Jennifer Margulis

Mothering Outside the Lines

How to Have an Empowered Birth; or the Second Longest Post in the History of this Blog

December 28th, 2010

In December I visited a labor and delivery ward at a prominent hospital in Boston. There were four women in active labor while I was there. They were all young and healthy with no risk factors of any kind.

Three were having their first baby.

One was having her second.

One was a vaginal forceps delivery after the woman was given an epidural and pitocin (a synthetic hormone that mimics oxytocin and is used to intensify contractions) and had spent most of the labor and two hours pushing flat on her back, one was a vaginal delivery with a second degree tear by a woman who was also given an epidural and pitocin and who also delivered flat on her back, and two were Cesarean sections.

The doctor I was shadowing wasn’t sure why the two women—both of whom had wanted natural births—were sectioned. But she did know that neither of the C-sections were emergencies. “I think it was for failure to progress.”

I can’t stop thinking about one of those women. She was laboring happily, walking the halls with a smile on her face, her partner shuffling along behind her, stopping to buttress herself against the wall when a contraction washed over her. She looked so healthy and alive. She was so present in herself. She looked to my inexperienced eye like the last person on earth who would need to have a C-section.

With the epidemic of Cesarean operations in America today, how do you avoid an unnecessary C-section? How do you have the kind of birth you want? How can you own your own labor and delivery and trust your body and your baby so that you feel euphoric when you remember your birth experience instead of depressed and disappointed?

1. Read the right books

If you don’t want to know anything about labor and delivery until it’s your turn, it will be very hard for you to be empowered when the time comes. It’s a good idea to read up on the process.

But what you read makes a huge difference.

I recommend you, your partner, and anyone who you want to be with you while you’re in labor, read the following books, in this order:

• Simply Give Birth by Heather Cushman Dowdee. This is a little known collection of very empowering birth stories where the focus is on the woman and her baby and not on the birth attendant or the intervention. Many of these are stories of women who chose to have unassisted births though Cushman Dowdee did not set out to collect unassisted birth stories per se. Though some of the writing is uneven and some of the narrators might be a bit too woo-woo for you, every story is empowering.

• Unassisted Childbirth by Laura Shanley. Even if you just read around in this book, you will learn so much from it. Shanley tells her own incredible birth stories (she had all of her babies unassisted. The first with four of her partner’s male friends watching!), shares birth stories by other women, and also tells about her philosophy that birth is a natural process and that laboring women should trust themselves. She talks, too, about the importance of mind over matter and of teaching yourself to think positively about the birth process instead of dwelling on fear or pain.

• Childbirth Without Fear: The Principles and Practice of Natural Childbirth by Grantly Dick-Read. Though this book was written in the 1930s, it is tremendously empowering and affirming (and the book that inspired Shanley and her partner to think outside the birthing box.)

• Ina May Gaskin’s Guide to Childbirth by Ina May Gaskin. This book is for both midwives and pregnant women. It includes many of the birth stories in Gaskin’s Spiritual Midwifery, as well as all of the technical details about childbirth. Though I don’t agree some of Gaskin’s approach (she and her midwives tend to interfere more than I would have been comfortable with when I was in labor), the book is a tremendously helpful, detailed, and well-written resource.

2. Mediate every day, say positive affirmations, and tell yourself that you will have a peaceful, fun, sexy labor

Next I’ll be telling you to hug trees. Thinking (if you prefer that word to the more woo-woo one) about the kind of birth you want, imagining yourself in labor, and psychologically preparing yourself to be the calm center in the eye of the storm can help tremendously. You can simply practice breathing. Breathe slowly and count each breath up to ten and then start over again. As you breathe and count imagine your body opening up, imagine the baby coming down the birth canal, imagine that you and your baby are a team working together in a dance that will change both of your lives.

3. Eat well and exercise, you’re preparing for a marathon

You wouldn’t try to complete a marathon without training first.

Being pregnant is a fantastic excuse to spend a lot of time exercising without feeling guilty that you should be _________ (fill in the blank: working more, spending time with your spouse, cleaning the house.)

Do the exercise that works for you: biking, hiking, pre-natal yoga, swimming, running, walking, dancing. You know this already but exercise really helps prepare your body for labor.

Yes, of course, you should eat well and exercise to prepare for an empowered labor. But even if you're in excellent shape, does that insure that you will not have unnecessary intervention during labor? Unfortunately, no. The best way to insure no unnecessary intervention is to have a home birth

4. Think carefully about WHO you want at the birth

This is not a very popular opinion but honestly if your partner or your mom faint at the sight of blood and are totally panicking about you having a baby, maybe you don’t want either of them there.

Sometimes men can interfere with the labor process, especially when they bring their own fear and baggage into your space.

If you think your mother is going to miraculously morph into the attentive person you always wanted her to be while you were growing up, don’t be surprised when she’s reading a manuscript in the labor room and ignoring you completely, that’s what she’s done your whole life and it’s not going to change now just because you want it to.

