Birth Plan

B.H. James

1. Liz and Bill will attend their weekly obstetrician appointment on Wednesday afternoon, which will feel routine for both until Liz’s blood pressure reads high and Liz and Bill are ordered across the parking lot to the hospital where, according to Doctor One, blood pressure readings will be taken every half hour for two hours.

1a. Though Liz’s blood pressure will have been normal the week previous, it will also have read high the week previous to that, resulting in tests for preeclampsia that involve the drawing of blood and the collection of pee (Liz’s pee) in a can.

1aa. The can is more of a jug, a fact that fails to curb members of the medical profession from referring to it as a Pee Can, a phrase Bill will repeatedly use as a rather obvious pun.

2. Crossing the parking lot to the hospital entrance, Liz will call her parents and announce that “We’re going to the hospital now!” Her parents will respond that they are on their way. Bill will comment that Liz’s phrasing may have been a bit alarmist.

3. Liz and Bill will pass through the sliding doors unaware that it will be 117 hours before they reemerge.

4. Liz will be outfitted with a stunningly undignified hospital gown and an elastic “sleeve” designed to fit snugly around the belly and hold in place external monitors monitoring contractions and the baby’s heart rate but which, despite its design, will promptly roll into itself, focusing the total force of its elasticity toward the digging of an inch wide and sixteenth-inch deep ravine across the mid back.

5. The nurses (who, without irony, will be enormously supportive and abundantly competent) will struggle with placement of the external heart monitor within the sleeve so that it continuously picks up the baby’s heart rate. It keeps slipping out of place, or the baby moves. This will become a theme.

6. Based upon blood pressure readings, blood work, and pee, Doctor One will instruct the nurses to admit Liz for the night, induction to commence first thing in the morning.

7. Liz’s mother, Ellen, will not only be on-site for the delivery, but will spend most of the next 100 hours in the hospital, as well as driving to and from Stockton a dozen or so times, delivering meals and providing the voices of reason, experience, and comfort.

8. Liz, now attached via cord or tube to three different machines, will try in vain to sleep through the night on a bed presumably designed to torture enemies of the state via the early onset of chronic lower back pain (even worse than the recliner Bill will be confined to for the next several days), rolling herself and her pregnant belly from side to side as much as possible, enduring every five to seven minutes the re-arrival of the nurse to readjust the slipped-out-of-place fetal heart monitor in its ravine-digging sleeve. The night nurse (again, enormously supportive and abundantly competent) will comment that given the difficulties with the monitor and sleeve, the doctor will likely order the application of an internal monitor consisting of a tiny corkscrew inserted through the you-know-what and stuck into the baby’s scalp, an order that indeed will be given around thirty hours later but abandoned when the doctor can’t work the little lever thing that releases the corkscrew.

9. Intravenous pumping of Pitocin (intended to induce labor by effacing and expanding the cervix) into the bloodstream will begin promptly at 7AM on Day Two (Thursday).

10. Liz will spend Day Two in deep discomfort—forced to remain in the former-torture-device of a bed, other than when using the restroom. When using the restroom, Liz must of course take her IV with her and must temporarily unplug the contraction and fetal heart monitor cords and wrap them around the back of her neck. This last detail—in a short story—could be seen as foreshadowing.

11. When the pain of remaining in the no-kidding-not-even-a-bed-more-of-a-random-collection-of-interlocking-parts-(one-of-which-happens-to-stick-up-right-where-the-normal-person’s-lower-back-is)-all-covered-in-a-thin-cushion becomes unbearable, Liz and Bill will begin periodically unhooking the monitors and walking around the room until a nurse shows up, then pretend that Liz was on her way to the bathroom. This will help a little but not much.

12. By the evening of Day Two, the intravenous pumping of Pitocin will have expanded the cervix from 1 cm to 2 cm.

13. Doctor Two, who is now on call, will—a bit ironically—give the patient who has spent the day having her pregnancy induced by IV drugs the advice to be patient and let nature run its course—“The baby will come when it’s ready!”

13a. Doctor Two, though female, will be shaped a bit like Super Mario and will be forced—when performing doctor stuff like pelvic exams—to hop up and down from the bed, a maneuver that fails to alleviate but rather accentuates the torturous effects of the torture bed on the lower back.

13b. Liz, who by now is finding being hooked to numerous machines, wrapped in a ravine-digging sleeve covered by a flimsy-and-not-quite-completely-a-garment hospital gown in a small square room on a torture-device bed being poked and prodded by hopping Super Mario doctors who when asked are unable to even speculate as to how long the induction at hand may take, to be all a bit claustrophobic, fails to find Doctor Two’s ironic yet enthusiastic advice comforting or helpful.

