Two hours after surgery, my legs are swollen, like two overstuffed sausages straining at their skins. It's 4 a.m., dark and quiet on the ward, but inside my room, all the lights are on.
Hiiiissss. Whoooosh. Whirrrrrrr. The IPC—intermittent pneumatic compression device—is a constant, mechanical hum. Nylon cuffs, wrapped snug around my calves, inflate and deflate like a heartbeat.
I am starting to feel again: the scratch of velcro, tingly big toes, fresh stabs of air into my lungs. The hot sheath of my torso throbs with every movement, cough, or breath.
I lie flat on the hospital bed, waiting. Waiting for more sensation to return.
Pain is a good sign.
When you can stand up, they tell me, you can go see your daughter.
A nurse hands me a miniature white paper cup and I swallow two tablets—ibuprofen, Panadol—but refuse the bright green and yellow capsule. She puts her hands on her hips and screws up her mouth with concern. No, I say firmly. No matter what she insists, I’m sure that the opioids will end up in my breastmilk.
Two translucent plastic bags hang from a hook at the top of my bed, pushing clear viscous fluid down a thin tube attached to my elbow crease. I watch the drip chamber, counting the drops, while I wait for Kether to get here. He took the baby when I was wheeled from recovery to the postnatal ward. They pointed out the Neonatal Intensive Care Unit as we passed. Several hallways, two corners, and three sets of swinging double doors away from me.
When you give birth by caesarean section, you don’t have to share a room with anyone. However, the constant stream of people buzzing in and out of the door in the hours that follow surgery make sleep or any kind of rest impossible. It's not always a bad thing. When I answer a question and my voice rasps, someone appears with a lemonade ice block. It is, in that moment, possibly the best thing I have ever tasted.
The room they've given me is big. Sterile and non-descript like you’d imagine, but with a blue vinyl armchair and a large window. Outside, it’s still dark and even though the curtains are open, beyond this room I can’t see a thing
HISTOLOGY REPORT
Lane, C
Delivery date: 25/01/2020
Gestational age: 36 weeks
Six months earlier, an ultrasound wand glided smoothly over my skin, swooping and twirling around my belly button like a skater moving over clean, unspoiled ice.
I squinted up at the grainy chaos on the overhead monitor to make out a shape like a small kidney bean. The wand nudged deeper, prodding at me from different angles and with increasing amounts of pressure. My bladder, swollen firm from the 1.5 litres of water I had gulped down earlier, protested loudly. I’d heard people sometimes pee right there on the table. Not me, I thought, as I groaned and gripped the vinyl sides of the exam table with my hands, feeling the satisfying crunch of waxy, sterile paper between my fingers.
Aha! The sonographer sung out. THERE we go.
This time, when I looked at the screen, the bean just floated up—the way a 3D image suddenly emerges from the mayhem of a Magic Eye drawing. A head, bulbous like a beluga whale, with four buds clubbed tightly at the ends. It trembled there, my live-streamed fetus, incomprehensibly real.
I watched the tiny body ripple then suddenly buoy upwards, like an astronaut moving in zero gravity.
Diagnosis: Single viable uterine pregnancy.
Every time my dad tells the story of the day I was born, he cries. He has told this story in the same way for my entire life.
When they pulled you out in surgery, you were completely blue, he says. I thought, well the baby’s dead, I hope Mary lives.
His voice always breaks on the word lives.
I grew up with the understanding that childbirth is something that can go horribly wrong, so I refused to create a birth plan. I didn’t want to jinx it. Kether admitted he preferred the hospital and I agreed, but secretly I imagined having our baby at home.
Four years before, I had been a support person when my friend, Lisa, birthed her baby boy into a plastic pool of water in their Berhampore kitchen. In between long intentional breaths, she groaned her way through eight hours of labour. At one point in the final stages, she clamped her jaws down on my hand, gnawing on my knuckles as she rode several waves of pain.
I wouldn’t have described what I saw as easy. The crimson crescent moons her teeth left tattooed on my hand spoke to that. Yet, I was inspired and elated. At the height of her labour, my friend went someplace else. In those wild moments when her pupils dilated out, entirely eclipsing her hazel eyes, there was also a sense of peace and composure at her centre. And I felt that too, somewhere inside me. An utter quiet, a deep trust. When she looked at me, it was like looking into the mouth of a dark cavern, her black pupils wide and endless.