Women in labor are very vulnerable to suggestion and they need to have supportive, kind, loving people to help them through every step of the birth. The father of your child can be an amazing source of strength and comfort. But in some cases he can be a hindrance. He isn’t doing you any favors if his energy is negative. Choose loving, supportive, kind, patient, experienced people to be with you. It’s also a good idea to have a friend who isn’t afraid of being your advocate if you butt heads with hospital staff.

If you don’t have close friends or relatives who have been through labor and who you want with you, hire a doula.

5. Stay out of the hospital for as long as you can (or have your baby at home)

The best way to have a safe and empowering birth is to have your baby at home. If you don’t believe me, ask Aneka, who had a safe and wonderful home birth after three hospital C-sections.

If you still don’t believe me, watch “The Business of Being Born,” the movie by Rickie Lake that made the ACOG so upset that they issued a hostile, anti-home birth statement in response.

If you’re lucky to have a birthing center nearby, have your baby there.

If a hospital is your choice:

• Forget about timing contractions and going to the hospital when they are less than five minutes apart. Don’t go to the hospital until you feel like you can’t stay on top of the contractions for one more second.

• Forget about going to the hospital if your water breaks. Stay home and watch a movie. Stay home and watch two movies. Conveniently forget when your water broke and don’t tell the hospital staff how long its been. They’ll want to put you on an unnecessary timeline and also might start you on unnecessary medications and unnecessary intervention.

First time labors can last a long time, much longer than the doctor has patience for. As a first-time mother what you feel is overwhelming may actually just be early labor. The longer you labor at home the better the outcome for you and your baby.

For most women having a baby is pretty intense.

Maybe you’ll be crying out during the contractions but laughing at yourself during the lulls.

Maybe you’ll enjoy being the center of attention or be mortified by the fact that you’re defecating in front of several people (to say nothing of losing all sorts of other bodily fluids in a public forum—it happens to all of us.)

Maybe you’ll keep your romantic sentiments and tell your partner you love him or her or maybe you’ll scream, “THIS IS YOUR FAULT, YOU DID THIS TO ME AND I’LL NEVER FORGIVE YOU!”

In a rush of body fluids, a baby girl was born. The doctor put her right up on her mother’s chest. “She’s so small,” the new mom said quietly, patting the floppy baby who was lying on her tummy, her voice full of awe and exhaustion. “I’ve never seen a newborn before.”

The whole world changes the moment your baby is born. When you first look into the baby’s eyes you meet someone you’ve never seen before but have somehow known your whole life. You have a lifetime to get to know each other better. What better way to get started than owning your labor and delivery and having the birth experience you want?

The longest post (in case you’re wondering): A Daughter with Special Needs

If you have children, what kind of birth experience did you have? If you are expecting, what kind of birth experience do you hope to have? Experienced moms and dads, what advice do you have for pregnant parents preparing for labor and delivery?

Tags: books to read about birth, empowered birth, empowered birthing, home birth, how to avoid a C-section, meditation during pregnancy, staying home in labor

[ 32 comments ]

The Epidemic of Unnecessary C-Sections

December 22nd, 2010

In my last post here at Mothering Outside the Lines I wrote about an amazing mom who decided to have a home birth to avoid a fourth C-section.

I emailed Aneka’s story to my friend Denise who still has angry, unresolved feelings about a second C-section. Denise was fully dilated and pushing when the doctor told her there was “no way” the baby would be able to slip under her pubic bone.

Any birthing woman is incredibly vulnerable. Her senses are heightened. She looks to those around her for support and love and encouragement.

What if that doctor had told Denise she was doing a good job? What if that doctor had offered her something to eat or suggested she sleep between contractions? (In her book, Ina May Gaskin’s Guide to Childbirth, Gaskin observes that women sometimes need to rest, even sleep, after transition to renew their energy to push the baby out. She also notes that food eaten at the right moment during labor can be the fuel a woman needs to rally.) What if that doctor suggested laboring on all fours? What if that doctor had just said and done nothing but stayed with Denise in an attitude of encouragement?

When your body’s working as hard as it knows how to birth a baby it can be devastating if a doctor or a nurse or a midwife tells you you aren’t doing a good enough job. Or even suggests as much with an impatient or unkind attitude.

When I was more than 15 hours into labor with my first child I was only at four centimeters dilated. Instead of encouraging me the doctor on call–the only man in the practice and the only doctor I had never met previously–told me I was being selfish and making my family suffer unnecessarily (my mom and my husband were there) and that I should think of other people and get an epideral and pitocin.

For Denise just trying for a VBAC had already been a fight. But how could that doctor have known that Denise’s baby couldn’t be born vaginally? Was the doctor subconsciously (or consciously) punishing her for having the hubris to try to do it her way? Or was the doctor just impatient for the baby to be born?

