Ezio was supposed to be an October baby, due around the same time as my 30th birthday. But my body and the midwives decided otherwise.
I had an easy pregnancy with Eira but still remembered the achiness of the late-third trimester. What I felt with Ezio was a little different.
My Apple watch informed me in the early third trimester my resting heart rate was trending higher, and in the late third trimester, I began to feel it. Each time I sat upright or came to standing, my heart would race. I remembered it being hard to get my heart rate high enough for walking to be considered exercise with Eira’s pregnancy, but this time, all I had to do was stroll casually to be "working out".
And I was hot. I mean really HOT. Constantly.
The season was changing to fall and some days Daniel would point out the chilly mornings. Meanwhile, I wake up feeling overheated sleeping in shorts and next to an open window and whirring fan.
And mostly, I had an overwhelming sense I needed to rest. Me? – a typically active person who struggles to slow down and spent Eira’s late third trimester whirring around our tiny apartment and walking around the river. How could I need to rest?
But the objective measurement that gave it away was my blood pressure. At my 29-week appointment when I first entered Mercy Birthing Center, my blood pressure was 112/67. At 32 weeks, it was 122/82. Two weeks later, the nurse who measured it said, “Hmm, that’s high. I think I’ll check it again.” The final readout was 134/84. Two weeks later, the same scenario played out and the final readout was 136/86.
“I’m wondering what’s going on with my blood pressure. Usually, it runs low, but it seems like these numbers are creeping up,” I told the midwife during my 36-week appointment. She didn’t seem overly concerned with my numbers but recommended home monitoring.
At home, I expected the numbers to go down because I was in a more relaxed setting. To my disappointment, they did the opposite, measuring consistently over 140/90.
“You’re just psyching yourself out,” Daniel said. But I knew anxiety could only raise the numbers so much.
“You know this is probably one of those things you worry about,” my mom said when we visited that weekend after my 36-week appointment.
One of those things like having a breech baby at 29 weeks, which I flipped (or gravity flipped) after learning a bit of Spinning Babies. Or one of those things like failing my first-step screening for gestational diabetes, which I learned was nothing to be concerned about after playing around with home glucose monitoring (and after passing my second-step screening with flying colors 2 weeks later).
Was it just one of those things I worry about or am I just in touch with my body?
At my 37-week appointment, the numbers spoke for themselves. 150/94 was my first reading and 131/100 was the retake.
"I’m really sorry to be the one to tell you this, but I’m going to recommend you go to L&D for an induction today," Maria, the midwife at the birthing center told me.
"These numbers are high enough to make me think this will likely develop into preeclampsia," she continued. "We don’t want you to have a stroke walking around. There’s nothing you could have done. It’s not your fault. It’s likely a complication of having COVID during the second trimester. We see it all the time. COVID is an arterial disease, and this can just be part of the process. Things will get better, and you should return to baseline once the placenta is out.”
“I told you!” I whispered to Daniel after we had been escorted down to L&D. Strangely, I was not afraid but validated to hear I wasn’t crazy. Something truly was off.
In triage, I sat strapped down to a fetal heart rate monitor and a blood pressure cuff which intermittently squeezed at my arm. Daniel went home to feed Eira breakfast, and I lay there looking through photos and listening to music on my phone. After about an hour, an OB came in with a status update:
“Well, your blood pressure isn’t quite high enough to diagnose you with gestational hypertension yet. We would need two readings of 140/90 at least four hours apart. So far, we’ve only had one above that level. Your labs also came back normal, so you haven’t developed preeclampsia yet. I’m going to stop torturing your arm and get you out of here.”
“Oh,” I said surprised but also reassured that my instinct to rest was spot on: Resting made my blood pressure look good.
“But the midwife I spoke with was fairly certain I’d need an induction today since I’ve been seeing numbers above 140/90 at home. Do you know what the next steps are?”
“Sometimes home blood pressure cuffs can read a little high, so why don’t you bring yours into your next appointment to get it calibrated? They’d like to see you again at the birthing center for a blood pressure reading two days from now, but in the meantime continue monitoring and call if you experience any signs of preeclampsia.”
I left the hospital that morning relieved, a little confused, and quite certain I needed to start packing my hospital bag.