Charlie was born after a series of short, sharp pushes. Less than ten minutes after he shot into the water, Lisa was up. She dried her body with a towel, got dressed.
We sat in the darkened room, one lamp glowing dimly in the corner, and marvelled at the new bub. As time stretched on, the intensity of the hours faded. Already, the events of the night before seemed so normal, even ordinary. And they were.
Women do this. We always have.
CLINICAL DETAILS
Fetal weight: 2,350 g / 5.18 lbs
Cord length: 75 cm
Completeness of placental disc: Pieces
A placental abruption is when the placenta detaches partially or completely from the wall of the uterus, robbing the fetus of necessary oxygen and nutrients.
I think the movements have stopped, I said to Kether.
I was eight months pregnant. We had recently returned home from our family bach in Ōhope, fresh off the buzz of our last infant-free summer holiday. It was 7 a.m. on a Friday morning, and we were up early, packing. The plan was to head over the Rimutakas to spend the day in the Wairarapa. Cape Palliser or Tora, we’d go wherever the surf was best. Kether would surf, and I would rest—lounging in the sun with my book, strolling on the beach, dipping my feet in the sea. What seemed like a great idea the night before, now felt frightening. Cell reception was patchy over the hill. Even though Keth didn't seem worried, my body tightened.
It’s probably just sleeping, he called from the kitchen. I didn’t feel reassured. I sat upright on the couch pushing my belly insistently, trying to provoke some kind of response.
A placental abruption is either revealed, with moderate to severe bleeding, or concealed, with little to no visible blood. In a concealed abruption, the blood gets stuck, trapped in clots between the placenta and uterine wall. Symptoms include abdominal pain, tenderness, severe backache, or significantly reduced fetal movements. Of these, I only had the latter.
And what’s significant? I wasn’t sure. At thirty-six weeks, I figured the baby was bigger now, with much less space inside to move around. A final scan done the week before showed the baby was occiput anterior—its back curved outwards towards my belly, chin tucked to chest, head snuggled down in my pelvis. Textbook birth position, the sonographer had said.
Yeah, I’m sure it’s nothing, I said, But would you feel?
We lay down on the couch together, our shoulders and heads propped up with pillows. I sat between his legs, and Kether put his hands on my belly. Let go, he said, tugging at my shoulders.
I sank back against his chest. His matter-of-factness and the way he sometimes downplayed my concerns could be irritating but if I'm honest, it also reassured me. Kether was a senior vet at a busy Wellington practice. Even in an emergency, his voice was measured and his hands steady. So after a long pause, when all he had to say was, Hmmmmmmm, I knew it was time to worry.
We live just around the corner, I beseeched the nurse. We’ll back in less than twenty minutes.
We’d been at hospital since early morning and it was clear I would be staying. I wanted my toothbrush, new contacts, a change of clothes. I wanted my hospital bag, the one we hadn’t gotten around to making up yet. Most of all, I wanted dinner. We promised to be quick and bring Indian takeaways back to the antenatal ward. The midwife on duty, willowy and tall with straight brown hair in a sleek bob, reluctantly agreed.
The plan was to spend the next three nights in the hospital so they could observe the baby’s heart rate. Every three hours, a nurse would switch on the fetal heart rate monitor attached to an elastic belt cinched onto my swollen belly. Two flat discs were stuck to my stomach and connected by cables to a large box with a digital screen parked at the side of my bed. The screen showed a continuous line graph, tracking the baby’s heart rate over time, displaying ever-changing numbers at the bottom right-hand corner in bright lime green.
Fluctuations on the line were healthy. Peaks and troughs were normal responses to the environment: movement, sounds, and the occasional squeeze of my Braxton-Hicks contractions. Like the tides, these changes were normal. The worrying part was the occasional moment when the tide only pulled one way, when something held the natural swell of the ocean back, when the heart rate would drop and the numbers on the screen went bold and started to flash.