We have a C-section rate in this country that is so high that Amnesty International has issued a call to President Obama to address what they call the systemic failures in the maternal health care system in America.

Augustine Colebrook, a midwife and mother of three who has just founded a birthing center in Medford, Oregon, recently taught a childbirth class for six couples.

Three couples were planning home births.

Three were planning hospital births.

The three moms who chose to birth at home had healthy babies and no complications.

The three who chose to birth in the hospital? They all ended up having C-sections.

As Tiffany, a labor and delivery nurse, pointed out in a comment on my last post, Cesarean birth can be a life-saving intervention. It is a wonderful operation, a medical miracle that can save the life of an infant and a mom when used in a real emergency.

An impatient doctor is not an emergency.

A hospital that profits from billable hours for the operating room is not an emergency.

A previous C-section is not an emergency.

A breech baby is not an emergency. (Babies turn during labor. Vaginal breech birth done correctly, which usually means with as little intervention as possible, has been shown to be safer than major abdominal surgery for most women.)

Twins are not an emergency.

Most people don’t realize that the skyrocketing C-section rate in America has devastating ramifications.

The United States lags behind 40 countries in maternal death rates.

It’s safer to have a baby in Bosnia and Herzegovina, a country recovering from civil war, than it is to have a baby in America.

Katelyn couldn’t lift her baby for weeks after having an unplanned C-section. Her son was born 11 years ago. The operation gave her terrible gastrointestinal problems that continue to this day.

Nora’s scheduled C-section ended in weeks of anxiety. One of her baby’s lungs collapsed and he had to be helicoptered to a hospital with a NICU. “I think the doctors got the dates wrong,” she mused afterwards. A doctor herself, she hadn’t realized that the risk of not letting her body go into spontaneous labor includes premature birth.

This major abdominal surgery has many other risks: hemorrhage, infection, organ damage, scar tissue adhesions (including placental accreta, placenta increta, and placenta percreta), delayed interaction between the baby and the mom which can lead to bonding problems and breastfeeding difficulties, a longer and more painful recovery time, post surgery stress disorders, higher chance of rehospitalization, higher chance of complications in subsequent pregnancies, higher risk of respiratory problems for your baby, and more.

Let’s follow Aneka’s lead and stop the C-section epidemic in America. Isn’t it time for American women to be empowered to give birth on their own terms without unnecessary, even life-threatening, intervention?

Tags: Cesarean, Cesarean complications, home birth, hospital birth, placenta, should you have a home birth?, unnecessary intervention, VBAC

[ 17 comments ]

Faulty Reporting on a Flawed Study on Home Birth

July 21st, 2010

The New York Times, as well as dozens of other media outlets, is reporting this week that a new review of studies shows that infants born at home have a higher rate of death than infants born in the hospital.

This is a strange way to spin a review of studies that, according to the authors, actually shows that in every other index measured, women who give birth at home have equal or more positive outcomes than women who give birth in the hospital.

According to the study’s abstract, women who give birth at home: “are less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation.”

However, the study also concludes that the evidence reviewed shows that babies born at home are more likely to die between one week and one month of life than babies born in the hospital.

I have not read the original study, or all of the studies cited to come to this conclusion. But other more knowledgeable critics than I have found that this review of studies, authored by Joseph R. Wax, M.D., et al, ” Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis,” is seriously flawed.

According to the Midwives Alliance of North America (MANA) press release, Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia, who is an acknowledged expert on assessing the quality of literature related to home birth, finds the study deeply flawed: “[T]he authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.”

MANA’s press release continues, “This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.”

In her article, “Tripled Risk of Newborn Death at Home?,” the Midwife Next Door provides links to and quotes from the original studies cited in this review. Her conclusion: “This is a situation where the evidence simply does not add up to the conclusion. The preponderance of the evidence still falls in support of safety of planned home births with a certified/registered/licensed attendant.”

The Big Push for Midwives also argues the timing of the release of and the framing of the conclusions of this review of studies is politically motivated. “Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

“The conclusions don’t match the study,” agrees Augustine Colebrook, CPM, LM, who has been in private practice for seven years and has attended over 300 births. “Home birth is actually safer for the low-risk pregnancy baby and mother … before, during, and after labor.”

But the American College of Obstetrics and Gynecology (ACOG) actively opposes home birth. ACOG issued a statement in February 2008 condemning home birth. The anti-home birth resolution belittles home birth advocates by claiming they are painting a “rosy picture” of birth and, despite the fact that over a dozen large scale studies show that planned home birth is as safe or safer than hospital birth, ACOG cites “safety concerns” as the primary reason for their position against home birth.

The new study will be published in the American Journal of Obstetrics and Gynecology, a peer-reviewed obstetrics journal that has an advisory board, an editorial team, and a list of consultants made up in large part of ACOG members. Most doctors in America are no longer attending home births. They lose their patients and a significant income stream when women choose to give birth at home. That they have a bias against home birth is understandable, though unfortunate. That they skew the scientific evidence to support that bias is unpardonable.

