Wednesday, November 19, 2008

A Walk to Beautiful

Today was not one of my favorite parenting days. Charlie didn't sleep well last night and his behavior today showed it and then he didn't go down for a nap this afternoon. Megan is teething and just broke her 1st tooth. She's well into the 6 month growth spurt which is generally alleviated with the addition of solids but Megan isn't wild about solids so there has been lots and lots of nursing at all hours as of late. I was cross and cranky and ready to run for the hills by the time my husband came home today and then I watched NOVA while I nursed Megan.

The NOVA episode tonight was A Walk to Beautiful and was about women suffering from obstetrical fistulas. WARNING: We are now wandering into a girl bit heavy post. I don't think it's too terribly graphic but if you flinch when passing the feminine hygiene aisle give a nice donation to the WHO and be on your way...

I was in labor with Megan for 18 hours. It was mostly back labor and was somewhat unproductive. My contractions were significant to wake me up by 7 am and I was fully effaced by the time I got to the hospital at 3 ish. But, I was only dilated to 3 cm. My contractions didn't form a good pattern and I dilated only 1 more centimeter over the next 3 hours or so (my memories are fuzzy). I hung out in the shower for a while but didn't want to get into a tub, which would have relieved my discomfort, because it could slow my labor even more. I finally got an epidural when we decided I should start pitocin around 7. The epidural was only somewhat effective. The doctor discovered that Megan was turned and got her to turn properly which helped rather more than the epidural. Unfortunately, she turned back (most unusual) so I spent the last hunk of labor, aided by pitocin and largely unaided by an epidural with a baby in a very wrong spot. It really, really hurt. Happily, I am a champion at dissociation and can therefore only rememeber that it hurt in the most abstract way. I remember simply focusing on not panicking and reminding myself that I really wasn't in danger or about to die. I went beyond breathing, relaxing, focusing, or coconut visualizations and simply tried to not try and fling myself out of the bed to run away from the torture and torment I was going through. I remember my husband pointing out that I was not relaxing and wanting to Do Something to him because "Duh!!!" but not being able to focus beyond the pain to do whatever it was.

I pushed for an hour. I know they were good pushes. My forehead began to hurt from the pressure of my pushing. I spun on the bed. I felt my muscles move in co-ordinated and strong movements. After an hour, Megan's foot remained in the same spot in my ribs as it had been for the last 2 months of my pregnancy. I was exhausted. I was very ready for a c-section.

After Megan was delivered (the epidural never did work so I was anesthetized), I was told that she was 2 pounds heavier than Charlie even though my measurements and weight gain had been the same. I was told that the opening she would have had to pass through was too small. I was told that she had never actually engaged in my pelvis and that was why she was able to rotate back after being rotated to a correct position. Finally, I was told that she had a 3 inch cone. I had pushed and pushed well but she wasn't going to come out without help. I am very proud of those 3 inches and also so glad I had ready access to high quality, obstetrical care.

The women in "A Walk to Beautiful" didn't have that sort of access. They were in labor for days, sometimes up to 10. Their babies died. They labored and labored and never got to meet a little person at the end of it. Worse, some part of the baby had pressed against the birth canal over and over with every contraction, compressing the tissue and slowly killing it. Eventually, a hole between the urethra and vagina and/or the urethra and rectum opened. These women were then shunned. A hut would be built to keep them "from being eaten by hyenas" where these women would hope for death living a half-life of despondency.

Over time, the women suffering from fistulas in Ethopia can go to one of a precious few hospitals devoted to treating fistulas to get surgical treatment. They can cure 93% of the women and at least help the rest. This is a story worth learning about. The interview with the founder of Thee Addis Ababa Fistula Hospital in Ethiopia is an excellent introduction.

There is nothing quite like a bit of perspective at the end of what formerly seemed a very long day.

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