.

This is the beginning of the ride down into powerlessness. This is when my individual will and desires start to bow their heads to my body’s processes and the needs of this tiny person, now coming forth.

This is when I become a passenger in my own body.

***

Dr. Robbie Davis-Floyd, a cultural anthropologist who specializes in the rituals of birth, points out that pregnancy is both “a state and a becoming.” If you translate the word “pregnancy” from Latin, it would literally read, “the state of being before being born.”

It is a kind of limbo. To be pregnant is to experience the world in flux. To see the world turned upside down and inside out. In her book, Birth as an American Rite of Passage, Davis-Floyd writes that,

“the near-constant inner and outer flux of pregnancy keeps the category systems of pregnant women in a continuous state of upheaval as old ways of thinking change to include new life” (p. 24).

So fluid is this state of being that I oscillate back and forth between wanting to be free of this pregnancy and not wanting it to end.

***

Labor also brings its own set of paradoxes.

In labor, the fastest way to progress is completely counter-intuitive.

You need to relax through the pain.

Try it the next time you burn your hand or stub you foot so hard you scream. Your first instinct is to clench and bear down. Not to breathe calmly through it.

Labor takes you out of the boat and throws you to the mercy of a series of invisible, crashing waves. At first, you might hold your breath through the pain and gasp for air in the breaks. But in time, the waves come at you harder and faster, leaving little to no time to breathe.

And that is when you realize that what you really need to do is stop fighting.

Let the water hold you down, down, down. Until you are still.

Because the more you resist, the longer labor is.

So surrender becomes your savior.

Surrendering to pain. Accepting it. Even though you don’t know when it will end.

That is the smoothest path through labor.

***

As a human being, I loathe this truth, that surrender is necessary in labor. I hate uncertainty and I cling to control. I avoid pain if I can.

But allow me to get spiritual for a moment.

As a Christian, I understand this truth.

Of all the symbols that Christians could have used to represent their most ardent belief, they chose a symbol of execution. Of Death.

Instead of choosing a symbol of humility (the manger) or peace (the dove) or bounty (the fish), Christians chose a symbol of intense pain and sacrifice. A sacrifice so crushing that it would obliterate body and mind, leaving behind only spirit.

They chose a symbol of death because they believed that it was only by dying to their previous lives that they would be able to embrace new life. They believed that before experiencing true humility and peace and bounty, they first needed to give it all up.

Because you can’t truly receive until your hands are empty.

Emptiness first. Then Plenty.

Death first. Then Life.

As a Christian, this is how I understand labor. I see labor as the most authentic expression of what I worship.

I follow a belief that Death comes first. Then Life.

Death to Self. Then, New Life.

***

As I’ve said before, January doesn’t seem like a month that goes well with birth. It stands in contrast to so many other months when we see evidence of life at work. In the United States, nature lovers will tell you that we are currently in Deep Winter, a period of seven weeks before Early Spring begins. In these weeks, we see nature as barren, perhaps even conquered.

But below the surface, the world is shifting and preparing for spring.

light-shining

I think about this as I walk in the mornings now, bundled beneath layers. Even though the winter air bites and stings, the winter light still warms me when the clouds break.

I went to church last Sunday and I was reminded that we are in the season of Epiphany, the time of year when Christians remember that God’s light doesn’t just shine on us. It comes down to light our way. Even though the darkness consumes so many hours of these winter days, the light is still there.

Even though darkness, light.

Even though Death, Life.

Even though pain, progress.

Even though two, one.

Even though being, becoming.

Even though ready, not ready.

Book of Life and Death: A Book Review

I picked up this book at a library book sale a few weeks ago. Two middle-schoolers handed me a grocery sack and said that I could fill it with as many books as I wanted for $5.00. This was one of the books that I grabbed.

Signs of Life

I’m so glad that I did.

***

Signs of Life is a cogent blend of journalistic investigation and memoir that explores hospice, palliative care, and our modern preference for treating the human body as a battle field and death as failure. But it’s so much more than that.