Tags: ACOG, ACOG's anti-home birth resolution, AJOG, doctors, home birth, home birth safety, infant mortality, Joseph R. Wax, MANA, obstetricians, prejudice against home birth, Susan M. Jenkins

[ 16 comments ]

A Baby Born on Wednesday: The Story of the Unassisted Birth

November 12th, 2009

Author’s note: Our new baby was born at home in our bedroom a week ago this Wednesday without a birth attendant present. This is the last installment of the story of how we came to choose an unassisted birth. If you’re visiting the blog for the first time, the story begins here.

When you’re expecting your fourth child and you’re past the due date, you become convinced that the baby will be a full-grown adult before coming into the world, which is why I pretended I wasn’t in labor for about 12 hours of regular but light contractions.

My uterus had been twitchy for days, and since the tightenings on Tuesday night were mild enough that I could sleep between them, I didn’t really think James and I would have a baby anytime soon. Besides, the squeezing feeling that woke me up was almost pleasurable.

Me: I wish I were in labor.

Myself: Maybe you are.

Me: This is way too easy. I wish real labor could be like this.

Myself: Maybe it can. Maybe labor can feel good. Maybe this is real labor.

Me: I hope I can get back to sle—

Myself: ZZZZZZZZZZZ…

I slept better Tuesday night than I had in a long time.

Wednesday morning James bustled the kids off to school. Before they left I felt my uterus tightening so hard I had to lean against the kitchen counter to catch my breath.

“Mommy! Are you having a contraction? Wait, let me get my joke sheet,” my 8-year-old, Athena, cried.

I’d been reading about how humor can really help a woman along in labor and Athena had secretly compiled jokes for me.

“Where did seaweed go to find a job?”

My mind couldn’t focus. Seaweed? Job?

“The kelp-wanted ads!” We both cackled with laughter as the contraction subsided, mine a tad hysterical.

“Maybe you’ll be coming home from school early,” I said, kissing the three kids goodbye. “Or maybe not…”

Then they were gone. I was restless and puttered around the house doing breakfast dishes, folding laundry, tidying the bathroom. I think I even vacuumed. Then I set my camera on a tripod and took some photographs. A couple of times while I was fighting with the self-timer I felt something crampy and jagged going on in my uterus but I ignored it.

I had no inkling that in a little more than three hours I would no longer be pregnant.

James came home.

“I’m not sure what to do…” I said. “I have an article to finish…”

“We could go for a walk,” he suggested. “Or watch the romantic comedy I rented?”

I sat down by the computer and realized I couldn’t sit down.

“Do you think I’m in labor or am I just being wimpy?”

James smiled at me. “Well … I’m inclined to think you’re just being wimpy…”

Nonetheless, I emailed my editor and told her I was in early labor, maybe, and might need an extension.

That was around 8:50 a.m. I put Sadé on the stereo and took a shower, then a bath, then a shower. By now it was obvious, even to a denialist like me, that I was in full-blown labor. I oohed and aahed and breathed through contractions.

Me: This isn’t so bad, see? Mind over matter really works.

Myself: Aaahhh. Ooohhh. That was a good one.

Arms straight, I propped my hands on my knees, which allowed my belly to feel suspended, and I kept the warm water pounding on my back.

Pretty soon, though, the tightenings got really intense.

Me: This is what I wanted. This is what I wanted. This is what I wanted.

Myself: Careful what you wish for.

James made juice with garlic, ginger, kale, beets, carrots, lime, and orange. He brought me some in the shower.

“I can’t,” I sobbed. “I’m sorry.” All the sorrow in the world seemed to enter my body because I couldn’t drink the juice my husband had so kindly prepared.

By then I was starting to lose it. I could no longer ooh and aah through contractions. They weren’t coming in waves with a peak building slowly but instead slamming into my body like a truck crashing into a cement wall.

Me: If you relax your eyebrows and your mouth, your vagina will relax.

Myself: F**k off. I can’t do this. It hurts too much.

Me: What about mind over matter? This isn’t pain. These are interesting sensations you need to pay attention to.

Myself: Ow ow ow ow ow ow ow.

Me: Breathe in and expand your belly, everything is opening up.

Myself: Shut the f**k up already, will you?

James stayed in the bathroom with me. I wasn’t breathing anymore. I wasn’t groaning. I was screaming, rocking my weight onto the balls of my feet, making loud animal noises that came from some primitive place.

“Help me,” I begged him. “Help me, help me, help me.”

“There are a finite number of contractions,” he said. “You’re getting there.”

I turned off the shower.

“Should we get the kids?”

“I don’t think I want them to see me like this,” I whined, utterly miserable, during a lucid moment between contractions.

We put a pillow on the back of the toilet and I made it through a couple of contractions, gripping James’s hands for dear life.

