Insomnia

Photo courtesy of neil-san.

To walk my street, alone at 12:30 a.m., is exhilarating, which isn't the emotion I should be striving for at this hour of night, but when one can't sleep... I had awakened to the dripping of rain off the eaves and couldn't get back to sleep, so finally pulled on a coat, hat and scarf and walked outside. The trees are dripping and the streetlights glitter on the grass. Our cat crawls out from beneath the minivan and meows before slipping into shadow.

I walk through the steady patter of rain hitting pavement, the occasional plink of a heavy drop falling into the gutter, the gurgle of the two outdoor fountains from the house four east of mine. I walk through patches of darkness and then into the glare of a streetlight, allowing the neighbor's dog to spot me from its front window and bark furiously through the glass.

I listen to the faraway whistle of a train, the whir of cars speeding down Pyramid Highway, my breath as a contraction seizes my belly. I walk up and down the middle of the street, forgoing sidewalks because the shrouds of shadow make me nervous. I am a horse at the track, warming up for the big race, steadily finding my pace as contractions grip and release. Two, three, four times, I walk along this stretch of H Street between G and 4th. H for home, for hope, for hurry. The rain lets up and I come inside for a mug of steamed milk with sugar and nutmeg, my eyes heavy and ready for sleep.

For every rule there is an exception

As I waddle to week 41:

Max sings "Flying Purple People Eater" in falsetto.

Sam licks his fingers, habitually, and complains about his dwindling stash of Halloween candy.

Chaja wanders about the house asking no one and everyone, "When will the baby come?" prompting me to grit my teeth and grumble that I'm making her replacement as she speaks.

What is a due date, anyway, but a statistical blip, a technique first used by a German doctor in the 1800s, and now backed up by ultrasound. But guess what? The Estimated Due Date is fraught with assumptions, among them the average lengths of a woman's menstrual cycle, the calendar year and the gestational period, which means the due date could be off by a week or so. But what about ultrasound, you ask? Doesn't measuring the developing embryo prove when it was conceived and therefore tell a doctor when it will be born? Yeeesss, but a scan performed in the first trimester has a 95 percent error margin of six days. And then there are more recent studies that lengthen or shorten the due date based on number of pregnancies, the mother's ethnicity and the quality of prenatal care.

Which means I crossed the finish line, but the race ain't over yet.

Worry Beads

My family and friends made me a string of beads at my baby shower that I keep running through my hands, caressing each bead's smooth or bumpy shape, watching the colors glisten in the sunlight. It is beautiful, and all the love it symbolizes is reassuring, because there is a risk with this pregnancy that didn't exist before, a scar that stretches like a dark smile just above my pubic hair that is evidence of the cesarean I had six and a half years ago.

I plan to VBAC, a decision that runs in direct opposition to the majority of the doctors who share on-call duties with my obstetrician. Should I go into labor this weekend, the two doctors who would meet me at the hospital are severely opposed to vaginal birth after cesarean. "Be prepared for a fight," my OB warns. And so I have prepared -- an alternative. My midwife, Diane, is a short, round woman with burnished hair and a contagious laugh who has birthed hundreds of babies. She and her two apprentices will come to my home and together we will bring this baby into the world -- gently, safely and without condemnation. My doctor knows of my choice. He acknowledges that it isn't science that holds sway over his colleagues but the fear of medical malpractice lawsuits that has them frowning over VBACS.

Granted there is risk to the mother and baby when a uterus -- once cut and stitched back together -- is asked to clench and stretch its muscle again. The chance that the scar will rip open is 0.7 percent or 7 in 1,000 women, according to the International Cesarean Awareness Network. In addition, there is an increased risk with each cesarean that the placenta will embed into the wall of the uterus and cause the woman to hemorrhage. The American College of Obstetricians and Gynecologists recommends that a doctor be immediately available for a woman choosing to VBAC.

For most doctors, this recommendation carries too great a risk to their livelihood, so they pressure women into cesareans. At one point, my own doctor said he may ask me to sign paperwork that spelled out a VBAC's risk in graphic language before agreeing to perform one, but he didn't acknowledge that a cesarean carries its own chance of catastrophe or death until I pressed the issue. Cesareans account for 29 percent of all U.S. births, and this week some researchers placed partial blame for the spike in maternal death rate -- the highest its been in a decade -- on this major surgery.

Shame on the doctors for forcing me to choose between home birth and cesarean, when most agree that the safest place for me is to VBAC in a hospital with a supportive staff. I am scared over these risks, no matter how small, and frightened of these doctors who would judge me harshly, and so I run my fingers through these beads and pray.