Brookes shares stunning observations and insight about the dying process and the grief that follows it. He does more than gather facts. He narrates his mother’s last six months as she slowly dies from pancreatic cancer. This bittersweet combination of history, science, and human experience provide a multi-layered approach toward understanding this topic.

I was first struck by one of Brookes’ first arguments:

The more we try to avoid death, the more likely we are to end up with exactly the death that we fear the most: helpless, afraid, in pain, alone. (p. 24)

Brookes combines interviews with doctors and hospice nurses along with his own experience with observing the dissection of a human cadaver to show us the absurdity of treating death as failure even though death is absolutely certain.

Who knows whether our panic and hand-wringing in the hospital corridor are at the thought that someone is dying, or that someone is dying the wrong death, in the wrong place? (p. 205)

This observation, I feel, is key to unlocking some of our modern discourse around death. We all know that we’re going to die. But when our moment has come, we’re encouraged to deny that it’s happening. This isn’t my time. This isn’t the way.

***

We typically view the concept of living in physical terms: breathing, heartbeat, and brain activity. But this is limited, as those of us who have watched our loved ones fade away piece by piece can attest. In an especially insightful passage, Brooks defines living in terms of our ability to be creative, even in the most mundane sense. As his mother’s health declines to the point that she struggles to continue her silversmithing, Brookes explains how losing this ability to create is a kind of death.

Any action is an act of knitting the past with the present to create the future, of making things that will exist that will have consequences, that, like earrings, will still be there to be given away or shown off. Inaction, the stricture of a sterile environment, severs the connection through time and thus suspends life, as if death had soaked like a beet stain backwards through time and saturated the fabric of life still left. (p. 168)

Our ability to create, then, becomes the vehicle that connects our past, present, and future selves. As Brookes narrates his mother’s dying, we see her selves slowly detach from one another: first, from her future self, and then from her present self. What remains in her final days is a self that digresses further and further from the present world until she is nearly completely engulfed in her past.

It makes me think of what my mother told me about my father in his last days. Suffering already from Parkinson’s and depression, my father died of complications after he fell and broke his C-2 vertebrae. Several days before he passed away, my mother walked into his room in the nursing home and he asked her if she had “his whites washed.” She asked him what he meant. He said that he needed his whites washed so he could get ready for his shift at the bakery. In his mind, he was living in a moment that had happened thirty years earlier.

***

Brookes also expresses the experience of grief in words that resonated deeply with me. Here are several quotes that need no explanation. They are just pure, simple truth. I underlined them. I starred them. I nodded ferociously.

I had thought that grief was a sign of lack of completeness, a wailing for the piece of the self that is missing, and as such, bereavement is necessary for us to individuate, to be whole. Now I saw that individuation is a machine’s notion of humanity: we pour into each other like inks in water. To be complete is not to be unaffected, or if we are separate, we are also part of something else, something we have in common, that infiltrates us at every cell. (p. 210)

Somehow grief had given me an exquisite awareness of the difference between the things that were suffused with life and those that lacked life energy, or abused it. (p. 211)

I felt as if I were breaking myself into little pieces and feeding them to vultures… The difficulty comes in the crossover between the inner and the outer worlds, having to deal with the pressures of the material world at a time when we have just been somewhere else. (p. 247)

I didn’t have the energy—and perhaps above all I didn’t want to have to be the one to spell it all out: I was wounded, and I wanted someone else to take care of me, someone who understood it already. (p. 248)

***

About a year ago, I opened up about my own experience with connecting birth and death in a blog post called “What Labor and Death Have in Common.” In summary, I feel strongly that experiencing the pain of childbirth pushed me into a space where death came up alongside me—and I allowed it to stay. I didn’t panic. I didn’t fear it, simply because there was no time to fear it. I was consumed by the waves of contractions. And so I entered a space where my body and mind went to mute and all I could sense was… quite frankly, God.

This experience was so profound that I couldn’t stop thinking about it. I wished that there were some way to fully convey what I had sensed during these hours, but language couldn’t fully articulate it. I felt that I had grown a new pair of eyes that could see a whole new view of the world, as if I had learned how to bend light to hit objects in a new way.