REASONS FOR EXAM
Maternal Indications: Placental abruption/unexplained bleeding
Fetal/Baby Indications: Unknown
Placental Indications: Anomalies. Noted below
One a.m. I was curled over a pillow like a turtle tucked in tight. I felt the cool, dry scratch of paper everywhere—paper gown, papered table, paper slippers on my feet—except where the gown was untied and open to expose my back. There was a sharp pinch and then a piercing-pulling sensation in the centre of my spine.
The needle is in, the anaesthesiologist said.
Cold fingers, like liquid metal, crept over my back. Someone took my pillow, helped me lie down. They asked me to lift my right leg. I burst into laughter because even though I issued the order, nothing happened. I couldn’t stop laughing. My eyes overflowed, wetting my cheeks. It was absurd. They pricked both of my legs in several places with a spare IV needle. Nada. There was nothing to feel.
I knew precisely what was happening. I wasn’t squeamish, I had done my research. I could have directed the scene. A precise horizontal slice through the fatty wall of my abdomen, the fascia hauled upwards with stainless steel retractors towards my head and downwards toward my pelvis, rushed fingers digging deep, pulling my abdominal muscles apart like curtains to reveal the pink, plush pocket of my uterus.
There was more and I dully sensed the action, but felt nothing.
It was a Saturday morning, 1:11 a.m. on Chinese New Year, when my daughter emerged abruptly into the world. After a long day of escalations at the hospital—acute assessment, antenatal admission, birthing suite—someone had pushed the big, red button. Bodies in blue emerged from everywhere and darted around us. A quick slice had splattered Keth across the face with blood. He kept that cheek turned away from me, smiling with his eyes over the paper mask covering his mouth and nose. When the frantic tugging finished, she was thrust high above the green surgical drape and held aloft for three shining seconds. Triumphantly. Like a prize.
My daughter was born by emergency c-section, cut out of my belly at thirty-six weeks. I never got to experience labour and although it might sound insane, I regret that. Surgery is just too neat. There’s no pain, no sensation at all, nothing to signal that life will never be the same. Surely this should be something you can feel. She was here, and I was numb.
They laid her on my chest. I couldn’t move my arms so Keth held her there, gently with both hands. I imagined the warmth of her quivering skin. I thought she would feel wet and slippery, covered in that waxy varnish. She looked straight at me, her eyes glossy, dark pools. A pair of arms reached in, took her away. It was then that I felt something.
I couldn’t move, but something surged inside me and extended towards my daughter, like the frond of a fern unfurling. This frond was ferocious—it burst up towards the ceiling, bent its delicate tip like a periscope searching, and shot towards the exam table to grab the child, drawing her back to her centre.
Which was me.
PLACENTA
The specimen was torn on one edge, into two pieces.
The umbilical cord was attached marginally and the attached portion
of cord was severely over-coiled with thirty-six turns, giving an increased
coiling index of 0.65 (well above expected range (0.1-0.3)
A placenta is created by the embryo. It develops from cells that originate in the fertilised egg, meaning that genetically it is part of the fetus. However, when the placenta embeds itself into the endometrium, it reshapes the existing maternal blood vessels and begins to interact directly with the mother’s uterine cells. The result is a hybrid, shared organ. A placenta is a mutual venture between mother and child.
A placenta looks like a thick, round pancake and has a dense, spongy texture. The baby’s side is sleek and smooth with blood vessels that branch out widely. It really does look like the tree of life. The other side of the placenta is rough and bumpy where it attaches to the mother’s uterine wall.
The older, more antiquated term for placenta is 'afterbirth'. The etymology is as literal as it sounds—just like the associative meaning: linguistically positioned as secondary to the main event and considered disposable. The afterbirth is what's left over, and in most western hospitals, incinerated as medical waste. In our case, the placenta become the locus of pathology. A search was deemed necessary to figure out what went wrong, to assign a cause to my complications, to explain the organ's failure.
In the care plan with my midwife, we requested that our placenta come home with us. We wanted to bury it in the large terracotta pot on our deck, let the remains nourish the growth of something new. A lemon or feijoa tree, we thought.
A few years after Zoe's birth, I learned that the word for placenta in te reo Māori, is whenua, the same word that is used for land. In traditional Māori custom, the placenta of a newborn child is often buried on their tūrangawaewae, the land of their birth or ancestry. I better understood my longing to have our placenta back, the seemingly random impulse we had to put it in soil. It was a gesture, a ritual, a circle that would feel completed.
