The nonchalent way Dr. Russell said “It’s time to start pushing” really caught me off guard. Even though we’d been given that extra time, and even though Sari had finally fully dilated, I was still very much anticipating that a C-section was imminent. After all, as far as I knew, the baby was still “malpositioned,” and Sari still seemed in a passive state of her labor. But I figured Dr. Russell wanted to give it the ol’ college try. She even made us open the room’s shades, letting in the late afternoon light to create more of an “active environment.”
So Sari started pushing. At first she wasn’t really “feeling it,” and with Dr. Russell and Gabriela coaching her, she had to learn how to push on the job. Basically, every time she saw a contraction coming on the monitor, Dr. Russell would tell Sari to hold her breath, tuck her chin, and push as hard as she could. Then, when Sari couldn’t push any longer, she had to take a quick deep breath and go back into the next one. Each push was supposed to be harder than the last, and the third one was supposed to be the hardest of all. Usually, by then, the contraction had passed, and it was time for a short rest.
During all this, Gabriela stood at Sari’s shoulder, whispering words of encouragement and looking into her eyes, holding her gaze, keeping her focused. I stood down at the base of the bed, helping to hold Sari’s leg back, and piping up when I thought it was needed, either repeating Dr. Russell’s pushing commands or just cheering Sari on.
For the most part, Sari was very quiet and responsive to our commands. In other respects, she was gone, totally focused on the job at hand. She gritted her teeth, pushed hard, and only occasionally let out an animal noise or straining grunt at the end of a push. Dr. Russell kept reminding her the exertion was in her bottom — not her face, not her neck — and that really seemed to help Sari locate and localize the pushing.
For my part, I still wasn’t convinced this was leading anywhere. Dr. Russell seemed so laid back, blasé almost, and her voice was so low, I really thought she was just letting Sari push for a while so we could say we tried before she had a C-section. She even occasionally left the room, leaving the three of us, and sometimes one of the nurses, to keep pushing by ourselves.
Slowly, though, things began to shift, and I started to think that maybe this was for real. For one thing, Sari started directing the pushing more on her own, and she also started wanting to change positions. Over time, she shifted from her back to all fours, then on her left side, then on her right, and then back to her back. She was becoming much more of an active participant. And as the epidural wore off, she was feeling more contraction pain — but also much more of a pushing urge.
Then things began to move very quickly. Sari was on her back and I was on her right side, providing counter-pressure as she pushed against my hip. The door to the room was open, and I could hear people milling around outside, talking and laughing. I thought Sari needed more privacy, so I asked Dr. Russell if I could close the door. She gave me a withering look. “No, I need that door open. This is a big baby, and if its shoulders get stuck, I’m gonna need like six people to run in here to help me out.” Wha—?! So obviously Dr. Russell was seeing some progress when she looked up there.
That little exchange and the fact that they kept moving the monitor further down Sari’s belly finally convinced me that the baby was really on its way. And Sari seemed to feel it too: her pushes were stronger, longer, and more intense. And she was really directing the pushing. Sometimes, even when Dr. Russell would tell her to take a rest, she would just go back at it. She was simultaneously worn out and completely determined to keep going. Again, I realized just how tough she was, and was amazed by what seemed like her limitless reservoirs of strength. I braced myself for the sight of my child coming out.
Suddenly, at the end of a long push, one of the other doctors in the room called out that they could see the baby’s hair. Sure enough, I could see it too, and after some more strenous exertions, a tip of the baby’s head appeared. “Push, don’t suck!” Dr. Russell exhorted Sari, and the head, after disappearing for a sec, reappeared, this time for good. I knew we were in the home stretch, and I told Sari that I could see the head, that she was doing it. She just moaned — and kept on pushing.
From then on, it was just a good half hour of pushing as the head kept coming. Dr. Russell asked Sari if she wanted to reach down to feel the baby’s head, but she couldn’t do it. It was too scary for her to think what was actually coming out of her. All she knew was she needed to keep doing it. Suddenly I realized that I had taken over the role of coach, guiding Sari through the pushes, reminding her to stay relaxed, to keep her chin tucked, and when to rest. I just kept telling her what a great job she was doing, and that soon we were going to meet our baby.
Dr. Russell walked out again, as we kept going, and she reappeared in her gown, trailing an ominous looking cart. She pulled over a low stool, stationed herself between Sari’s legs and started clipping various tools — forceps and such — to the front of her gown. She pulled back the cover on her cart, revealing more intimidating implements, none of which I wanted to think about. Then she explained to Sari that we were almost there, that Sari just had to push through this last, hardest part of all, the “ring of fire,” and then Dr. Russell would be catching our baby.
It was hard for me to see how much pain Sari was in during this last set of pushes. But I could see the result. And Sari knew there was no turning back. She had to get that baby out. Push! Push! Push! As I held her leg back, she was pushing so hard against me I almost fell down and had to grab onto the bed. Counter-pressure to her counter-pressure! And the baby’s head kept coming out, bigger and bigger. Out of the corner of my eye, I noticed the room had quietly filled up with people: nurses, other attending doctors, and residents.
Then, with one last superhuman push, our baby popped out and slithered into Dr. Russell’s arms — along with a rush of greenish amniotic fluid. There she was, an exquisitely formed little person, pink and perfect and covered in green goo. I couldn’t believe it. There was a flurry of activity as Dr. Russell expertly flipped the baby upside down, clamped and cut the cord, and handed off our child to one of the other doctors. During all this I somehow managed to see — and shout out — that our baby was a girl.
Two other doctors had the little one on a small table where they began wiping her down and cleaning her, inside and out. It was amazing and heartbreaking to see how much they manhandled her, pounding her little back and chest, suctioning her mouth, swabbing out her ears, cleaning her eyes, and running floss into her nose (in one nostril and out the other). Dr. Russell explained that because the baby was born with meconium, it was vital for them to clean her up, to make sure none of it got into her mouth, eyes, ears, lungs, or stomach. And the strong cries the baby was making were a good sign that she hadn’t ingested any.
Meanwhile, I was alternately crying, shouting, and looking back & forth from Sari to the baby. Poor Sari was being cleaned up herself, as well as being stitched up. At last, they had the little one cleaned out and toweled off, and Sari was finally able to hold her to her chest. Incredibly, after that long ordeal, Sari was totally present and back to herself, and Gabriela was there to help her with the baby’s first latch to her breast.
As the room emptied out and we were left alone together, I thought back on the last incredible 38 hours, and how we had all worked so hard for this result. All these long months, I had had trouble really imagining our baby. Not knowing the gender didn’t help, but even so, I just never let myself think of it as anything more than a proto-baby, a possibility of life and not the certainty of one. Definitely not this beautiful, delicate, fully formed little person.
As I hugged Gabriela and thanked her for all she had done for us, I admitted that I had been scared beforehand, not knowing if I would have the stomach to see my baby coming out. I had no idea how beautiful an experience it actually is, how it’s the farthest thing from scary or disgusting. And Gabriela laughed. “Ha! Men are so silly! That’s always what the husbands say!”