I wrote about this in my book, Becoming Mother, but I placed it in a separate appendix at the end of the book, not totally sure that all readers would truly understand what I was talking about, or perhaps be turned off by too much “woo-woo.”

So imagine my surprise when I read Brookes’ account of how he felt after had said good-bye to his ailing mother and accepted her impending death. His description of walking alongside the inevitability of death mirrors perfectly my own experience in childbirth and the first few days that followed.

I was of this world, but not affected by it, my mind unencumbered by gravity. Remarkable thoughts kept occurring to me… It was as if I had burrowed through all the rubble of tedious necessity in my life and found myself in a chamber lit by some unknown source, walls covered with pictures and hieroglyphics… I felt immune to trouble or hardship; I couldn’t imagine anything that could defeat my spirit. It was as if I had an umbilicus to God… The euphoria lasted about five days… (but then) I felt like I had lost my soul: I simply couldn’t think myself back to the state of grace I had known… Being so close to death, it seemed, was offering me wisdoms that I wasn’t using. (pp. 193-195)

I could have written these exact words about my own encounter with experiencing and witnessing life’s beginning.

In fact, in my own book, I write these words:

I felt the presence of God for the first time in the darkness of a shower, hours past sleep deprivation, and in the hardest hours of labor. In those sacred moments, punctuated with pain, I was finally truly aware of a portion of the self that is beyond the body and beyond the mind. My spirit soared into the foreground. And there, in the quiet darkness, as water spilled over me, I was connected to the Divine. Its energy flowed into me, took control, and pushed me forward. It stayed with me for days. It caused me to glow. (p. 274)

After such a profound experience, I also went through an opposing wave of emotion, feeling that I had lost my center. I kept trying to get back to those moments of clarity and spiritual connection, but it just wasn’t possible.

I had a similar experience when my father passed away, though not nearly as profound. And it truly made me a believer that those who draw near those moments of birth and death also enter sacred spaces. Life coming in. Life going out. Life all around.

***

After I finished this book, I flipped to the front matter to check its year of publication and noticed a stamp from the library on the inside cover. Discard, it read.

I laughed. The irony was too much.

Then I flipped back to this passage:

To talk only of death makes death triumphant. The best thing we can do for the dead and for ourselves is to give them back their lives. It’s a kind of resurrection. (p. 232)

I feel that this is what I’ve done for Signs of Life today, as I retell its story, hoping that it finds even more readers 20 years later.

Sway

It was one of those unusual days that turned into an unusual night.

Work was hectic. I was getting geared up to travel in a few days. I was attending an in-town conference that included networking dinners.

And the grocery shopping still needed to happen.

So there I am at Kroger at 9:30 on a Friday night, nodding my head to “Name” by the Goo Goo Dolls, which I find oddly comforting. It takes me back to a world where my chief concerns were learning how to write a thesis statement and whether or not that boy in geometry would ever want to talk to me about more than just my homework answers.

Then, I groan as I put it all together. I’ve entered the phase of my life when I’m part of the most heavily marketed demographic for advertisers: young mothers.

Wonderful.

I load the cart with the fruit collection (apples, pears, oranges, bananas, and berries of all kinds), the veggie collection (broccoli, carrots, lettuce, cucumbers, tomatoes), a bunch of food from the “hippie section” because my husband is allergic to X, Y, and Z, then I swing by the health and beauty section to pick up travel size contact solution.

I’m tired. I’ve been getting up at 5:00 a.m. so I can work out before the day begins rather than coming home luxuriously at 3:00 p.m. to exercise before I pick up my daughter from daycare. My FitBit reads 11, 534, 11,355, 11, 536.

As I draw near the checkout lanes, a lady turns her register’s light on and beckons me. Her short hair tapers and ends against her neck, just barely brushing her collar. She adjusts her dark-rimmed glasses and starts sorting my groceries. Even though it’s late, she still rapidly types in the codes of all my produce–from memory of course.

“And are you having a fantastic night?” she chirps.

