Our local altweekly has as its cover story this week an article on home versus hospital births
, with the sensational subhead "Inside Baltimore's Home Birth Underground." Lay midwifery here is illegal, so the midwives interviewed for the article are given pseudonyms, like drug dealers.
This has got me thinking about Floppy's birth. I've told his birth story a lot. I tell it routinely to Floppy of course. But I also used to tell it to my students, whenever I lectured on pregnancy and childbirth. I don't tell many other personal stories in class -- or, for that matter, on the web -- but I think it's a powerful tale, and illustrates a lot about what happens in hospital births usually, and what alternatives there might be that preserve birth as an astonishing miracle and the beginning of a love affair, instead of a source of pain.
Giving birth to my son was without a doubt the absolute peak experience of my life. It tapped all of my physical and mental capabilities, but rewarded that exertion with a sense of bliss and accomplishment and unity that I can't imagine any other work I could do would ever equal. That's not how it goes for most women, though. It wasn't how it went for my friends.
In a massive case of "it's in the water," most of my female friends and acquaintances were pregnant around the same time that I was. As far as I know, they all wanted natural childbirths. Certainly they all wanted a safe and happy birth experience! They were also, like me, mostly well-educated, well-off women with good medical insurance. You'd think that would be a good thing, but when it comes to birth, education, insurance, and money leads to more medical intervention in birth. And more medical intervention in birth does not lead to happy birth stories.
Their outcomes? In the year around Floppy's birth, 8 of my friends gave birth to 9 children (one woman had two kids in a single year, but not twins). Five of those births ended in a C-section. That's much higher than the national average, which is around 23%, although the CityPaper article says that the rate in Maryland hospitals is 32%, and my understanding is that rates of C-section are increasing.
Of those who managed to escape major abdominal surgery to birth their babies, 1 had a painful birth experience that improved after she received an epidural. Another had a very painful, brief birth – she had wanted pain medication, but gave birth too quickly to have it. Only 2 births – to the same woman, attended by a midwife both times -- were natural and positive experiences with no complications.
None of my friends -- all under 35, with low-risk, uncomplicated first (and in the case of the one friend, also second) pregnancies -- should have had stressful, painful, complex births. And yet all but one of them did. So you can imagine how nervous I was! I'm not known for impressive pain tolerance, I was not, at the time, an expert of any kind in childbirth, and I had chosen an obstetrician to attend my birth, because I respected the education the MD represents. I wanted her expertise, but I didn’t want a c-section if I didn't need one!
I did a lot of very smart things before Floppy's birth, all of them pretty much by accident rather than by design. We took Bradley Method birth classes
because my doctor’s childbirth classes were only two sessions long, and I didn’t think that was enough to get me through labor without drugs. I was initially wildly disappointed in these expensive classes. I mean, really, what is a childbirth class supposed to cover? Breathing techniques, meditation, magical skills to manage pain, right? That was what I thought. Instead, most of the class provided textbook information: menu plans, statistics, and information about how labor is managed , informaton about different interventions used in birth, and how scary and dangerous they all are. The instructor was persuasive -- and terrifying! -- but I didn't see how all this fine knowledge was going to help when I was having uninterrupted contractions! I could not have been more wrong, though. It turned out that I needed that statistical information when my birth didn’t go as expected – and so my childbirth classes were one of the most valuable things I did. But I was disappointed at the time. I also had a doula, Jessie Weber,
who was fantastic. I knew that doulas -- the word is Greek for a female slave, but in English refers to someone who supports the mother and family with pregnancy or birth -- cause improved birth outcomes in research: fewer C-sections, fewer complications, shorter labors, less pain, less use of pain medication. But I chose mine by the highly scientific method of asking my OB whom she liked. She hemmed and hawed and said, er, maybe the hospital could give you a good referral. So I called the hospital's doula line, and took the first person who called us back. Who turned out to be Jessie, fortuitously. My parents and my husband
, as well as my obstetrician and the nursing staff, all came to my birth
. I didn't know it at the time, but having wanted family members at the birth also decreases medical intervention in birth, so that was also a good choice. Having family there meant more hands to help with labor support, and I turned out to need them, apart from the joy of having them there to watch Floppy take his first breath. I also chose a hospital
– Woodwinds, in Woodbury
, Minnesota – that was known for its emphasis on natural birth
, although I don't know anything about their actual labor outcomes.
Most of the things I did -- with the exception of choosing an obstetrician to attend me -- were things that are associated in research with having natural labor with few complications. I would do all those things the same way again, except for the OB. If I have another child, it will be with a midwife.
My labor began when my water broke, and it lasted 18 hours from start to finish – so it was a longer than average labor, which is about 12-14 hours for a first child, and less for subsequent children. The first eight hours were cake -- I had a few mild contractions, but nothing difficult to handle. I danced around the hospital ward with my husband, bounced on a birthing ball, and hung out.