I stood up from the toilet and a flood of fluid flecked with blood gushed down my legs onto the bathroom floor.

“I think my water broke,” I moaned.

“Oh good!” James sounded chipper.

All of a sudden I felt like bearing down. By this time I was talking to myself in an almost schizophrenic way. “You’re okay Jennifer. You’re okay. You can do this. You’re doing a good job.” I didn’t really believe it but the reassuring words helped me anyway. I was also chanting in a tight and whiney voice, “Honey, honey, honey. I don’t think I can doooo this.”

Everything felt like elbows and hard angles and cramps and my body seemed to be taking on a life of its own. But it—I mean we—were going so fast I could barely hold on.

During another lucid pause, I looked at James. “You okay?”

“Fine.”

“You’re not worried?”

“Not at all.”

He was so focused and centered, completely unfazed by how miserable I was. Though reluctant about doing this birth by ourselves, once in the moment James was totally there, totally present, and totally calm.

After my water broke I somehow managed to walk the 10,000 miles between the bathroom and our bedroom though I’m not sure how. We put down a cloth pad and some disposable chux. I leaned against the dresser. I leaned on James. I squatted. I stood. I went on all fours. My legs were shaking. I was sweating. I was dying of thirst. I wanted to be touched. I couldn’t bear to be touched. Nothing felt right. I was pushing now with my eyes squeezed shut and the most animal-like groans coming out of me.

Pushing during my last three labors was easy and pleasurable almost—I only had to push two or three times before each baby came right out. This time felt different. I felt like I was tearing in half. The pressure was unbearable. Everything felt stuck. I was pushing so hard I felt sure the baby would emerge from my rectum. It was the hardest thing I’ve ever done and by far the hardest stage of this labor.

But in between the knee-weakening, body-shaking Mack truck pushes, time stopped. I was completely lucid and pain free. I could have talked about the weather, the stock market, or Obama’s health care proposal. I felt strong, healthy, in my body. It was so surreal that I wasn’t sure I was really in the bedroom squatting on chux, moaning for water (which my husband gave me sips of through a straw), trying to birth a baby.

James grabbed the flashlight. “I see the baby!” He cried, full of joy. “I see the head!! There’s tons of black hair! I’m the first one to see the baby!!!!” He sounded as happy as Etani, my 6-year-old, trick-or-treating on Halloween. His glee was contagious. I started to laugh.

After the next overwhelming, body-numbing, elephant-pressure need to push, a tuft of hair stayed out even as I felt the head retreat. On the next push the head was out. James told me later the baby, eyes closed, was frowning, moving its head from side to side disapprovingly, as if to say, “Where is this place anyway? Do I want to be here?”

“I don’t think I can do this,” I cried after the head was out and there was a lull between pushes.

“You can. It’s happening.” James was so matter-of-fact and logical. “Here comes a shoulder!”

In a slippery gush after the first shoulder, the baby came out. James caught it. I was on all fours as the baby was being born and with the relief of the baby coming out, I sat down backwards. He handed the baby to me. I was laughing and crying at the same time. “Oh my god, we did it, we did it.” The baby–it was a girl–started bawling lustily, coughing amniotic fluid and spluttering with discontent. I cried with her and so did James. We were so happy—finally—to meet the tiny being who had been growing inside me for nine and a half months. The whole world had changed now that this new life was in it.

I was such a baby during the contractions—crying and pleading and screaming, “help me”–but birthing this little person by ourselves was the most empowering experience of my life.

Human women have been having babies unassisted for more than 200,000 years. I’m not strong or brave or exceptional. If I can do it, you can too.

Jennifer_baby_Etani
Baby_and_siblings
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Coming up next week: 10 Things No One Tells You About Pregnancy; Experiments in Lotus Birth; When a Baby Spits Up Blood; Nervous Nellie 4th Time Parents, and more.

Tags: home birth, labor, unassisted birth

[ 46 comments ]

A Baby Born on Wednesday, post 4

November 11th, 2009

Author’s note: Our new baby was born at home in our bedroom this past Wednesday without a birth attendant present. This week’s posts are the story of how we came to choose an unassisted birth and about the birth itself. The first installment is here. The second installment is here. The third installment is here. The final installment, about the labor itself, will be posted on Friday.
bathtowels

“So, who’s your midwife?” A friend asked.

“Oh, someone from out of town,” I heard myself lying into the phone.

“Have you chosen a midwife?” A mom from my daughters’ school wanted to know.

“Um, well, sure, yeah,” I hedged. “Hey, have you signed up to volunteer at the Winter Faire?”

It was my mother who asked the most urgent questions. She called James on the sly and told him to make sure we picked someone—anyone—as soon as possible. Away on a business trip close to my due date, she phoned from Puerto Rico to be sure we had a birth attendant.

“We found a midwife Mom,” I said. “A young woman who’s very competent. You have nothing to worry about. She’s great.”