I roll my eyes. “I mean, where else would I rather be?” I joke.

She laughs. “Well, at least it will be over soon.”

“I can’t wait. This day just keeps going and going…”

We laugh together, but then I instantly feel the need to dial back my complaining. I wonder how many hours she has been on her feet today. I remember how hard all those hours of cashiering at Target were on me–and I had a teenage body during those years.

“What about you?” I ask. “When do you get off?”

“I’m off at 11:00,” she smiles, “And then I’ll get a good six hours before I get up and go to the nursing home.”

She tells me that she has been volunteering at a nursing home in downtown Dayton for the last twenty years, mostly as a companion. She even brings her daughter, who is now in high school.

“It’s hard sometimes, you know…” she says, “When you get to know the residents, all about their lives and their families. Nothing really prepares you for when they transition.”

I nod along as she talks, until she gets to that word, transition.

I know what she means, of course, but I’m struck by the word. I’ve never heard of someone refer to death in this way. But she keeps on going as if what she has just said is completely mainstream. She talks a little more, but I’m still stuck on how she has framed the concept of death.

We say good-bye to each other and I look down at her name tag.

It says Sway.

***

After four days at the TESOL 2016 Convention in Baltimore, Maryland, I’m sitting in the airport with three of my colleagues, all of us eager to get back to our normal lives.

As I’m sitting at the gate waiting for my plane, I flip through four days of notes and start to make lists of things to do, things to read, and things to consider. A complete distillation of what I’ve learned in the past four days–at least as much as I can manage before my memories fade too much.

But then I hear applause.

And then more applause.

And then more applause.

I stand up to see if I can figure out what’s going on. I see a few American flags and I think, Oh, some soldiers are coming home. That’s sweet.

I go back to my notes. But then there’s more applause. And more. And more.

A crowd gathers.

“What is going on over there?” I ask my colleague, Olena.

“Just go and see, if you want.”

As I draw near the gathering crowd, I see that a few hundred people have gathered around a gate and a line of formally attired soldiers are each shaking hands with an old man who is being pushed in a wheelchair.

I think I understand, but I want to make sure. I ask a stranger next to me.

“It’s an honor flight,” she says. “For World War II veterans.”

One by one, about forty veterans travel down this corridor of applause, as these young soldiers reach out to shake their hands. People cheer and applaud. They take video and pictures. One of the veterans buries his head in his hands and the audience responds with even more cheers.

It takes time and a lot of corralling, but the lead organizer of the honor flight manages to take a group picture.

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Photo taken by Nathan Erhardt

***

Sunday afternoon. Back at the grocery store. Since we only need to get a few small items, I let my daughter push the just-right-for-her-size kid’s cart through the maze of Sunday afternoon shoppers. I leave a hand on the edge of the cart to make sure she doesn’t plow over someone else’s foot by accident.

When we finally approach the registers, I fall into a line that is three customers deep, which seems to be typical for this time of day.

The line advances. And that’s when I see Sway.

She smiles when she sees me. I tell her that I just got back from my trip and she asks how it went. I tell her about the honor flight and the World War II veterans and her face lights up.

“It’s funny,” I say. “I was hoping that I could tell you about it and here you are.”

“Well, it makes sense,” she says. “It’s all connected.”

I turn this idea over and over again on the way home.

Underneath Miscarriage

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A Christmas card we received on the day we found out.

 

Death surrounds new life, but it largely goes unnoticed. It starts in a womb where the death, birth, and growth of cells happen every month. A tiny fertilized egg trusts its fate to this volatile environment. Sometimes, it works out. Sometimes, it doesn’t.

About one year ago, I wrote these words in one of the final chapters of my book, Becoming Mother.

I just recently lived to experience the pain of these words.

Truth be told, I had a miscarriage before I was pregnant with my daughter. But it happened immediately after I got a positive home pregnancy test. Just as quickly as the news came, it was taken away. It felt like a mistake. Oops! That wasn’t meant for you.

I was never able to really own that pregnancy.

But this miscarriage, this one that just happened, this one is all mine.