That Friday, I entered the birthing center equally dreading and prepared for the reading. Based on the numbers I had seen at home, I was confident I’d have my second high blood pressure reading today and they’d truly recommend the induction now. And as much as I wanted labor to progress naturally, I had seen too many episodes of Call the Midwife to know the severity of preeclampsia and gestational hypertension. Strokes and seizures were always the saddest episodes that left mothers dead or seriously debilitated. I really didn’t want to mess around with that.
The nurse sat me down and explained she’d be back in 10 minutes to take my blood pressure. She looked at me knowingly and handed me a small, laminated card explaining belly breathing. “While you’re waiting, you might try this,” she said with a sympathetic smile. We both knew what the consequences would be if this reading was high and didn’t have to acknowledge them aloud.
Daniel and Eira entered the room and I lay down on the couch belly breathing and letting Daniel stroke my hair. Although I knew how to relax, I also knew these practices could only do so much when my current baseline was so high.
The nurse came in to take it and frowned. “I’m getting 150/94,” she said looking at me sadly. “But I’ll go get the midwife and see if she’ll let me take it again in another 10 minutes.”
About 5 minutes later, the midwife Becky entered and took the reading herself.
“148/96,” Becky said and hesitated. “At this point, you’ve had two readings high enough for us to call this gestational hypertension. We do recommend induction at 37 weeks because if we wait around, you’re very likely to develop preeclampsia.”
“Would it be too late to wait until Sunday to start the induction?” I asked, hoping to arrange for my parents to watch snowpea before then.
“Well, officially, the recommendation for gestational hypertension is to induce at 37 weeks, so I would recommend starting the induction today. But you have some say in this, too. We saw in triage your readings were normal when you’re resting, so focus on that tomorrow and we’ll schedule your induction for Sunday.”
We made the arrangements, made plans to come in immediately with any preeclampsia warning signs or readings above 160/110, and calibrated my cuff. My cuff was spot-on – both the midwife’s and mine read high.
“Your body just doesn’t like being pregnant,” Becky said, looking at me sympathetically.
My mind immediately jumped back to my pregnancy with snowpea and I wanted to scream, “But it didn’t use to be this way!”
If COVID colored Eira's birth story by shutting down the birth center in Boston, with Ezio, it was clear COVID had shaped my body’s experience of pregnancy.
Having a scheduled induction – even if it was scheduled suddenly – was an odd experience compared with the possibility of going into labor at any moment. All of a sudden, I knew exactly when I would start the process of birthing my baby and could plan exactly how I’d like to spend my last few days of this joyous, slightly scary time.
My final hours were equal parts celebration and rest: I bought labor snacks and a bouquet and braided a flower crown. Daniel meticulously painted my belly with henna. I bathed my feet and body in Epsom salts and petals. I lounged on my birth ball and drank cups of raspberry leaf tea. I practiced restorative yoga and sang with my harmonium. I welcomed my parents, and we ate spicy Indian takeout. I drew Tarot cards for the new moon and The Moon was the answer to how labor would proceed. We went out for ice cream for dessert, and I got my order in a lavender cone. Finally, I showered one last time, set out my hospital clothes, and wished snowpea sweet dreams.
I tried to sleep, but sleep did not come easily, and around 12:30 am, we got the call from L&D.
“Is this Lacey? We’ve got a room ready for you, so you can come in for your induction,” the nurse chirped.
“Okay, we’ll be right there,” I replied, equally cheery.
I raced downstairs and paced the living room, waiting for Daniel. “Chill. You’re being so uncool,” he said, still groggy.
“Hurry up!” I replied.
“Should I speed to get there since you’re ‘in labor’?” Daniel asked in the driver’s seat.
“Now you're being uncool,” I replied.
“It’s wild that I’m not having contractions now. I feel more like I’m going to a doula gig than my own birth,” I told Daniel as we made our way down the silent city streets. I was new to doula work in California, but it had prepared me well for this. Three of the four births I had seen were inductions, and I had seen the range of possibilities for what course this labor could take – 12 hours with a vaginal delivery to 3 days ending in a c-section. I was ready for anything at this point.
We made our way to check-in and I shot Daniel an eager smile. “Chill,” he repeated.
“I’m excited,” I explained to the nurse.