Our placenta came out in two pieces, one large cushy pillow and one jagged finger of tissue—a remnant from where it had wrenched off the back wall of my uterus. With a high posterior placental placement, the small abruption was hidden until an obstetrician asked to do a pelvic exam when I first arrived at the hospital.
She pushed one finger into my still-tight cervix to check dilation, which fired shafts of pain through my pelvis, strong enough to provoke my perfectly positioned fetus into abrupt movement, resulting in a complete change of placement. That's when the bleeding started.
At the time, the doctor said the blood was normal, routine even after a pelvic exam. Later, when they prepped me for surgery and discovered the blood sitting in thick clumps and long strings inside my vagina, they used the word emergency out loud. Several times.
Why did this happen? I would later ask the doctors, the nurses, the midwives, the specialist consultants who moved in and out of my hospital room over the first few days. With no definite answer, everyone pointed to the same numbers on my chart—the numbers following the letters D.O.B. A woman in a white coat shrugged when she told me, We know placentas degrade faster the older you are. The line of interns behind her nodded knowingly as they filed out of the room.
I’m sure there’s truth to this, the biological disadvantage for mothers over forty. Yet age brings advantage too. I wonder if my younger self—the one more invested and engaged outwardly in the world, the one who hated slowing down or missing out on things, the one attached to my professional identity and consumed by my work—would have noticed this kind of subtle complication, picked up on the clues that something was amiss, and be willing to say something, in the way my forty-two-year-old self did.
It’s easy to dismiss what we feel because we worry we might look foolish or make a big deal over nothing.
There isn't much to send back, the technician explained on the phone.
The organ had been dissected, chemically fixed, sliced paper thin, embedded in paraffin wax, and stained with dyes.
It's not the kind of thing you'd really want to put in the ground, she said gently.
PLACENTA, CONT
The fetal surface was smooth and glistening, grey-blue in colour.
The fetal vessels showed a normal pattern and appearance.
The maternal surface, however, was ragged and irregular,
and completeness could not be assured.
The week before I found out I was pregnant, I had a dream that I died.
I wasn’t really worried. I knew that dreams about death didn’t necessarily mean you were dying, or that anyone else was. I had read that death in a dream meant a part of you was being transformed or transmuted. Something edgy and sharp fluttered inside. That unsettled feeling stayed with me until I got the positive pregnancy test. Then, I understood.
I wasn’t going to die, but everything was going to change.
I'm not sure how to even consider standing up.
Kether bends down towards me. Here. His mouth brushes against my ear. Wrap your arms around my neck. I do and he stands slowly upwards, hauling my body up with him. My eyes immediately spill over. His strength, my helplessness, this new kind of intimacy. The room wobbles for a minute and the flash of pain makes me gasp, but I am standing on my own feet.
This time, you can take the chair. But next time you will walk down, the nurse says.
She sees the look on my face and shrugs. Take the tramadol, she says.
Keth wheels me through the heavy swinging doors of the NICU, then into a large room right next to the nurses’ station. The room is lit softly. A steady rhythmic beeping mingles with soft whooshes and the sound of something ticking in the far corner.
He rolls my wheelchair over to a rectangular box with high clear sides. Inside, a small baby is sleeping. A handknit beanie covers a flush of damp black hair, her fingers are curled into a soft fist at her mouth. Under the cerulean blue UV lights, with a slim tube in her nose, there is a perfect tiny human.
My hands start shaking and I clutch at my chest, diaphragm spasming. My body convulses in silent sobs that tug painfully at my sutures. Keth steps closer. He moves his mouth at me. I see that he’s speaking, that he wants to reassure me, but I’m underwater and there's a loud rushing in my ears. I can’t hear him, can’t hear anything—and anyway, I don’t need it, not that kind of comfort.
I know the baby is OK, that she’s going to be just fine, but I can’t talk, can’t explain, can’t tell him what it’s like. To see this baby—my perfect tiny human, my daughter. Lying on her own. Separate from me.
All I can do is shake my head, lift one hand into the space between us, and wave it raggedly back and forth. He gets it, nods slowly. He stands behind me and places his warm, heavy hands on my shoulders. I sink. We breathe.
We just breathe.