This pregnancy was different. Every pregnancy is different, they all say. But from the day of ovulation to the day this baby’s heart stopped, I felt that something was off. Although I’ve never been one to place much trust in intuition, my radar was on high alert this whole pregnancy.

On the day I ovulated, I felt like I had a war going on inside of me. My right ovary hurt, my right Fallopian tube ached, my uterus contracted and tugged in hot spasms. I had never felt anything quite like this, so my brain settled on the idea that I was miscarrying. Although… how could that be? I’m just now ovulating!

I came home from work, still in pain, still confused. By the next day, the pain was gone, but I was so bloated and swollen I had to wear loose fitting pants.

As timing would have it, my annual gynecological exam was the following week and my midwife told me that it had probably been a ruptured ovarian cyst, especially since the pain was now gone.

Okay, an ovarian cyst… Strike one. But maybe I can still get pregnant.

And I did.

After I got the positive pregnancy test, I calculated my expected due date: August 1, 2016.

Huh… That doesn’t sound right.

I re-entered the date of my last period. Same answer. Of course, it was the same answer, but it didn’t seem right. It didn’t feel right.

I gave the pregnancy test to my daughter and told her to give to my husband. I thought it would be cute. He was still in bed, still groggy. He rolled over, looked at it, and asked if there were two lines there. I said yes.

He seemed underwhelmed, so I asked him what was wrong.

“I’d just feel more comfortable about this if you hadn’t had so much pain when you were ovulating.”

Husband doubting the good news. Strike two.

At five weeks pregnant, I was reeling. I had lost my emotional footing. I was so irritable that I couldn’t stand myself. Absolutely everyone was pissing me off. A colleague belaboring a point. My husband leaving dishes in the sink. My daughter not wanting to get in her car seat. My students not doing the reading. Every time someone pissed me off, I had to talk myself through it. This is a stupid thing to be upset about. You’re only feeling this way because you’re pregnant. Calm down and don’t say something that you’ll regret later.

And then the foggy thinking. I was so much foggier than I remember being at the end of the third trimester with my daughter. One day, my brain switched over from knowing it was Tuesday to thinking it was Wednesday. I rushed to create a lesson plan for my Wednesday class in one hour when I had another day to do it. Only as I was about to walk to the class did I realize that it was really Tuesday.

At six weeks pregnant, the extreme fatigue started. No. Let’s be real. It was extreme exhaustion. Between 1:00 and 3:00 p.m. every day, I was utterly useless. I had to work, sure, but I was completely checked out mentally. If I could leave work early, I did. Once I made it into our house, I immediately crashed on the sofa. Not enough energy to get upstairs.

This baby was kicking my ass. And I still wasn’t telling anyone about it, save my  mother.

Then at seven weeks pregnant, on the morning of Monday, December 14th, I was brushing my teeth and looking in the mirror. And I had a horrible thought.

I’m not pregnant anymore. 

I wasn’t reeling.

I wasn’t foggy.

That day, I was tired, but not nearly as exhausted as I had been.

Maybe I’m not pregnant anymore.

What a morbid thought! What the hell is the matter with you! Think positive. Maybe this is just going to be an easy pregnancy. 

That week, my digestion slowed to an absolute crawl. I started eating smaller meals more frequently, and I felt better. Then, the nausea started to kick in and I took comfort in it.

See? There. I told you.

At eight weeks and one day, I went in for the first ultrasound. For days, I had been prepping myself mentally for this.

But why?

I had never had an ultrasound where a doctor had given me bad news. They had always been exciting. I had always left with either good stats or pictures to show off.

Yet in my head, I went over the scenarios.

A baby in a Fallopian tube.

A dead baby.

A baby with no head.

A baby with no legs.

Two babies, both dead.

After each scenario, I would chide myself.

What the hell is the matter with you! What kind of mother are you to be thinking such morbid thoughts? You’re going to become a self-fulfilling prophecy if you’re not careful.

Imagining my child dead. Strike three.

