Birthdays and Helicopter Rides

"You deliver like a Hopi woman." This is one of the greatest compliments I ever received. It came from a Hopi nurse, and was given to me after the birth of Anna, just a month after moving to Hopi in 2005. Hopi and Navajo women with low-risk pregnancies delivered their babies at the Hopi Health Care Center, and were prepared for natural childbirth. There were no pain meds or epidurals available there, and no obstetricians (it was staffed by family practice physicians). Women who might need pitocin or other interventions were transported to a full-service hospital, usually Flagstaff Medical Center or the Tuba City IHS hospital. Hopi women were known for being stoic and strong in childbirth, and I was determined to be the same.

And with the birth of Anna, I was. Everything worked out as I hoped it would. I delivered like a Hopi woman and walked home two hours later, holding my beautiful daughter in my arms. "Don't you feel empowered?" asked a neighbor as we walked past on the way back to our house. Yes, I did.

So when we found ourselves unexpectedly pregnant with our third child two years after moving to Hopi, I was confident I would be able to deliver like a Hopi women again. Way too confident, as it turned out. As we prepare for Eliora's birthday tomorrow and I remember what happened nine years ago, I feel deep gratitude and wonder for God's protection in the face of some really foolish decisions Luke and I made.

At my 13-week prenatal appointment, I struggled to control both my nausea and two rambunctious, noisy kids in the waiting room of the Hopi Health Care Center. When it was finally time to be seen, I put both children (aged 2 and 4) in a chair in the exam room, implored them to be still, and climbed onto the table. My blood pressure was mildly elevated, around 135. The doctor (and family friend) who examined me raised her eyebrows and remarked to another doctor walking by, "Do you see this blood pressure number? We'll have to keep an eye on it." I felt ashamed and conspicuous. Convinced that my elevated blood pressure was caused by the trying presence of my two kids, I decided that staying away from the health care center from then on would be the solution. I didn't want my pregnancy being seen as high-risk.

I never had another prenatal appointment. After all, my previous two pregnancies had been uneventful, and I was young and strong and living a great adventure. I was even married to a doctor, who would be able to notice and catch any warning signs. My life was stressful enough already. Why do something that would cause more stress? I planned to just continue being pregnant until I went into labor. Then, I would labor at home, with Luke or a doctor friend checking me, until I reached a dilation point of six. Then I'd go into the health care center, push the baby out, and walk home with her in my arms. After all, it had worked out beautifully when Anna was born.

As it turned out, Luke and I were shockingly good at ignoring warning signs. At around the halfway point of my pregnancy, I began having vision disturbances - bright auras that would grow to encompass my whole field of vision, often lasting for hours. Stress, we decided. One especially frightening aura began while I was taking the two children on a walk to the tree. It was so bad that I wasn't sure I could get them back, and was beginning to wonder what they would do if I collapsed in the middle of the desert. When I finally got home, I answered the phone to a company wanting to know my address so they could ship something to me. I could not remember it - the part of my brain that stored things like addresses was completely inaccessible. I was scared enough that I paged Luke and he came home in the middle of the day to give me a couple hours to nap and recover. Then he went back to work, assuring me that I was probably just having a migraine.

Every two or three weeks, our family would make a mammoth Saturday trip into Flagstaff to shop and do business. We loaded our car with all our recycling and our children, drove two hours through the reservation, spent the day loading up on groceries and supplies, then tried to make it home before dark. I began checking my blood pressure at one of the grocery stores we shopped at, and worried a little because it was always high - around 150. Luke wasn't worried, though. "Look at you - you're so stressed," he would say. "It will be lower when we get home." But we never checked it when we got home.

In retrospect, I knew in my gut that something was wrong, but I desperately wanted to ignore it. I didn't share my unease with Luke, leaning on his reassurance as proof that there was nothing to worry about. After all, he was a doctor, and he wasn't worried, so I was safe. Luke, on his part, was absorbed in his work (as the physician in charge of scheduling, he solved the problem of understaffing by slotting himself into all empty time slots), and it didn't occur to him that something could actually go wrong with me.

In the middle of the night at exactly 37 weeks, my water broke. Although the timing was inconvenient for us (my mother wasn't due to arrive for another week or two and there was nobody to watch the kids), I felt relieved that the miserable pregnancy was finally coming to an end. We called my parents, who began scrambling to rearrange their plans, then tried to get a little more sleep. Luke even went to work the next morning, promising to come home for lunch and take over childcare so I could labor in peace. It was a long morning, as I found it difficult to focus on both contractions and kids.

Finally, Luke returned home to check my progress. With him came Anna, a fellow physician and neighbor. Anna brought a blood pressure cuff. She was alarmed to find my blood pressure in the 150s, but I assured her it was only because I was stressed from laboring with kids all morning. Give me an hour to relax alone, I begged, and it would return to normal. Okay, she conceded, but Luke needed to check throughout the hour, and if it was still elevated, I had to come into the health care center.

It remained elevated, to my deep shame. I felt that I should be able to control it, and was bringing needless interventions on myself by my failure. I walked over to the health care center, where nightmarish things began happening. No longer low-risk, I couldn't deliver there any more. A helicopter transfer to Flagstaff Medical Center was initiated, and I was hooked up to an IV of magnesium sulfate, a horrid drug meant to both bring down my blood pressure and to stall labor until I could get to Flagstaff (I was only dilated to a 4, so I had a ways to go). I knew that as soon as I arrived in Flagstaff, an emergency C-section awaited me. I struggled to stifle my sob of disappointment and pain as Anna inserted a catheter. My dreams of delivering like a Hopi woman again were falling in shards all around me.