“Oh? Is this your first baby?” she asked, likely thinking there was no way I could be so eager if I knew what was to come.
“No, my second. I just like birth,” I shrugged.
A nurse met us in the waiting area. "Oh, I love your bag!" She gushed, her energy matching mine.
In the elevator, she asked why we were there, and I explained the situation. "Oh! We see gestational hypertension a lot with COVID babies – err, I mean! with babies whose moms had COVID during pregnancy."
The labor room was not quite as luxurious as the birthing center suites but thankfully more spacious than triage. Daniel stretched out on the couch and I reclined on the hospital bed as the nurse strapped a fetal heart rate monitor to my belly.
“Wow, your belly is beautiful!” she exclaimed.
I pointed at the artist and grinned, remembering that Daniel's motivation for painting so meticulously was to avoid having the nurses gossip about his sloppy work.
Later, the midwife on call entered the room.
“Hi, it’s Jenny!” She stepped into the light and greeted me as Daniel lay with my rebozo covering his eyes on the couch. “I was your midwife at your first appointment at the birthing center. I just took a look at my notes from the visit. You told me for your first baby, you had a long labor until you had your water broken. You labored in the tub, then your baby was born. This might look a little different."
She paused, and I nodded in response.
"You’ve developed gestational hypertension that would very likely develop into preeclampsia. So, we’re going to do some things to get labor going before it gets to the point of being scary," she continued. "Depending on whether you’ve started dilating, we’ll likely be giving you something to help with cervical ripening. That may kickstart labor or we may start Pitocin after that to get contractions going. Can I take a look at you now?”
I butterflied my legs and exhaled as Jenny pushed in. “You’re about 1 centimeter dilated, 40% effaced. That’s about what I’d expect for 37 weeks. How do you feel about starting with Cytotec to help with cervical ripening?”
Cytotec is the drug name for misoprostol, a synthetic prostaglandin originally marketed to reduce the risk of gastric ulcers but which happens to be effective at causing strong uterine contractions (possibly to the point of uterine rupture if given too much or too quickly). Interestingly, misoprostol is one of two pills commonly used for first-trimester self-medicated abortion, which has been increasingly criminalized here in Missouri, where abortion laws are among the most restrictive in the country. Basically, it’s powerful medicine.
“Okay, let’s do it,” I replied.
Around 3:30 am, I was given my first dose of Cytotec in the form of two chalky tablets that I was told to dissolve between my cheek and teeth. Jenny had informed me my baby was lying to the right and advised me to sleep on my left with a peanut ball between my legs if I could tolerate it. I had just practiced getting comfortable on the peanut ball with Anna, our doula, the other night, so I was prepared for this.
Sleep didn’t come easily but once it arrived, I was able to catch three hours uninterrupted.
Shortly after waking around 7:30 am, Jenny came in to check me again.
“You’re about 1.5 cm and 70% effaced now," she informed me, and I exhaled. "Your Bishop score is up from a 4 to about a 6, but we really like to see it at 8 to start Pitocin. What do you think about starting another dose of Cytotec?”
I agreed and was handed 2 more chalky tablets to suck on. I was told I was having contractions but to that point, I had only felt light continuous cramping. Jenny advised me to eat breakfast while I could and start moving. The nurse transitioned me to a portable fetal heart rate monitor and I was set free.
I set up the room with tea lights and affirmation cards and put a jazzy yoga playlist on my Bluetooth speaker.
“Can you turn that down?” Daniel asked, lifting my rebozo from his eyes on the couch. “I’m trying to sleep.”
“You’re not the one in labor,” I reminded him.
Around 8:30, breakfast arrived, and Daniel sent a photo to my dad of our spread of food. “All this with coffee for $12! I love St. Louis,” he remarked.
Anna arrived shortly after to check in and drop off more labor tools and things to set the mood: more tea lights for the bathroom, a diffuser filled with clary sage, and a giant blowup birthing stool. Our setup felt complete.
Daniel napped some more with my rebozo, and I positioned myself on the birth ball with my upper body leaning forward on the peanut ball which was propped onto the hospital bed. I thought I started to feel a pattern to the cramping, so I started resting and moving in rhythm with it. As I sat on the birth ball, the nurse came in to check my blood pressure. 157/84 was what the machine read.