***

In the days after I received the bad news that the baby had stopped growing at six weeks and six days (i.e. the day before I had my first thought that I was no longer pregnant), I felt the full gamut of emotions.

Anger.

Sadness.

Frustration.

I wanted to know where I had been when this baby’s heart stopped beating on Sunday, December 13th.

Was I in church? Had I been reciting the liturgy? Help, save, comfort, and defend us, gracious Lord?

Was I singing “We Need a Little Christmas” to my daughter as we drove home from church?

Was I napping?

Was I doing a prenatal yoga video, my hand resting over my abdomen in shavasana pose?

I was so furious.

***

“How are you doing, baby girl?” my husband asked me on the day after we found out. The house was quiet. Our daughter in bed. Christmas Eve still a day away.

I shrugged.

“What are you thinking?” he asked.

“Pshhh… You’re not going to like what I have to say.”

“Just say it.”

“What am I thinking? I’m thinking, what a waste of time. What a waste of effort. We had this all planned out so that I’d have the longest maternity leave possible, given the holidays and the academic year. And now, it’s just all gone. All that coping with irritability and the fatigue and the nausea…  All of that time… My birthday, Thanksgiving, our anniversary, and now Christmas… all of it spent emotionally invested in this thing that didn’t go anywhere. That’s what I’m thinking.”

But I held back.

I didn’t tell him that I was also thinking, Let’s just get this over with so I can move on. Let’s cut this thing out of me so I can replace this empty hole with something living. Something more worth my time. Let’s just get on with this so that I can stop being so damned depressed and start feeling happy again. 

Doug leaned back in his chair, a frown on his face.

“It wasn’t a waste of time, Sweets. Don’t think that.”

I shook my head.

“It wasn’t a waste. We made something special. Yeah, it didn’t last very long, but it was something we made together. And I think that’s nice.”

His words cut me. And what I bled was the truth that had been too painful for me to admit.

I had loved this baby.

Yes, this six-week-six-day-old baby, which medical textbooks call a “fetus.”

I loved it.

Me. The pro-choice woman who had also been comfortable using the word “fetus” instead of “baby.”

I loved this baby.

All of my anger and frustration had been window dressing for the simple fact that I was sad to lose someone that I had loved.

And here I was, denying it. Because denial was easier than facing the truth. That I had lost someone that I had loved. That I could feel so strongly about this baby that I would never meet.

I would be the only person on this planet that would ever know this baby the way that I did. And here I was, calling it a waste of timeA waste of effort.

I was so ashamed.

***

I said my good-bye to this baby on Christmas Eve after a long, desperately needed workout. Sweating, lying on the floor in the back room of our house, I rested my hand over my abdomen and cried.

I don’t want you to think that I didn’t love you because you couldn’t live up to my expectations. Just because your heart stopped beating… it doesn’t mean I didn’t love you. You didn’t have to be perfect. You didn’t even need to be fully formed. I still loved you. It doesn’t help me to imagine that you might be better off dead if you had some chromosomal abnormality–because I know I would have loved you no matter what your problems were. I would have taken you in whatever form you came. 

Because that’s love.

Irrational.

Wholehearted.

All-in.

***

This miscarriage has brought gratitude into full view again. When we’re deep in pain, we’re suddenly able to look back and identify all those moments when we should have been feeling gratitude–but we chose to feel a thousand other emotions.

Like it or not, I’m re-learning the humility of waiting. Waiting to heal. Waiting to pick myself back up. Waiting to try again.

But perhaps the waiting will be good for the part of me that foolishly believed that I could just remove death and replace it with life, just like that. A switcheroo before I would have time to deal with the pain of this loss. In a Facebook world brimming with good news and happy times, loss has become even harder to deal with. “Happiness” becomes the new default setting, and everyone seems to be experiencing it. And so it’s easier these days for loss to feel abnormal.

But the truth is, the abnormal is often the normal that we just don’t talk about in polite company.

Perhaps I need to learn that again. Perhaps I need to remember my own words.

Motherhood does take away. But it also replaces. Sometimes our hands are empty and sometimes they are full. And accepting this truth helps me find contentment and joy.