But at some point after that, my labor became very painful and stopped progressing. I wondered if perhaps this was “back labor” -- painful but pointless contractions caused when the baby is turned backwards in the uterus and gets stuck there. Nobody seemed interested in my theory; the nurse felt my belly mid-contraction and said the contraction wasn't "strong enough" to push Floppy out.
My obstetrician wanted to give me pitocin. Now, pitocin is not some scary chemical. It's chemically identical to oxytocin, the body's own mechanism to create contractions. It's used to induce labor, and used to "augment" a labor , like mine, which doesn't seem to be going anywhere. Obstetricians like pitocin because it is reliable -- if you give it, labor is going to happen -- but every woman I've talked to who had pitocin, no matter how committed to natural childbirth she was at the start, ended up with some kind of pain medication. A pitocin contraction hurts!
I can make a logical guess about why this is. Pitocin does not cross the blood-brain barrier.
Now, neither would oxytocin (they're the same, remember?), but oxytocin is synthesized in the brain in the first place. It starts out in the hypothalamus. It's likely that when the brain is triggered to make enough oxytocin to push out a baby, it also makes endorphins and whatever other chemicals make up our natural pain management system. Probably the same stuff as you get with an orgasm, actually, since orgasms in both men and women are also powered on oxytocin. But an injection of pitocin never makes it to the brain, so when you labor on pitocin, you labor without these delicious innate pain relievers. Hence your sudden, unanticipated need for an epidural!
Anyway, in my birth, the pressure to accept pitocin to augment my stopped labor became intense. Eventually, everyone
loudly, repeatedly agreed that I needed augmentation medication – my doula, my husband, my parents, and my doctors and nurses. My physician father told me later, when I was no longer a crazy laboring woman, that if he had been my physician he would have walked off the job!
It won't surprise any of you who know me that I was the only -- loudly -- dissenting voice in the face of all this united agreement. Floppy wasn’t distressed, as best as medical science could tell, so I kept repeating a statistic from my birth class: 85% of all women whose waters break give birth naturally within 24 hours. No one was very impressed with my statistic!
I also wasn't convinced my contractions weren't strong enough, as they all said. They certainly hurt plenty strong! I thought Floppy was probably reversed in my uterus and stuck on my pelvic bones -- that was what it felt like, and I clung tightly to that small shred of expertise. No one but me knew what it felt like!
I was worried that pitocin, which would dramatically increase the intensity of labor, would put him in distress without helping him move. But everyone said I needed the medication!
What do you think I did? I told my doula, Jessie, that I thought Floppy was stuck, and I asked her what we could do to move him. Jessie knew all sorts of tricks – tricks to make labor faster, tricks to slow it down, tricks to conserve energy and reduce pain. So I thought maybe she’d have a trick for this too – although I wasn’t too hopeful!
Miraculously, though, she did have an idea. She did a technique on me called a rebosa
– a Spanish word for baby shawl. She stood over me as I laid on the bed, and passed a sheet under my back, lifting me in it as a cradle and gently shaking me from side to side, as if I was swaying on a hammock. Then she had me roll over on all fours, and she cradled and shook my pregnant belly the same way. Finally, she had me stand up, and she passed the sheet behind my back and shook me in it as we both leaned back in opposite directions. I actually felt Floppy move during the rebosa, when I was on my knees, so I wasn't surprised when 20 minutes later I was in active labor, with the nurses cheering my new, strong contractions (which felt exactly no different to me). Three hours later he was born, entirely without medical intervention, and much to the amazement of everyone, who thought he couldn't possibly be born on his own.
There really is a warm, hormonal glow around my first memories of my son. I remember his eyes, and my husband holding him against his bare chest -- but not the fact that it was apparently me who told him to take off his shirt so Floppy could cuddle on skin. I remember him nursing, and the amazing burst of manic energy I had after my 18-hour whirlwind tour through labor medicine. Nothing has ever felt more miraculous to me
, than making him.
But it could have gone very differently. Without my doula and my childbirth classes, I too would probably have had a C-section. Floppy was -- as I thought, as I felt when he moved during the rebosa -- stuck in a posterior position, so pitocin probably would have put him in distress without moving him, as the intense synthetic contractions slammed his little head harder against my pelvic bones. Once he was in distress, I would have genuinely needed a c-section, and I would have happily consented to one. What else could I have done? They would have recorded me as a case of dystocia caused by an abnormally small birth canal, or something, and I would have thought of Floppy as a medical miracle. But I didn't need a c-section. All I really needed was a doula who knew how to do a rebosa!
My birth is a great example of how and why childbirth classes and labor support reduce medical complications and create better births. If you're having a baby, get a midwife. Get a doula. Take childbirth classes; take notes. And, as the obstetrician Robert Atlas quoted in the City Paper story so eloquently says, "Don't. Be. Induced." Or augmented, or heparin locked, or continuously monitored, or any of the other hospital crap anybody asks you to do. It's birth, not an illness. You can do it. It's your body. It will be amazing.