Cutting Ties and Letting Go
By Lori Sebastianutti
Lori is a writer and teacher from Stoney Creek, Ontario. She is the former managing editor of the Fertility Matters Canada blog and her most recent work appeared in The Hamilton Review of Books. You can find her on Twitter @sebastianl74 and on Instagram @sebastianlwrites and can read more of her work at lorisebastianutti.com.
There were two men in the room when I got pregnant – one holding my hand and the other at the base of my stirrup-bound feet. A woman pressed a cold ultrasound wand on my lower abdomen and another man passed a catheter through a small window from an adjoining room. It wasn’t the most romantic setting but no less miraculous.
I got pregnant with my first child after seven and a half years of trying, and multiple in vitro fertilization (IVF) procedures. The reproductive endocrinologist (RE) who helped us achieve this feat was not the first one we saw, but we wanted him to be the last, so we stuck through four years and five IVF transfers before we saw those coveted two pink lines.
After our 12-week ultrasound, we got his clearance to have our care transferred to an OBGYN.
“Can we stay with you?” I asked.
I knew that in addition to performing fertility procedures he was also practicing obstetrics. It had been painful seeing pregnant women exit examination rooms while I left with a flat belly and hundreds of dollars’ worth of fertility drugs.
“Sure,” he said. “But your baby will be born at Joe Brant.”
I tried not to let it bother me that my child would be the first in a family of Italian immigrants who settled in Hamilton, Ontario to have “Burlington” listed as his place of birth on his birth certificate. I didn’t want to start over with someone new, not after we had come so far. Would a frightened child let go of their parent’s hand in a crowded room?
The pregnancy would be marked by two distinct features: hyperemesis gravidarum and anxiety. I refused to take medication for either and I simply “pushed through.” Round-the-clock nausea and vomiting relented at 20 weeks, but the anxiety persisted until the day I gave birth and beyond. At every turn during those 40 weeks and 5 days, I thought something would go wrong. Was I really going to be a mother after eight years? Wast this just a cruel joke? I was convinced that one day I would wake up and realize that it had all been a dream. I would be back on the other side of the window, face pressed up against the glass watching all the mothers rock, nurse, and care for their precious babies.
But it was real and I wanted to be as prepared as I could. My husband and I took two birthing classes — one offered by the hospital and the other by a doula who had been my counsellor during the last two years of my infertility journey. A specialist in hypnosis, she tried to help me uncover any barriers that were preventing my body from achieving pregnancy. The medical diagnosis of “unexplained infertility” had done nothing to provide answers, so for two years we worked through affirmations and visualizations, and she listened to me cry when yet another friend or a family member became pregnant with ease. Now that I was on the other side, I wanted to work with her during her hypnobirthing classes to support the mind-body connection during the birthing process.
While I did my best to absorb the myriad of information presented in both classes, the only true goal that I had for the birth of my first child was to deliver him vaginally. Infertility had robbed me of so much — the chance to follow a projected timeline for my life, the opportunity to fit in with my peer group, and most significantly the ability to achieve a spontaneous conception. With a vaginal delivery, I hoped to witness the power of my body in a way that women had been experiencing for millennia. I was, however, open to the idea of a C-section if it was deemed medically necessary. The health and safety of my child would veto any feelings about the way I hoped he would come into the world. I had full faith in a doctor who had given us the chance to be in this position in the first place. How could a miracle-worker steer me wrong?
At forty weeks, my doctor decided to schedule an induction. In five days, he would be on call and he knew how much I wanted him to be the doctor to deliver my child. He had been there when my son went in, and my husband and I wanted him to be there when he came out.
The day before the induction, he had me come to the hospital to have progesterone gel applied to encourage dilation. The next morning my cervix was measured at 1 cm and I had antibiotics administered through an IV as I had tested positive for Strep B. After a sufficient amount of time, my doctor broke my water, and a nurse started the Pitocin drip while my husband, my mother and I waited for contractions to begin.
Begin, they did. From the outset, they came fast and furious, not slow and controlled as I had learned in my birthing classes. Almost immediately I felt as though my insides were being squeezed so tight that I thought I might explode and fall into pieces on the hospital floor like a popped balloon.
Despite my constant pleas for an epidural, I was told that the anesthetist was in a complicated surgery and since he was the only one on call, I would have to wait. For the next five hours, I cried, screamed, and threw up until he finally walked through the door.
“I bet you’re happy to see me,” he said. The tears rolling down my cheeks were my answer.