It wasn't long before I felt so wretched that I was just ready for everything to be over as soon as possible, even if that meant a C-section. The mag sulfate caused intense hot flashes, and my contractions were overwhelmingly painful. I was stuck on my back, which made the pain worse. I dreaded a helicopter ride in this state, especially without Luke by my side.

Suddenly, I was jarred from my misery by a familiar pressure. I instantly knew what it meant. Instead of stalling my labor, the magnesium sulfate somehow accelerated it. The intense contractions I felt had been transition, and I was ready to push. Luke ran out of the room to let Anna know, and all chaos erupted.

Magnesium sulfate is not good for newborns, so IVs were hurriedly ripped from my arms. Anna told me she didn't want me to deliver in the triage room, so I held back the urge to push while a gurney was rushed to my bed. I scrambled onto it and was wheeled into the delivery room just in time to thrust my baby out into the world.

For one wonderful moment in time, the chaos and nightmare ceased and Eliora drew her first breath. She was perfect: five pounds of scrawny, healthy, vocal personhood. (The pediatrician in Flagstaff later told me that mag sulfate babies were usually floppy, but not Eliora. She was alert and feisty.) She was put into my arms and began nursing immediately. Relief and joy filled the room. All was well.

Alas, it was not to last. My blood pressure refused to drop. The helicopter showed up, and I found out that I would still be transported, alone (there room for only one patient in the helicopter, so it would have to return for Eliora). The magnesium sulfate was restarted and my new daughter was taken from me while the medics stood around impatiently, waiting for me to deliver the placenta so we could go. An hour after birth the placenta had still not emerged, so Anna performed a manual extraction (a procedure more painful even than transition labor).

As the medics prepared me for the helicopter transport, I cycled through a crazy mix of emotions - shame, fear, loss, and euphoria. Luke assured me that Eliora would be well cared for, cuddled, and loved while we were apart, that the other kids would be okay, and that he would be safe driving to Flagstaff in the dark.

I was strapped to a gurney and loaded into the helicopter, my face six inches from the ceiling. The medics told me it was a good thing I had delivered already, because you can't give birth on a helicopter, and they would have had to land in a cow field if I delivered on the way over. I turned my head to the window and tried to take in the view, but I didn't have my glasses on, and everything was blurry. A new visual aura began, which made sightseeing even more difficult. The medic next to me swore quietly as my blood pressure soared towards 180, and he and his partner scrambled to hook emergency medicine up to my IV.

I hope this is the worst picture of me that will ever be posted on the internet.
'Cause it's pretty bad.

We safely landed on the roof of the Flagstaff Medical Center, and I was wheeled to the high-tech OB procedure room. Medical staff kept on checking on me, asking where my baby was and showing surprise to find me no longer pregnant. The obstetrician came in and told me he supposed it was good that he could no longer perform a C-section on me. He sounded disappointed. When the intake procedures were complete, I was left alone with a dry sandwich and my mag sulfate drip. I lay in bed and missed my new baby. Every time I heard the phone ring at the nurse's station outside my door, I worried that somebody was calling to say that the helicopter had crashed and Eliora was dead. (Just three weeks later, a helicopter really would crash on the roof of the Flagstaff Medical Center, killing all but one of the occupants.) Finally, a nurse came in and helped prepare me for a shower.

I was soaping up when the nurse called to me that Eliora had arrived and was being unloaded from the helicopter. Frantic with excitement and relief, shaking uncontrollably (mag sulfate is a powerful muscle relaxant and turned my limbs to jelly), I struggled to get out of the shower and pull on a hospital gown. I emerged from the bathroom just as Eliora was pushed into the room, a tiny and unhappy baby secured in a giant clear incubator/transport box. As they extracted her and did a quick exam, I collapsed into bed and held out my trembling arms.

Receiving my daughter into my arms again is one of those deep moments of joy that mark my life. It's a memory I treasure and relive every birthday. My joy was made complete when Luke showed up about a half hour later, successfully avoiding drunk drivers and stray animals as he sped to Flagstaff in the dark.

Flagstaff Medical Center - in wonder at our new daughter

I wasn't completely out of the woods. My blood pressure remained high, and I endured 24 hours of the magnesium sulfate drip, with hourly medical exams to make sure it wasn't killing me instead of helping me. Eliora was discharged from the hospital a day before I was, since it took awhile to keep my blood pressure at non-stroke levels. I discovered that I could not will my blood pressure lower (although it was through no lack of trying). I had to take beta-blockers for several months before it finally stabilized at a safe level. The sight of a blood pressure cuff still causes a panic response in me.

Another terrible picture of me.
Magnesium sulfate doesn't improve one's appearance.

To this day, we don't know if I was officially diagnosed with preeclampsia or just PIH (pregnancy-induced hypertension). Some day, we'll request my medical records from Flagstaff and read what they say. We don't know if all the interventions I endured prevented a stroke or seizures, or if I would have been just fine without them. What we do realize now is how incredibly naive and full of hubris we were to ignore so many clear warning signs. We understand why doctors are advised not to manage the health of close family members. Luke had to endure an M&M (morbidity and mortality) meeting of the medical staff at the health care center, in which mine was the case discussed. They concluded that prenatal care is always important, and Luke should have insisted on it.

Finally, we see so many ways that God protected both me and our sweet little Eliora. My foolishness could have led to tragedy, but instead I get to write a story with a happy ending. Nine years later, we are both still healthy and strong, in body and mind. Happy birthday, sweet Eliora! You are a miracle of grace.

Eliora, dressed and ready for discharge