About one year ago, I wrote these words.

But it was just recently that I was reminded of their power.

 

Words for a grieving friend

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Writing words of comfort for a grieving friend is a nearly impossible task. Of course, nothing you can say is really much comfort. It doesn’t change this new, emptier life that your friend now faces.

But what words can do is provide connection. And connection can keep us from falling into the gaping hole left by our loss.

Connection pulls us up and out.

Connection joins us to others who have also suffered great loss.

Connection helps us to honor and aspire to that same insane and courageous decision to continue to love even though we now know just how much love can cost.

So this is what I wrote to my friend:

“For me, the best comfort when I was grieving was knowing that I was loved. Flowers, cards, and hugs—they didn’t change reality, but they helped me to know that even though I had lost someone I loved, love had not abandoned me forever. And living with grief is a delicate balance between honoring the memories of the one you lost and finding love in those who remain in this world.

Friend, as you walk this path of grief, know that you are loved. It by no means makes the journey any easier, but I do think that knowing that you are loved helps broaden your vision when grief condenses all existence into a singular point.”

What labor and death have in common

I had been told that labor was painful. That it could last for days. That drugs help.

But I never expected that experiencing labor would mimic the process of dying.

I first realized this when I wrote a poem about giving birth. As I reread a certain group of lines, I saw the connection. Here, I describe what it was like when I fought against the pain of the transition stage of labor.

I clutched. I gripped. I clawed. I seized.

I groaned. I moaned. I moaned. I groaned.

I reasoned. I pleaded. I begged. I shrieked.

 I cursed. I cried. I cursed. I hated.

I doubted. I despaired. I questioned. I bargained.

 Until I surrendered.

 And then I believed.

The turn in this poem (highlighted in bold) shows me giving in to birth and allowing myself to feel the pain. And this helps me re-imagine labor—as a form of dying. It’s right there in the lines of the poem—You go through all the same stages of grief. Reasoning, pleading, begging, cursing, hating, doubting, despairing, questioning, bargaining

And finally surrendering.

Unbearable, incessant, rhythmic pain will do that to you. It will grind you down into the salt that you really are.

Some who read this may think, Oh God, that sounds awful! I would do anything to avoid all of that. No one should have to suffer.

Part of me agrees with you.

And part of me now acknowledges that suffering can also open your eyes to greater truth—realizations that you cannot grasp until all of the anchors have been ripped free and you find yourself floating away on powerful currents. But there is beauty in surrender, in reaching the edge of your abilities and reason, and acknowledging that you are not so important that you can’t be completely humbled. That you are not so special that you just get to say “pass” on this one.

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And that is what labor and dying do–they reduce you. They re-orient your compass to true north. You are not the center of the universe. You are a small part of something much greater and much more powerful than you will ever be. We call it “God,” but that word is not enough. No word will ever be enough.

So stop fighting.

Stop grand-standing.

Stop asserting your own will and power.

Just stop. And feel.

Perhaps it is a combination of belief in our self-importance and our own powerlessness to protect that self-importance that drives us to try to control birth and death. Perhaps this partially accounts for our eagerness to hook ourselves up to machines which we believe to be more powerful than our own bodies. Or even to distrust our own bodies’ signals in favor of data pouring out of those machines.

Certainly, there is a time for using medical technology to mask or relieve our pain. When our bodies run amok with cancer and chronic, degenerative diseases—conditions when nature goes haywire—I am grateful to live in a time and place where I have options for healing or palliative care. But there is also a time to acknowledge what birth and death really are—natural processes. Stages of life. And denying or being afraid of them only intensifies the pain.

In my own experience, I know now that the urge to fight childbirth and escape the pain originated from outside of me.

It crept in when the doctor told me that I wasn’t progressing quickly enough,

or when the lines on the EFM monitor pronounced double-peaked contractions,

or when the doctor suggested that I could make all the pain go away if I just got the epidural.

After each of these in moments, I doubted the power of my body to get through the experience.

They knew what was going on with my body more than I did. That was how I felt.

