Endgame

The midwife is late. At 9:00 a nurse we've seen only once before tells us that she'll do the check, since Shannon is occupied with a birth in another suite. Euphoria! Full dilation. The only thing between here and a baby is the Push, a phase, we are informed, that typically takes first time moms between 1 and 2 hours.

A sweet tempered young woman in a blue scrub is assigned to help us push. Catalina's epidural is reduced by half so she can feel the relevant muscles, a sort of chin-up bar is rigged to the bottom of her bed, and the young woman shows her various canonical positions, most of which involve hanging from or pulling on the bar, knees wide apart. Exhaustion is palpable, but the news of the Last Phase seems heartening, and Catalina dutifully begins to squeeze and grunt with her contractions (which she can now feel, but only lightly.)

At the beginning of the push, Piro is positioned at +1, meaning the crown of his head is 1cm below the line of the pelvis. This is considered a favorable position in which to begin pushing; at +4, the baby 'crowns', and full emergence follows shortly. Shannon tells us that the rate at which the baby descends is variable, even unimportant: what is important is that the mother 'show progress'. Her check at 10p.m. reveals that Piro is still at +1. Disappointed, exhausted, and still barely in touch with her contractions, Catalina struggles to stay awake. The nurses all concur that the push phase should be characterized by an overwhelming desire to 'get that baby out'; the only major desire Catalina has at the moment is to sleep. She struggles on, but when the next check at 11p.m. reveals the same level of descent, the room is swept with a now somber realization that the plan needs changing.

The midwife theorizes that we're seeing the same pattern of interlarded strong and weak contractions that characterized her earlier active labor, and that the present set of weak contractions are probably inadequate to advance the baby. Why the contractions are weak is anyone's guess, but at this point the uterus is probably exhausted, and slowing down to rest. Under normal circumstances, we might be able to wait for it to recuperate and pick up, but with membranes ruptured for over 30 hours, waiting is not a luxury we have. Everyone concurs that it time for Pitocin.

Catalina starts on a low dose, and her epidural is reduced still further to augment feeling in the muscles. Now she has real pain, and we're back in the cycle of seeing her fight tooth and nail for every advance. Two hours of grueling squeeze are followed by another check: we've gained a centimeter at most. Catalina looks savaged.

They call in a doctor, a tight-lipped, waifish woman with an arrogant demeanor. Without saying much, she performs a manual check, confirming that Piro is facing occiput posterior, i.e. with the back of the head against the spine of the mother. This explains both the intense pain and the slowness of the labor. She also confirms that the amniotic fluid contains myconium, i.e. a baby bowel movement, which could be a sign of fetal distress. She spends five minutes attempting to rotate the baby by hand before leaving to discuss the issue with the attending physician.

He arrives, similarly arrogant, a tall, well-build man in his late forties. He describes the situation as follows: Catalina is effectively done (her uterus is exhausted, to say nothing of her spirits), time is short, and the labor is not progressing. Moreover, her uterus feels warm, and he's fairly certain she has an infection. Two options: one, cut in from above, two, pull out from below. Given the near certainty of infection, a C-section might have serious implications for any future child bearing plans. As for the 'below' options, there are two: the pump, or forceps. The baby is slightly deflexed, however, meaning his head is tilted back, augmenting the tightness of the fit and reducing the probabilities that the suction cup would fit well. It would probably slip off and end in failure. Moreover, trying both suction and forceps in succession radically increases the odds of cerebral hemorage, so if one fails, it's on to a C-section. His recommendation is the forceps.

The final scene: a mob around the bed, the doctor, his two residents, two principal and about ten auxiliary nurses, the midwife, the doula, my own lankey self. 'All the pushing you did before was practice', the doctor says, 'this is for real. It's got to work.' The doctor cranks the epidural. 'Pitocin is our friend', he intones, and cranks that too. All the heavy drugs we thought to avoid coursing full blast through the system. A contraction materializes on the monitor, Catalina takes a large breath, and then she's pushing with everything she's got, eye-popping, tendon-straining, braining-clouding pushing, for the count of ten, then another breath, and the whole thing over again, and one more time again. Three sets of crowd-cheering, beeper-studded, life-and-death push on one end and pull on the other. And then a pause: the doctor does the check. 'Excellent. Good descent. Let's do it again.' And so we do, once more, twice more, ultimately about eight or nine cycles of three 10 second pushes per contraction, and on the tenth, I see a huge distorted clown face, eyes skewed above a massive nose emerging through green-yellow-black-red slime, a mouth twisted purple, Picasso-like away from the rest, a hairy cone above this, below, fin-like hands and feet, the huge filanges of a primordial creature, grotesquely oversized limbs, and gnarled chord curling away in the bowels of my woman. Piro, welcome to the world.