“Wow, that’s really high!” I exclaimed. All the readings beforehand had been beautiful.
Immediately, I returned to the peanut ball in bed.
Becky was the daytime midwife on call, and she came in to check me around 11:30.
“Should I mostly be laboring in bed?” I asked Becky. “I had a high reading when I was up and moving around on the birth ball.”
“I wouldn’t worry about that too much. You’re here now so we can monitor you, and there are things we can do if the numbers get too high. So, you can feel free to labor in whichever position is most comfortable. But if you prefer to lay on the bed while you’re still comfortable to conserve energy, you can also do that for now.”
But I knew those “things” we could do if my blood pressure got too high were not necessarily things I wanted to deal with in labor – namely, magnesium sulfate.
Coincidentally, I met someone on Peanut, a friendship app for moms, who had the same issue and was being seen at the same hospital. In fact, she was in the same hospital at that same moment for an induction and told me that morning she had just given birth. She also had a two-year-old daughter, had COVID during the second trimester, and had developed gestational hypertension. But for her, the numbers were a bit higher and things had started to progress into preeclampsia.
“Just don’t get two readings of 160/110! It’s their policy to use magnesium if you do,” she warned me and told me she still felt woozy from the drug. I had heard horror stories from other moms about feeling out-of-body after taking magnesium sulfate during labor. I decided to labor side-lying as much as I could – just in case.
Next, Becky checked my cervix.
“Jenny said you were about 1.5 cm, 70% effaced after the first dose and I’d say you are about the same. If we start you on Pitocin now, it could lead to a quicker labor. But if we give you one more dose of Cytotec, it might help to ripen you and raise your Bishop score more beforehand. Which do you prefer?” she asked.
“Which do you recommend?” I asked back, knowing that I was absolutely not the expert in induction methods.
“I would recommend one more dose of Cytotec because it mimics natural labor more,” she advised.
“Okay, then let’s go with that,” I agreed. Personally, I had heard more horror stories about Pitocin and didn’t want to be tethered to an IV, so more pills were my preference. I was handed the tablets and placed them inside my cheek.
This dose was different. I could tell right away.
Almost instantly, the now-regular tightening began to border on painful. I wanted to get more food in before things really picked up. I looked at the menu, had another contraction, and pushed it in Daniel’s direction.
“Hmm… I’ll have the grilled cheese and tomato bisque,” he said slowly.
“I’ll have the same," I said quickly through another contraction. "Can you call this time?”
“You’ll want different side orders, so you can call in,” he said, scrolling through his phone.
I breathed heavily.
“Just text your order to me,” he decided. And slowly and laboriously, I sent the order to his phone.
My parents and Eira arrived shortly before lunch did. I was also hoping I could coordinate their visit with my pre-labor cheery glow, but I was definitely starting to feel things. I tried to smile and muscle through as Eira played with the various blow-up balls and scattered my tealights from their altar. Daniel made some jokes about inductions being easy compared with natural labor which I didn’t appreciate, and I told him he hadn’t seen anything yet.
Lunch arrived and I managed to eat most of my grilled cheese, but the contractions were growing stronger. I tried to feed my mac n cheese to snowpea, but when she tried to sit on my lap, she brushed against my hep lock as my uterus contracted again.
“Ooooh, no Eira,” I exhaled.
My dad tried to ask me something about cloth diapers, and I waved my hand and said, “Don’t worry about it now.”
Daniel continued making jokes I didn’t appreciate, and I got quiet as the contractions intensified. Oh no, this was back labor. I elevated my bum off the hospital bed, closed my eyes, and exhaled.
“Oh dear, I think we should be going soon,” my dad observed.
On the hospital bed, I lay with the peanut ball between my legs and started to moan.
“Do you want some love?” Daniel asked, finally letting up with the jokes.
“Ye-essssss,” I hissed desperately.
“Can you push right here on my back?” I asked, placing his palm on my sacrum. He pushed in and I let out another soft moan as another contraction came.
“Thank you, my love,” I said softly after the contraction passed, and he climbed into the tiny hospital bed with me.
“Ohhh, there’s another one,” I whispered, closing my eyes, and I pressed his hand into my back. The warmth of his body made me soften into the contraction and I let out another moan.