14. At 8 pm, Doctor Two, despite her apparent trust in nature and its course, will hop onto Liz’s “bed” and without warning use a crochet hook to break her water. When again asked, given this turn of events, for a timeline, or an opinion of any kind as to one, Doctor Two will respond as before.

14a. Once Doctor Two hops down and departs, the new night nurse—Heather—who is also a midwife and is from South Africa and therefore has a South African accent and who apparently prefers to remain relatively silent until doctors—or at least Doctor Two—are out of the room, proceeding then to share her expertise—at times in contradiction with the doctor—or at least Doctor Two—with her patients, will inform Liz that now that her water is broken the cervix should begin expanding at around 1 cm per hour, also informing Liz that what had failed to be mentioned was that the effect of the Pitocin on the soon to arrive contractions would be contractions that unlike those described in birthing class would not rise and peak and fall and after a declining period rise and peak and fall again, but rather would begin at peak level and stay at peak level and follow fairly closely one after another and therefore it is recommended—given the Pitocin—that the patient have an epidural. Bill, having been trained by reality television that anyone with a British-like accent is an expert and is to be blindly trusted, will nod vehemently in agreement. Liz, after enduring the first handful of the as-described-by-Heather contractions, will agree as well.

15. Liz will endure thirty to forty more minutes of the aforementioned contractions waiting for the anesthesiologist. Bill (recorder of this plan) will be forced out of room (thus limited details) in the process of which Bill will leave his phone, which will ring during the procedure, causing the anesthesiologist, who will be a bit testy, to shout at Bill in absentia.

16. By around nine, with the epidural in effect, it will seem as if “smooth sailing” were in order: the Pitocin continuing to expand the cervix at about one centimeter per hour. This smoothness will disappear around 3 am when with each measured contraction on the monitor screen the baby’s heart rate begins to drop noticeably, an occurrence the nurses will attribute (probably) to a wrapped umbilical cord and which happens all the time and not to worry because they’re keeping an eye on it.

16a. The next 4 hours or so will be one long montage of staring at the monitor screen and watching the baby’s heart rate drop and then pick up and drop and pick back up again.

17. Shortly before 7 am, Doctor Two—her shift ending in mere minutes and having just failed in her attempt to work the little lever on the corkscrew internal monitor—will call for an emergency cesarean section. Doctor One—her shift beginning—will arrive to perform the operation, as will an anesthesiologist and two more nurses and all of these people will begin talking really fast at the same time to make sure the preparation for the c-section is appropriately scary and stressful. Ellen, Liz’s mom, will be kicked out, Liz will be wheeled away, Bill will be handed scrubs and told someone will be back in one minute to take him to the operating room.

18. 20 minutes later, a nurse will come to the delivery room where Bill has been pacing back and forth and lead him to the operating room where everything will be blue, including Liz’s lips, and Liz’s skin will be pale, and her eyes will look foggy and she’ll say she can’t breathe, the spinal tap having had to be given much higher up due to her scoliosis, keeping her from “feeling” her lungs, and when Liz says to the anesthesiologist, a man named Dr. Catz who seems like a nice man but who likes to grab things, that she can’t breathe, Dr. Catz will grab the oxygen mask and pull it off of her and say “How’s that,” and then grab Bill by the shoulder and say “look at that,” and Bill will peek over the curtain spread in front of Liz and a flurry of activity in the middle of which Bill will see his son’s head emerge with the umbilical cord wrapped around the neck just as Doctor One says, “Cord is wrapped. Three times,” and Liz will ask something like “Did you see him?” and Bill will look down at Liz and then look back over the curtain and see Doctor One pulling at his son’s head, the cord gone and the neck stretching, then blur, blur, blur and the baby will be out and be blue like the room and someone will carry him to the table and Liz and Bill will watch and he’ll start to cry and Liz will start to cry and will ask the someone if he has all his fingers and toes and the someone will laugh and say “Yes” and the baby will suddenly not be blue and Liz will look at Bill and Bill at Liz and they’ll be parents.

Author Portrait

B.H. James is the author of Parnucklian for Chocolate and co-author of Method to the Madness: A Common Core Guide to Creating Critical Thinkers through the Study of Literature. He holds an MFA from the University of Nebraska-Omaha and teaches high school English in Northern California, where he lives with his wife and two sons.

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