But then I regained my focus. And I was able to take myself into a space where it was just me, the pain, and the moments between the pain.

With each contraction, my pain threshold rose and rose. I savored those moments between the pain, rather than focusing on the moments with the pain. When I was left alone, the messages from my birth attendants—my husband, my doula, and my nurse—were that what I was experiencing was normal. None of them acted like there was a reason to freak the hell out. I was not like other hospital patients, sick or diseased with a body gone haywire. What I was going through had a beginning, a middle, and an end. And what I needed was assurance that we were getting there.

It took some effort and planning to create this “birth as a process” environment in the hospital, where the assumption is typically “birth as a potential problem” in need of regulation and control.

But at least it’s not taboo to talk about birth like this.

Death, on the other hand, is far more likely to be seen as a problem, rather than a process. It’s the worst possible outcome. It’s failure. It cannot possibly be what we want.

***

My father died one year ago. Bipolar depression robbed him of his spark. Parkinson’s disease stole his smile and his gestures. Then, it ultimately caused him to lose his footing, fall, and break his neck. Gone was his ability to walk, and temporarily, his ability to independently breathe. He lay in the hospital for a month, unable to move and barely able to talk. When he recovered enough ability to lift his arms and breathe on his own, doctors started making plans for him.

Plans? Really? Plans for what?

My father was depressed. Unable to walk. Constipated and unable to relieve himself independently. His ongoing insomnia was exacerbated by the challenge of sleeping in a neck brace. It was a C2 vertebrae injury, so there was little hope of restoring many typical bodily functions—all of those small movements that we take for granted, but make us feel human. Feeding ourselves. Putting a shirt or shoes on. Picking up a pencil for a crossword.

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December 2008

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July 2012

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August 2013

So I wondered what these plans for the future were. Returning home? That seemed unlikely since he required someone to lift him and my mother certainly couldn’t do that. Going to a nursing home? Separated from his wife of 38 years. Confused by the constant shifts in caretakers, as nurses clock in and clock out. These were the plans? Were these the plans that the doctors would have wanted for themselves?

After my father fell, I admit that my prayers were not for him to heal. At best, they were vague prayers asking for God’s mercy or asking for God to ease his pain. At worst, they were prayers that his life would end soon. That he wouldn’t suffer in such conditions for weeks and months and years, according to the doctors’ plans. That his last moments of life wouldn’t be confusing or difficult. That he could understand what was happening to him so he could accept it instead of fighting it.

But then again…

Would I?

Would I be able to accept the end when I know it’s near?

These are questions without answers. Thoughts for the thinking, not for the deciding. At the end of life, it’s hard to know what we’ll want. Just as it is when we are in the hardest hours of labor. Our birth plans may be clearly and precisely articulated, but when the shit hits the fan, it’s hard to anticipate where everything will land.

But what I am sure of is that the experience of labor has prepared me for that winnowing down of self, that preparation to join a grand Divine, beyond human comprehension.

I think about what the end of life is like for women who have gone through labor. As they are dying, do they remember labor? Do they remember the way that it reduced their existence into a singular point? Are they better able to accept what is happening to them?

Is labor a special glimpse into the spiritual world that only women are fortunate enough to be able to access?

Because something happens once you become a link in that chain of life, a witness to life’s awesome resilience and power of renewal.

When you give life, life gives you something back—wonder.

The kind of wonder that results from the utter destruction of all your previous understandings and assumptions. The kind that forces you to re-examine all the surviving shards to see which ones deserve to go on and to acknowledge which ones have become dust, lost to the wind.

Wonder.

Over so many things.

How could my body do that?

How could this baby already be breathing on his own?

What will I do if this child dies? How could I go on?

Do all mothers feel this way?

What did I do to deserve any of this?

And Why?

Why Life?

Why Death?

Thoughts for the thinking, not for the deciding.

Like this post? Pre-order a copy of “Becoming Mother: A Journey of Identity” or Check out previous posts here.

Or watch this short related clip of me reading my favorite passage, in which I describe an unexpected spiritual moment.

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