I remembered how tense I felt in the hospital during my first labor and observed there was none of that now. I felt so relaxed here just laying in bed and letting the waves move down me.
“Do you want to move to the couch?” Daniel asked and I looked back and saw him struggling to stay put on his tiny strip of the hospital bed. He extended the couch seats into a pull-out bed and I landed back down on my left side.
“Oooooh,” I breathed as another contraction moved through me.
“They’re coming too fast!” I observed when it finished. From the very start, there had been barely a minute between each contraction, and it was starting to catch up with me.
We created a rhythm in sync with the quick pace of contractions. A few on my left side, a few on all fours, and a few back to my left side again. I moved the peanut ball and Daniel’s hands into position with each transition and things felt like they were starting to flow.
“This is getting intense,” I whispered between contractions as I lay back down on my left. “I think we should call Anna.”
Daniel got up to retrieve my phone and read, “The mom from Peanut says, ‘How’s it going? Hopefully you’re progressing! It took me 2 rounds of Cytotec to get to 2 cm, then 17 hours on Pitocin before pushing.’”
“WHAT?” I exclaimed between contractions. “SEVENTEEN MORE HOURS OF THIS? I can’t – I can’t – these drugs are too strong. It’s not like natural labor. I’m going to need an epidural if we still have seventeen hours of – OHHHH,” and I moaned into another contraction.
I heard the door open and tried to look in the direction of the nurse. “It sounds like things are starting to pick up,” she observed. “Do you think it’s past a 5 or 6 now on the pain scale?”
“Yessss,” I breathed.
“Would you say a 7?” she asked.
I hated these questions. “It’s at least a – at least a ssssseven,” I said and moaned into another contraction.
“I’ll get Becky,” she decided and whisked out the door.
Minutes later, Becky arrived with two nurses at her side. I didn’t bother to get up or mask my moaning as I lay on the hospital bed, waiting to be checked.
“Can I check your cervix?” she asked softly.
“Yessss,” I moaned.
And after a pause... “You’re about 4 cm, 100% effaced.”
I breathed a sigh of relief as her hand slid out. At least I wasn’t at 2.
“I’ll let Anna know,” Daniel said and picked up his phone.
“Do you want to get in the tub?” She asked.
“Yessss,” I moaned again, then let out a low ohhhhh with my next contraction.
“That’s it, Lacey! Beautiful,” the nurses cheered softly.
I heard the tub filling with water in the distance. I remembered when I was 4 cm during my first labor, I still had at least 12 hours to go. In a flash of fear, I turned to Becky and whimpered, “Do I still have to start Pitocin?”
“I don’t think so,” she said slowly. “Your body has kicked into labor, and it remembers what to do.”
Becky gave me a hand to stand up and as soon as I did, I had another contraction. But this one felt different. Suddenly, I felt the urge to push.
“Ohhhh,” I moaned. And when it finished, “Can I pee before I get in the tub?”
I really did need to pee. But the moment I sat down on the toilet, I had another strong contraction and realized nothing was coming out until the baby did.
Outside, they heard me moan and Daniel opened the door. As soon as I came to standing, I had another contraction and leaned over the edge of the tub. “Ohhhhh,” I moaned again.
“Did that one feel pushy?” Becky asked.
“It felt pushy,” I confirmed.
Daniel helped me out of my white tattered labor dress. I tried to pull it off and it ripped at the shoulder. I tried to get in the tub, but I had another contraction and moaned low.
Naked now besides my henna belly and fully uninhibited, I felt primal, and it felt different from my first labor. I remembered a video I had seen of a Brazilian woman during a home birth, and I remembered my tarot card, The Moon. From the corner of my eye, I saw the nurses turn on the light for the newborn bassinet, and through the pain, I beamed a smile. This was happening.
Getting into the tub felt laborious because I continued contracting back-to-back, but once I was there, I relaxed into the warm water. I stayed kneeling, surrounded by tea lights, and halfway immersed in the deep water.
“If you feel like you need to push, stand up and lean over the wall behind you. We can catch your baby from there,” Becky instructed me, and I nodded in response.
“Does that feel better?” someone asked. The voices around me seemed to coalesce.
“Yesssssss,” I replied. Then, “Ohhhhh,” as another contraction came. Then, “Ohhhhh-uh,” another one on top of it.
