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Birth Story

Our first child was born in an idyllic situation, with no intervention, in a little house by the beach, and with just a few people we knew and trusted at our side.

 

We wished for a similar birth for our second child.  However, when I was about two months pregnant I decided to use a grant from the Organization of American States to participate in a graduate program, hosted jointly by CATIE, and INCAE, two Costa Rican research institutes.  My husband would be taking care of our children and, as the director of CATIE told us, with inexpensive housekeepers in Costa Rica, it might actually be easier to have a newborn there than in the U.S.  The recruiter from INCAE also insisted I would have plenty of free time for my family, and that having a baby while in the program should pose no problem.

 

The first month of the program was at CATIE, and all went as expected.  The next eight months were to be at INCAE, and there things were not as expected.  Classes kept us busy all day and projects required we attend our study group after dinner until late at night, every weekday, and many weekends.  Perhaps because I was absurdly busy, instead of truly taking full responsibility for our daughter’s birth we put significant trust in professional advice.

 

Conveniently, the campus doctor was able to check my blood pressure and weight and measure my belly each week.  We chose a local midwife who was both university educated and also trained at the El Paso (Texas) midwifery school famed for its rigor.  When Miriam was in a breech position at 34 weeks, our midwife told us she was not trained in breech presentation so we started looking for a different birth attendant.  A local doctor, who does attend breech births, even at home, would be away on Christmas vacation.  We found another, Dr. Arcia, in a town that was about 3 hours away. Our emergency backup plan was to go to the local hospital, where I would probably receive a C-section, unless the on-call physician was over 50 years old.

 

We made plans to move to a hotel near the doctor’s clinic.  Because it was Christmastime, transportation was hard to find.  To confirm Miriam’s breech status we had had a very late ultrasound, which reassured us that we would arrive about 8 days “early” at the hotel and since our son had arrived two weeks “late,” we were not desperate.

 

Miriam arrived 9 days “early.”  That night we had dinner with friends, at our house.  A little after 10 pm our friends went home.  Soon after that we went to bed.  Some time after midnight I was woken up by a sudden and curious small pain in my side.  About ten minutes later I felt another and I woke up my husband.  I took a short walk outside and suddenly I felt an intense rush that was very painful until I moved to my hands and knees.

 

After a second or third contraction, that each time brought me onto my knees I walked toward the street. A taxi had arrived, called by the campus guard. The taxi driver said he preferred not taking me, and I agreed that I needed an ambulance. The guard called one.

 

I made my way slowly back to our house, and to our bathroom, pausing for another contraction or two.  I believed I would have diarrhea.  Once on the toilet I realized I was giving birth.  I told my husband and he ran outside and yelled to the ambulance workers to hurry. I told Miriam that I was impressed that she was moving so quickly, and that in a breech birth she must not go slowly.   I moved from the toilet onto my hands and knees (a preferred position for breech birth) and set myself to remember the few instructions I had heard from the Internet, Dr. Arcia, and from a woman who had borne breech.  My husband came in and saw that Miriam was out up to her hips and kicking her little pink legs.  He caught her and wrapped her in a blanket.  It was 1 in the morning and the bathroom was cold.  With one more contraction Miriam emerged up to her chin into my husband’s hands.

 

Right then the ambulance doctor walked in.  I saw that the doctor was very young, and that she was in a terrible panic.  Her driver was looking at her strangely, as she entered the room yelling, “Stop pushing.  Move to a bed.  I need to operate!”

 

I could see the doctor very clearly, and saw that she was not completely in her right mind, and asked my husband not to let her touch me. We later found out that the doctor misunderstood the situation and thought Miriam was “stuck,” and also had assumed that Miriam had been “stuck” since we called the ambulance, 20 minutes earlier. She never asked a single question.

 

When we didn’t comply she yelled “SOY DOCTORA” and pulled the blanket off Miriam, while my husband tried to explain the importance of keeping her warm.  Then she elbowed my husband painfully in the ribs then grabbed Miriam from him. At the moment the doctor grabbed her, Miriam showed her fear by stretching out her little arms and legs (in the moro reflex).  This is the moment that my husband most regrets, the moment when he gave his power, and his baby, over to the doctor.

 

I told the doctor not to cut me.  I told her that I could no longer resist pushing, and, reaching around and placing my own thumb in Miri’s mouth, I tried to show her how to put a thumb into a baby’s mouth to tuck her head, to protect her neck while I pushed (a common maneuver to help a breech baby).  The doctor paid no attention and instead while I pushed, she yanked and chopped.

 

The doctor must have used just her one free hand to chop at me.  Her scalpel was such as one uses in high school biology (we still have her tool).

scalpel.websize

During the doctor’s “operation” Miriam stopped kicking and when she emerged she had turned from pink to ashen.  The cord was healthy and still pumping, (and had not been around Miriam’s neck) but the doctor ignored my weak plea to wait to cut it.  Nor did she give me nor my husband the baby to hold.  She seemed unaware that newborns need warmth.  Even if she had missed that detail in medical training, it is strange to us that she wouldn’t have the human instinct to wrap up a baby.

 

I am not clear about what happened after that, as the doctor had injured me greatly, and I was in some amount of shock.  I am not clear about how the placenta came out.  Did the doctor yank it out? We left on two separate stretchers in a little van for the hospital.  I watched my little girl, left naked , except for a bit of foil blanket which was not wrapped, and so it flew off as the van moved.  The doctor blew into her mouth a few times but not in the usual neonatal resuscitation way. I wanted to ask the doctor to give Miriam skin to skin contact, but I was weak and couldn’t find words.

 

Upon arrival at the hospital the ambulance doctor fainted.  Miriam looked dead, and her heart rate was low.  Because we are opposed to heroic medical intervention, my husband asked the hospital to let her die in peace but instead they used a cocktail of drugs and intubation and revived her.  Meanwhile, an older, experienced surgeon, Dr Lobo,  gave me 52 stitches to try to repair what he said was “an illogical cut.”  “Quien hizo eso?” he chanted as he sewed. The ambulance doctor had not given me a regular episiotomy.  In her panic, she had chopped off a portion of my inner labia and then cut deep into my perennial muscles, into my gluteus muscle, close to my rectum.  Dr Lobo suggested that Costa Rican Social Security would pay for plastic surgery.

 

Because I have a history of unusual reactions to it, I didn’t want anesthesia.  My husband’s hand has tiny scars where my fingernails dug into it during the sewing.

 

Because it was Christmastime, this young and  poorly-trained doctor had been replacing more experienced paramedics, due to the vacation.  The young doctor confessed her mistakes to her boss and quit her job a few days later.

 

The medical director Dr Gina Goldoni of the ambulance company, Emergencias Médicas, said she was so sorry she hadn’t been on call, or one of her other colleagues, and that we just had bad luck to get an inexperienced and young person. She was so sorry that the ambulance had ever come–she knew well from personal experience and a residency she had done in obstetrics that non-interference is almost always the best thing in birth, and that vaginal breech birth is no reason to panic, or to pull.

 

The medical director’s honesty has been an enormous comfort to us.