“I’m. Just. So. Relieved.”

I hung up the phone and went into the kitchen.

“I think I just lied to my mother,” I said to James.

“You told her we had a midwife,” he laughed. “But you didn’t tell her the midwife was going to be at the birth.”

It had taken him a good four months but James had come around and actually seemed to be looking forward to the birth. He was as excited and impatient for us to be in labor as I was. And we really had identified a midwife in the Valley who supported our choice to have an unassisted birth and offered to be our “knowledgeable family friend,” willing to come over if we needed her, though not technically as a midwife (for which she could lose her certification) but just as a friend.

I told fewer than half a dozen people our plan for an unassisted birth. I didn’t want to talk about it because I didn’t want people sending negative or fearful energy in our direction. I also found it trying to allay other people’s irrational fears.

“I’m not a hero,” I heard myself say several times, “I have nothing to prove … if something goes wrong or if there’s any reason that we need to, the hospital is a 2-minute drive from our house. I trust my body. I trust myself. I trust that I will know if something is wrong…”

I spent an hour on the phone reassuring my best friend that unassisted childbirth was safe. Sue wanted me to talk her through everything that could go wrong, so I did.

I told her what most people don’t know: that taking a shower is more dangerous and results in more deaths than having a baby, that driving in a car to the hospital is the most dangerous part of labor—besides what can go wrong because of hospital intervention—that large scientific studies most recently in Canada, but also in the United States, New Zealand, and Australia have all shown very clearly that homebirth is safer than hospital birth, and that there are women all over the United States having unassisted births, but because they fear social disapprobation and people’s irrational rage, they mostly keep it to themselves.

I suggested she read Heather Cushman Dowdee’s incredible cartoon about the unassisted birth of her son and look at Shauna Mama’s unbelievably moving and amazing photographs of herself catching her own baby during an unassisted birth.

I told her about Sarah J. Buckley, the Australian family physician, whose husband is also a doctor, who decided on an unassisted birth at age 40 with their fourth, a daughter who surprised them all by coming out breech (with no complications).

I also spent a lot of time preparing for the birth. I bought two kinds of “chux’s”: one package of disposable absorbent pads and one single chux made of cloth; I also bought ultra thick sanitary napkins and witch hazel (you put witch hazel on the napkins and put them in the freezer for after the birth); we had a handy man install a metal bar in our bathroom shower so I could lean against it during labor if I needed to; I drank loads of red raspberry tea, which is supposed to tone your uterus; I exercised every day; washed our cloth baby diapers; cooked and froze a huge batch of burritos; and started being obsessive about keeping the bathroom—where I expected I’d be laboring a lot of the time—clean and tidy. My friend Jenny leant me an herbal tonic to stop post partum hemorrhage and I asked friends to be on stand by to drive the kids home from school (Athena and Etani both wanted to see the birth) or pick them up from after school activities.

But most importantly I spent quiet time every day imaging the kind of birth I wanted us to have, relaxing, and meditating. If you know me in real life, you know that I’m not much for relaxing and I tend to dismiss the hooey-wooey stuff that people in Ashland like so much. I usually don’t have the patience for baths or the concentration for meditation but I’m trying to change that. To prepare for this birth I made myself slow down. I lit candles and sat in the tub and practiced making “aahh” and “oohh” noises, thinking about the baby moving through my body, being gently squeezed by contractions.

“I will have an easy, gentle birth,” I told myself every day. “I can do this.”

“My body is strong,” “The birth will be fun,” “I will keep a sense of humor,” “James and I will catch our baby,” “Contractions are an interesting sensation to pay attention to,” “This will be an easy, gentle birth.”

I said these things over and over to myself and made myself believe them. But here’s the truth: I wanted to have an unassisted birth more than anything and I couldn’t wait to go into labor but there was a small person in the back of my mind who thought I was asking for too much and was secretly terrified that something would go wrong.

Cartoon courtesy of Heather Cushman-Dowdee.

Tags: childbirth, home birth, unassisted birth

[ 8 comments ]

A Baby Born on Wednesday, post 3

November 10th, 2009

Author’s note: Our new baby was born at home in our bedroom this past Wednesday without a birth attendant present. No name (yet). No weight (we don’t own a scale). No midwives. This week’s posts are the story of how we came to choose an unassisted birth and about the birth itself. The first installment is here. The second installment is here. To read the rest of the story, please check back daily.

The not-yet-certified midwife we chose for our second home birth, M., had dreadlocks down to her ankles. She didn’t have an office. Instead, she brought her 4-year-old daughter with her when she visited our house for prenatal appointments.

Mostly we just talked.

She told me about how everything always got broken in her house but she didn’t get angry at her ten children because there was no point. She told me about how one of her daughters was autistic and would walk in circles for hours, a smile on her face. And how her second oldest wanted to be a midwife too.

I told her how I tore during Athena’s birth.

“You won’t tear this time,” she said. “You didn’t need to tear.”