After two attempts to get the medication started, I lay in bed watching my contractions on a screen while feeling nothing but comfort. I took a short nap and when I woke to intense pressure on my bowels, I notified the nurse. She told me that she would call the doctor as this indicated to her that it was time to push.
I began pushing with the nurse holding one leg and my husband the other. When the doctor made his way into the room all suited up, he told me I may need forceps or vacuum extraction to help my son descend. Determined to avoid both of those scenarios, I pushed with all the might I could muster.
After an hour, my doctor told me I was going to need an episiotomy. I vaguely remembered the word from the birthing classes. I knew it meant my vagina would have to be cut to help my son’s head escape. It didn’t sound pleasant, but I trusted my doctor whole-heartedly.
“Okay,” I said between pushes.
After numbing the area with local anesthesia, he used a pair of surgical scissors to make a small incision to my perineum and posterior vaginal wall. My husband said he remembers a large squirt of blood escape like water from a burst pipe. With the next push, my son was out and eight years of struggle and heartache unleashed into a torrent of tears. As they were examining my son, and after I had been stitched up, I grasped my doctor’s hand and thanked him between sobs.
There is one word that characterized the days and weeks after the delivery of my first child. PAIN. I couldn’t sit, walk or move in any way without feeling a pulsating ache in the most intimate part of my body. Nurses were changing shifts every 12 hours telling me to sit up and walk around. My small room was constantly filling and emptying of well-meaning family members and friends.
Emotional pain soon followed as I found breastfeeding next to impossible. The first 24 hours my son needed little nourishment, but as his appetite grew, my inability to relax and ignore the pain prevented any real progress. I asked a nurse for stronger medication than the extra strength ibuprofen and acetaminophen I was interchanging every four hours, but she told me it was “doctor’s orders”. Anything stronger would be incompatible with breastfeeding. My husband fed him his first bottle of formula as I looked on from the bed trying to ignore the large rock in my chest.
During one of my physical exams, a nurse told me my incision was healing beautifully.
“But I’m in so much pain,” I said.
She nodded. “It’s a small incision, but he cut through four layers of tissue. That’s why you feel it so much.”
After three days of regular Sitz baths and squirt bottle cleanings, we left the hospital with a thriving newborn. What followed was intense guilt and depression over the inability to push through the pain of my episiotomy and breastfeed my son.
One night while my parents were visiting, I quietly escaped to the nursery and tried to put him to the breast. He struggled to latch and began to wail. My mother entered the room with a small bottle of formula and passed it to me. As tears streamed down my cheeks, she asked what was wrong.
“I’m a failure,” I said. “I couldn’t feed him with my body.”
“Look at him,” she urged.
I looked down at my hard-fought baby with his round face, wide eyes, and pink cheeks.
“How can anyone who made him be a failure?”
In psychology, the term transference refers to the redirection of a patient’s feelings for a significant person to the therapist or doctor. When the feelings are overly positive it is called “God Syndrome.” This occurs when the doctor is overvalued and becomes a type of god in the eyes of the patient.
I didn't think of my RE as a god, but in my mind, he was a “miracle worker.” This allowed me to put all my trust in him. The medical community came through when I needed it the most, how could it possibly lead me astray?
The emotional wound left by my episiotomy took much longer to heal than the physical one. Eventually, I shifted my thinking, which allowed me to put more faith in myself than any medical professional. Now it was my turn to do the cutting.
When I turned 39, my husband and I were ready to try for baby number two. Knowing that time was not on our side, we switched doctors. I began treatments in a clinic with higher than average success rates for women over 37 who wanted to use their own eggs.
To our delight, I became pregnant after four months. This time when my RE asked me if I had any preference for my obstetrical care, I was prepared. I asked to be referred to a female team of obstetricians in Hamilton who rarely performed episiotomies, except in very particular cases.
With my second son, I only pushed for twenty minutes and had two surface tears that I barely noticed. His birth prompted further reflection that even though I may not have had an episiotomy if I had given birth at another hospital with a different doctor, it was okay. I choose to be gentle with myself knowing that vulnerability was a logical state for me to be in after an almost eight-year struggle to become pregnant.
I’m glad I got a second chance at giving birth. My first time didn’t turn out quite as I hoped it would, but it put in motion the long process of learning to have faith in an imperfect body. It’s still a work-in-progress, but I realize that I can be grateful to others and self-trusting at the same time. Today, I choose to see the divine in a mind that can decide for itself and a body that can work miracles.