I am in the tail end of conversations, overheard whispers, words and thoughts and half-completed discussions. The adoptive parents are here, they will be at the delivery. They want to stay with the baby but the hospital will not let them. Something happened in the past; adoptive parents now must obey visitation rules. Night charge head nurse talks to the head head high up and bargains: they will be allowed to go to postpartum and watch the bath through the glass windows in the nursery; they will be able to take the baby to the lobby and bond. Baby will have a security tag.
The adoption is only legal if the mother signs the papers after birth, and if the father does not object within a reasonable amount of time. My patient does not want to see her baby, touch him, do anything to him. She knows that if she looks at him she will love him and not be able to give him up. She cannot afford this child; she is on the verge of putting her life back in order, making something besides a scratched-out living. And the father is an on-again, off-again source of support. Not reliable. She has given this careful thought. She is certain that this is best, for her, for baby, for her daughter with her.
It is a strange tableau.
There am I: staff OB tonight is kind and good and hands-off; he hands me the towel and lets me deliver the baby from crown to placenta. There is she, her sisters holding her feet as she pushes; the epidural is good and she is determined. And there, near her head, in the corner, are the adoptive parents, watching, serious, nervous.
The delivery is good - what makes it good is that she pushes when asked to push, stops when asked to stop. My hands are becoming slowly more certain as they move over the crown of the infant, stretching the perineum, pushing against the contractions to control the head's delivery, turning it into an inexorable slide rather than a sudden tearing pop. Suction. Check for nuchal cord. Mother breathes, pants, waits. Grip the baby's head in two hands, fingers under jaw and occiput, pulling down as mother pushes, and feeling for the subtle give that is a shoulder sliding beneath the pubic bone, then completing the upstroke of a "J" to deliver the posterior shoulder without tearing the perineum. One hand slides down from occiput, fingers finding the arm, pinning it against the body - a baby's arm can lacerate as it pops out, turning a smooth delivery into a necessary repair. And once the shoulders are free, it's a hand at the neck and a hand at the ankle to catch this living thing that nearly falls into my hands. I may take up sitting to deliver; it's easier to hold the babies.
Normally, O Best Beloved, this is the cry of triumph - a proclamation of gender, a passing of a wet, bloody, squirming creature to its mother's belly, wrapping it in blankets, cutting the cord, all the while filled with jubilation. Normally, catching the baby is a glorious moment.
Tonight, I caught an infant boy sliding flawlessly from his mother's womb, by neck and ankle, held him, and said quietly, "I've got him." Dr. said to the mother: "Do you want me to cut the cord?" She flung a towel over her face and began to sob. We clamped and cut the cord. The baby went into the nurse's arms as soon as he was suctioned, whisked away to another room, gone. Where normally I deliver a placenta to the background tableau of outraged wails, cameras, and adoring commentary - tonight the room was silent but for the wracking, bone-deep weeping of the woman on the bed. She could not be comforted; the OB later told me that her reaction was that he had seen in women whose children are born dead.
It was business and nothing more, between her legs: look for lacerations (none), check the placenta, deliver the placenta, catch the placenta. Massage the uterus (oh, that Technicolour blood) until it stops pouring out clots and then clean her. Massage the uterus again; a little atony but not much. Business. The routine helped to quell the festering sense of despair that filled the room, but it could not consume it completely. I doubt that anything could have.
I went, after the delivery note was complete, to see the baby and the adoptive parents. They were awkward - it was awkward. I complimented the baby. The adoptive father said "She did well." The mother nodded.
I did not know what to say, O Best Beloved. We were talking about the delivery; she pushed with fantastic determination and did exactly what she was asked. But I could not erase from my mind that grieving woman in her bed, thighs painted with the blood of birthing a child she could not bear to break her heart by seeing. I could not tie together the tattered ends of pain and call it good. I was, momentarily, inside a hollow emptiness as wide as a Titan's drum, looking up at a black and barren, starless sky; I had no sufficient words and no name but sacrifice for the thing that she had done.
Yes, I said, she did.
Someday, O Best Beloved, I will perhaps be able to tell you whether I spoke truth or falsehood. But perhaps I will never know, in this world a thousand shades of grey. I know only that there is pain and blood to the bringing of life; I know only that there is ending and there is beginning and that sometimes the two are one.