Off Her Back

By Cynthia Overgard
Issue 145, November/December 2007

The summer I learned I was pregnant, the notion of making a commitment to natural delivery in a birth center—without doctors or pain relief of any kind on the premises—was furthest from my mind. Like many other newly pregnant women, I reluctantly envisioned my hospital birth to mirror that of every other actual and fictitious birth I had ever heard about: Agonized and disoriented, I would be rushed urgently into a medical scene amid bright lights, confusing equipment, and an assortment of intense, unfamiliar faces. I envisioned myself in the usual, dreaded position of lying on my back, my knees bent, nobly trying to resist an epidural for as long as possible before acquiescing to that temptation, praying all the while that my baby and I would not be harmed by the anesthesia. This vision, unsettling as it was, had been far too deeply ingrained by society and mainstream media for me to have realized that I actually had a choice in the matter.

t the same time, I had become haunted by the number of cesarean sections—both emergency and elective—I was hearing about. I dreaded the possibility that my obstetrician might choose to deliver my baby by C-section without irrefutable evidence that the procedure was necessary. It stunned me that the rate of C-sections had quintupled in my lifetime,¹ and while I had met some women who spoke positively of the procedure, which had quickened their labor and eliminated the daunting effort of having to push out a baby, my own simple curiosity held me to the opposite position: If my body was capable of doing something so astounding as producing and delivering into the world another human being, then I intended to experience that miracle for myself.

The myth of my first trimester: childbirth requires medical care
One evening, while conducting research on the Internet about pregnancy and childbirth, I happened on a website in which a mother shared the details of her natural homebirth. Within moments, a longing formed within me—I saw that easy, natural birth was indeed possible; I just didn't believe it was possible for me. Emotionally unready to consider it further, I gave myself precisely what I needed in that moment: permission to stay on course with a conventional hospital birth, like every other rational, educated, metropolitan New York woman I knew.

I did, however, take something away from that website—recommended reading: Henci Goer's The Thinking Woman's Guide to a Better Birth.² Like the moment I shook my husband's hand for the first time, my purchase of the book presented itself as a casual gesture rather than the life-shaping blessing it turned out to be.

With Goer's book as my primary resource, I began to educate myself about the complexity of our nation's obstetrics industry. My education came at a cost: an ever-increasing fear of the very hospital birth I had planned. Stunned to learn that doctors were held to revenue targets at the hospitals in which they practiced, a cynicism grew within me. Soon I understood the risks associated with medical intervention in the delivery room: Even seemingly innocuous procedures, such as the use of an electronic fetal monitor, suddenly looked like threats. I discovered that each form of intervention would increase the odds, often dramatically, that a further, more drastic procedure would then be necessary. Electronic fetal monitors, Pitocin, cesarean sections, amniotomies, epidurals, episiotomies—they all formed an entanglement of interdependent risks and complications.

At my 12-week checkup, I asked my own obstetrician a straightforward question: her cesarean rate. Her response was that she had no idea; the obstetrics practice hadn't bothered to calculate those numbers in years.

"The national average is around 27 percent [2003],"³ I said. "Would you guess this practice comes in higher or lower?"

"Definitely higher," she said.

Anxiously, I demanded to know how much higher. "Is it greater than 30 percent? Thirty-five percent?" She looked at me regretfully. I pressed on. "Forty percent?!"

She finally nodded. "Yes, at least, but I don't have exact numbers."

Incredulously, I asked why they were performing such an extraordinarily high rate of C-sections. Were they elective, or did the obstetricians in her practice really feel that life-or-death situations were so frequently at hand?

"Yes, some are elective," she began. "Many women feel they would prefer to have their own doctor perform a cesarean rather than take the chance of delivering vaginally with a less familiar doctor from the same practice."

And you actually give merit to that choice? I wanted to ask. Major surgery, unnecessarily performed as a matter of familiarity and convenience?She continued: "As for emergency C-sections, for starters, the baby could be breech, the placenta could be too low in the uterus, or the cord could be wrapped around the baby's neck. The mother could be too old, too heavy, or too thin. Or she could experience failure to progress—we like to see at least one centimeter per hour. Other concerns arise when the baby is overdue, premature, too big, or if the mother has a condition such as gestational diabetes or is carrying multiples. And I'll be honest with you: Litigation plays a big role."