“I didn’t?” I knew instantly that she was right.

But the birth process with my son started inauspiciously. My water broke at 11:00 p.m. and catapulted me into active labor. With my oldest daughter my water had broken at 11:00 p.m. as well, though she wasn’t born for another 22 hours.

I sobbed as amniotic fluid went into the toilet. I didn’t want to have another birth like Hesperus’s and I felt scared and tired. I didn’t wake James because I was afraid that everything would happen like the first time and that he would get exhausted. Instead I sat on the office couch and sewed up his robe, inside out, until the contractions were too intense to stay still. By then M. was there, though James was still sleeping.

M. was right, of course. I didn’t tear. The labor lasted only about four hours and was not nearly as bad as I had feared when it started. My friend Kathleen, a medical doctor who came as a friend not a doctor, showed up about twenty minutes before the birth.

When our son’s head crowned, I started walking away and Kathleen panicked, “Jennifer! Where are you going?!”

“JUST DON’T DROP THE BABY,” I cried, and twisted my body onto the bed as he slid out. M., who was crouching behind me, caught him.

My son's birth, attended by a midwife-in-training and a friend, had the least intervention

That’s when Kathleen flew into a frenzy of action, grabbing a towel and vigorously rubbing the baby, directing James on how to cut the cord, whipping out a tape measure to measure his tiny perfect head. (“Can you leave him alone, please?” I said, annoyed. “It’s better to have a baseline, Jennifer,” she answered, clicking her pen closed as she finished writing on the chart.)

Our bedroom was small and it felt like there were a lot of people present. M. had essentially done exactly what we needed her to do: nothing. She checked the heartbeat five times while I was in labor but she did it so unobtrusively and gently that I did not even notice. Kathleen, who later told me that sitting on her hands and watching—this was the first and only home birth she had ever attended—was one of the hardest things she’d ever done, had done too much.

M. and Kathleen being there made James’s presence that much less important.

They were the authority we were deferring to, directing a natural process that could have unfolded on its own.

As much as I love and appreciate both of them to this day, their presence made the birthing that much less intimate, that much less about our family, that much less about our love for each other and our trust in the process.

We still weren’t at the same place about unassisted birth, but James agreed that our best birth had been Athena’s BEFORE the midwives arrived, when it was just the two of us, James and me, working as a team to ride out the contractions and help my body open up.

Maybe, just maybe, this birth could be like that one. But sans midwives.

Talking about our previous births, reading about unhindered childbirth, and thinking more about it, James started to believe that an unassisted birth might actually be a good idea.

Maybe, just maybe, our next birth could be without midwives

Interested in reading more? Post 4 tells the story of our unassisted birth.

Tags: home birth, prenatal care, prenatal intervention, unassisted birth

[ 11 comments ]

A Baby Born on Wednesday, post 2

November 9th, 2009

Author’s note: Our new baby was born at home in our bedroom this past Wednesday without a birth attendant present. No name (yet). No weight (we don’t own a scale). No midwives. This week’s posts are the story of how we came to choose an unassisted birth and about the birth itself. This is the second installment. The first installment is here. To read the whole story, please check back daily.

When Athena was born I got an unnecessary tear

“We both started at the same place,” James explained during another “conversation” about unassisted birth. He put his hands side by side to show me what he meant. “And we both moved away from that place together.”

He kept his left hand in place and moved his right hand to show how we had both changed together: We started off as children of divorce who grew up in the 1970s playing soccer, eating Fruit Loops and Ding Dongs, watching TV every day after school, and participating in the mainstream without question, and together we became young parents who had a traumatizing hospital birth with almost every unnecessary intervention possible (except a C-section) who decided after months of research not to follow the CDC vaccination schedule, to make our own organic baby food, to hold our baby when she cried despite doctors telling us we would “spoil” her, to use cloth diapers even though everyone we knew said it was too much work, and to question the assumptions of our childhood.

After educating ourselves about it, reading everything we could, and meeting people who were more progressive than the limousine liberals I grew up around and the right-wing conservative business people from James’s side of the family, we left the world of medical hospital births behind and decided to have our second and third babies at home.

“But then,” James continued. “You made this even bigger leap,” he put his right hand as far from the left hand as he could. “Now you’re over here,” he bobbed his right hand up and down. “It’s taking me a lot longer to catch up, but I’m trying. I’m almost there.”

Our friend Nik was sympathetic. “I think it’s amazing what you want to do,” he told me. “But I understand it from James’s point of view, too. He has a lot to lose.”

Most people in America believe what Nik was implying: to have a home birth without midwives present is dangerous.

I could die.

The baby could die.

Maybe that’s what James was really afraid of.

But when James and I talked about our two home births, we realized that the only things that went wrong during Athena’s birth were midwife-induced.

Because it was February in New England during a snowstorm, the midwives did not come until the last 20 minutes of the labor. Even though I was in full-blown transition, I still remember Jharna barreling into the room.