“That one sounded different,” Becky said softly. “Did it feel different?”
“They all feel pushy,” I replied. “Is it okay to feel pushy if I’m only 4 centimeters?”
“I think you may be more than 4 centimeters,” Becky said calmly, and I moaned into another contraction.
“Do you want to try getting out and going on hands and knees on the bed?” She asked.
“Yes,” I nodded, and Daniel helped me out of the tub.
I climbed onto the hospital bed, leaned forward over its raised head, and moaned into another contraction.
“Don't be afraid to push,” Becky told me. I did and I felt relief as the baby moved downwards. I didn’t know how to push a baby out on all fours and frankly felt very exposed in this position. After a few contractions, I repositioned myself onto my left side, where I had been lying for the majority of this labor.
From here, I could see the room with its dim lights and tea lights that glowed in front of my affirmation cards. Yoga music played through the speaker and seemed to color the room green and blue. Another contraction came, and I pulled my left knee in as I pushed.
I was surprised no one was coaching me, positioning me, or telling me what to do. Instead, the nurses and Becky watched and cheered in hushed tones.
Anna walked quietly in around then and I felt relief that she had made it just in time. She joined the small gathering at my bedside, and I continued to push with each contraction. My leg was cramping from having spent the whole day in this position, so after my next push, I rotated to my right. It felt better but still not quite comfortable.
I sighed and moved to my back. I knew this was just about the most boring birthing position, but I also knew how to birth a baby like this.
“Yeah, this is what worked for you with Eira,” Daniel encouraged me.
On the next contraction, I pulled my knees in and let the baby move down. Oh yes, this was the one. I felt his head descend. Becky observed, “Your baby bump is moving down.”
Things were moving quicker now, and I realized there was no escaping. Baby oakleaf was on his way!
I didn’t realize Daniel had been holding my hand until he had Anna take over momentarily. Things were progressing but it still felt like something was in the way.
“Can I check you to make sure you’re fully dilated?” Becky asked. “You are and I can feel your water bag bulging. Once it breaks, I think we’ll have a baby. Do you want me to break it?”
I looked at her, said yes, and braced myself.
“Ohhhhh!” I exclaimed as the baby’s head moved down, down, down. It felt as though a waterfall was flowing through me and I panted to control it.
“That’s it, Lacey!” The room cheered around me.
In the same single push, I felt the “ring of fire” as the baby’s head became visible.
“All that hair!” someone exclaimed.
“Go slow,” Becky said, and I continued to pant.
I heaved a sigh of relief as the baby’s head emerged.
“When you feel the next contraction, give one more push,” Becky said. I did and the body slid out.
He was brought up to my chest and I gasped at how tiny he was. He was delicate and blue but fully alive with a head full of hair and completely ours. I held him tightly to my chest and cooed as I felt his soft skin, “My baby! I’m your mama!”
“When you feel the urge to push again, you can push and the placenta will be – ” Becky began.
“I feel it,” I said, and in the same breath, the placenta slid out.
“Oh, there it is,” Becky said, surprised to receive it in her hands so quickly.
As I held onto Ezio, she held the placenta up for me to see.
There it was – not quite as pretty or heart-shaped or pink as Eira’s placenta but one that seemed to be darkened and diseased by COVID – one that caused all this chaos in the first place and may have killed me if we had left it in long enough. It was wrapped in aluminum foil and passed off to Daniel who would freeze it until we were ready to use it to plant a tree. I’m not sure whether it will bear fruit or flowers, but our tree will be a sort of memento not only to our little fighter but to this pandemic era that shaped his birth.
"Is it okay if I check you for any lacerations?" Becky asked.
"Yes," I nodded and prepared myself for the worst after such a quick and forceful final push.
"There's no tearing here," she said.
"Again!" Daniel smiled at me.
"That's two for two!" I smiled back.
"And that was because you were so controlled," Becky said.
I couldn't believe it. Controlled and yet covered in blood, amnionic fluid, and everything inside. Controlled and yet I had spent hours involuntarily moaning, mooing, and cursing as I caught my breath. No tearing, no magnesium, no Pitocin at all. Just a few little white pills, my body, my baby, and our diseased placenta wrapped in aluminum foil.