“Have you checked her?!” she asked loudly to Kristen, who had arrived a few minutes before and had just enough time to set up her equipment. Jharna’s tone of urgency broke into my concentration—I was standing by the edge of the bed having a toe-curling contraction and my water was breaking.

“No need to,” Kristen replied. “I know she’s in transition.”

Though Kristen was calm and centered, Jharna started ordering all of us around. “You need to get on the bed,” she told me. “YOU NEED TO GET ON THE BED RIGHT NOW!”

James and I had not considered where I would birth the baby (other than at home) and this sounded reasonable at the time. I clambered onto the bed, gave three terrific pushes, and the baby practically flew across the room. During the minutes this took to happen Jarna managed to yell at me again to say that if she didn’t call my friend and toddler they would miss the birth. Then she bellowed down the stairs for Sue and Hesperus to come up.

Hesperus watched Athena being born

At the same time, Kristen looked at the baby’s head when it came out and said, “Oh good, no cord.”

James pointed to the white serpentine thing wrapped around the baby’s neck and said, “What’s that?”

“The cord,” Kristen conceded, gently pulling it up and away from the baby’s neck.

Because I had pushed from a supine position, as ordered by a midwife, I ended up with a second-degree tear in my perineum that needed stitches.

Athena was a small baby and I am a wide-hipped woman.

It took years for me to realize that the tearing was completely unnecessary, the result of Jharna’s arbitrary idea that the baby needed to be born on the bed.

Or perhaps the idea was not that arbitrary and was actually for their convenience: if a woman is lying down and still (instead of moving, alternating between standing, squatting, and being on all fours), it makes it easier for the midwives to see what’s going on and to catch the baby.

After the birth, Jharna and Kristen disappeared into our guest room because Jharna’s back and neck were tight and she needed a massage. I’d like to think now that they were trying to be considerate and to give us some space, but even at the time I remember feeling slightly put out: they had been in our house for less than an hour and were already thinking more about themselves than about us and our new baby.

When I got pregnant for the third time, I called Kristen and told her I’d like to hire her but I did not want Jarna—who had no children of her own—at the birth. Kristen and I had become friends and I told her frankly that Jharna’s energy felt really negative. Though she initially agreed, she changed her mind. “You’re asking me to go behind my partner’s back,” she said. “I can’t do that.”

The birth attendant we chose this time, Megan Hill, was not yet certified as a midwife. But she had ten children of her own, all born at home. Five of her ten had been born without any outside assistance.

Photo of Athena, 3, taken by Hesperus

Interested in reading more? Post 3 tells the story of our second home birth, attended by a midwife-in-training and a doctor.

Tags: home birth, midwives, unnecessary intervention

[ 13 comments ]

Why Gloves?

November 3rd, 2009

I snuggled in bed with my 6-year-old son Etani last Saturday and we decided to watch some home birth videos on the Internet. In order to feel prepared for this labor, I’ve been reading everything I can about home birth, practicing breathing and vocalizing, visualizing the kind of birth I hope to have, and talking to my kids a lot about what to expect.

Etani wants to be there. He says he doesn’t want to be involved but that he’ll peek around from the door and watch. My daughter Athena, who’s eight, also wants to be at the birth. My oldest daughter, who turned ten this summer, says she thinks it’s “gross” and has plans to walk to a friend’s house once I’m in labor. (I’m secretly hoping she’ll change her mind … I’ll let you know what happens.)

There are dozens of home birth videos on YouTube and the one Etani and I watched was of a baby born on Christmas Eve. It was a calm and inspiring birth but there was one thing that bugged me: The midwife who caught the baby was wearing these bright green latex gloves, which means the first thing that touched the baby’s skin was latex.

Isn’t it better for a baby’s first tactile experience to be a human being’s hands? If your hands are washed, what could the danger of touching a baby possibly be? I guess midwives wear gloves in case something goes wrong and they have to put their hands up the woman’s vagina, but it seems like we should trust the birth process enough to skip the gloves. If they become necessary, a midwife (or doctor) can quickly put them on.

Athena and Etani were both born at home. James was hoping to catch them but I needed him beside me and we let the different midwives who attended each birth catch the babies. I’m sorry to say the midwives were wearing gloves. This time we’re hoping to do it differently: either James or I will catch the baby. And we won’t be wearing gloves.

Tags: gloves, home birth, imagining birth

[ 8 comments ]

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Jennifer Margulis

Mothering Outside the Lines

How to Have an Empowered Birth; or the Second Longest Post in the History of this Blog

The Epidemic of Unnecessary C-Sections

Faulty Reporting on a Flawed Study on Home Birth

A Baby Born on Wednesday: The Story of the Unassisted Birth

A Baby Born on Wednesday, post 4

A Baby Born on Wednesday, post 3

A Baby Born on Wednesday, post 2

Why Gloves?

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