Taking Charge of Giving Birth
A commitment to natural delivery in a birth center, without doctors or pain relief of any kind on the premises, was the farthest notion from my mind the summer I learned I was pregnant. Like many other newly expecting women, I reluctantly envisioned my hospital birth to resemble every other actual and fictitious birth I had known. Agonized and disoriented, I would be rushed 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 with knees bent, nobly trying to resist an epidural for as long as possible before finally acquiescing to the temptation, praying all the while that my baby and I would not be harmed by the anesthesia. This vision, unsettling as it was, was far too deeply ingrained by society and mainstream media for me to have realized I could choose otherwise.
At the same time, I was haunted to know surgical births were fast becoming the norm in the United States, and in fact cesarean sections had skyrocketed from 1 in 20 births to 1 in 3 within my lifetime. What was a rarity 30 years earlier had earned its rank as our country’s most common major surgery, and I dreaded the possibility that my obstetrician might deprive me of my birthing experience by performing the quick but drastic procedure without irrefutable evidence that doing so was truly a matter of life and death. That early in my pregnancy, I had yet to learn that cesareans statistically posed a far greater mortality threat to both mothers and babies over vaginal birth. I was guided instead by my intuition: If my body was capable of doing something so astounding as to create and birth a baby, then I wanted to experience that miracle for myself.
One evening, while conducting Internet research on childbirth, I happened across a website in which a mother shared the details of her natural home birth. To my amazement, she never described a single sensation as painful. I skeptically considered whether she withheld the negative details, or possibly even fabricated the whole tale.
But photos of husband and wife, newborn and siblings, removed all suspicion. Serenity, intimacy, and laughter shaped each scene. My mind struggled to accept what I saw. Certainly I always knew natural childbirth was possible, but I never dreamed it could be so simple. My heart physically ached with longing, compelling me to admit a natural birth was my dream. But I quickly dismissed the notion, rallying myself into society’s conventional way of thinking: Surely any educated, metropolitan woman like me would be out of her mind to birth outside of a hospital. I reminded myself that natural childbirth was nothing more than the unfortunate, inevitable fate of our ancestors. That’s why virtually no rational woman today, or so I believed, declined pain medication that was readily available and administered by experts. To think that we could so easily numb the sensations of childbirth—surely we modern women should consider ourselves the luckiest in history.
The Myth of My First Trimester: Doctors Operate in My Best Interest
I became determined to educate myself on the complexity of the obstetrics industry in our country. My education came at a cost: an ever-increasing fear of the very hospital birth I was planning. I was stunned to learn doctors were held to revenue targets. In the 1980s, hospitals successfully lobbied congress to allow them “nonprofit” status in order to exempt them from paying federal income taxes, while imposing no salary- or profit-restrictions on the executives. This loophole impacted American families immediately: The safest year to give birth in the U.S. peaked in 1987. Today, the U.S. maternal mortality rate has shot up to the highest in the industrialized world, while every one of the other nations dramatically decreased over the same time period.
A cynicism grew within me: Natural birthing meant less revenue. My research exposed even seemingly innocuous and routine procedures as significant threats to the mother’s and baby’s safety. Moreover, each intervention increased the odds, often dramatically, that a subsequent, higher-risk procedure would be required purely in response to the adverse side effects it caused.
If patients had the right to informed consent, then I couldn’t understand why more women didn’t refuse some of these interventions. Pitocin and Cytotec, for example, have never been FDA-approved for the elective induction of labor, yet millions of women followed their doctors’ recommendations for non-medical induction. Were women provided with full disclosure? Were they told they could refuse?
At my 12-week checkup, I asked my own obstetrician a straightforward question: her cesarean rate. Her response was a casual wave of the hand, claiming she hadn’t bothered to calculate those numbers in years. After I pressed her relentlessly for an estimate, she finally admitted it was close to 50 percent.
Incredulously, I asked whether she truly believed life-anddeath situations were so frequently at hand. I added that the rate of C-sections was just 5 percent in 1970, and that the World Health Organization said no country on earth should exceed a rate of around 10 percent.
“Some are elective,” she began. “Many women 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?
“As for emergency cesareans,” she sighed, “I don’t like if the mother is too old or too young, too heavy or too thin, or if the baby measures too small or too large. I also don’t like if the baby arrives too early or late. Other concerns are multiples, low amniotic fluid, placenta previa, a breech baby, gestational diabetes or failure to progress—that is, I’ll need to see you’re dilating at least one centimeter per hour.”
It didn’t occur to me that she provided no evidence. I sat bewildered at how she could recite such an exhaustive list with a straight face, and dejectedly realized all three of my mother’s vaginal births had exceeded 10 hours. Why are women today being subjected to an arbitrary and unnaturally short timeline when our ancestors were not? And whose idea was it to brand us a “failure” in the very diagnosis, with invasive surgery as its looming punishment? Little did I know, “failure to progress” is our country’s number one reason for cesarean section, and held no correlation whatsoever to the outcome of a woman’s birth.
“I’ll be honest with you,” she finally added. “Litigation plays a big role.”
I was unprepared for the ubiquitous “litigation argument” so frequently used by obstetricians. This defense allows doctors to give the impression that they aren’t willing to take any chances, thereby creating grounds to perform a surgical birth and reduce the likelihood of a malpractice suit. The irony is that this assertion manipulates couples into inferring that a cesarean is the safer method of childbirth, when in fact it is statistically far more likely to produce an adverse outcome for both mother and baby.
Ironically, my obstetrician figured she could comfort me by drawing an imaginary line along my lower abdomen to show me where she would make the incision, assuring me that even a bikini would cover the scar. That she misunderstood me so greatly was staggering. If we were discussing the potentiality of undergoing major abdominal surgery in order to save my baby’s life, then wasn’t the scar inconsequential? I couldn’t imagine surgeons of cancer and organ transplants reassuring their patients of the cosmetic outcome.
Soon thereafter, my husband and I learned that hiring a doula—a labor assistant—would statistically improve my odds of a comfortable, vaginal birth. When I told my obstetrician a doula would attend the birth with us, she shrugged. “Fine with me, if you really want to spend all that money.” Then she added, “Just make sure your doula remembers who’s in charge.”
That evening I told our doula what the doctor had said. She stated plainly, “Of course I remember who’s in charge. You are.”
I am? I nearly cowered at the thought. Her words took hold as I slept. In the morning I telephoned my obstetrician’s office and asked them to prepare a copy of my medical file: I was leaving the practice.
My bold move led me to a disheartening, circular thought process: Where would we deliver our baby? Fear held me paralyzed between two extremes: the doctors and medical intervention I was determined to avoid, and the agony I assumed would accompany natural birth.
My husband discovered we lived an hour from Connecticut’s only free-standing birth center, and we made plans to visit the following day. We engaged in a lengthy, enjoyable consultation with the midwife director. When I asked her for their cesarean rate, she opened a file drawer and read us their statistics; this proved comforting not only because their surgical birth outcomes were in the single-digits, but that they cared enough to track the data in the first place. Afterwards, my husband and I were led upstairs to the beautiful birthing suites. I was struck by the setting: The plush double bed, hardwood floors and floral window dressings were reminiscent of a New England bed-andbreakfast. We walked through the bedroom and into a large, marble bathroom, complete with a free-standing showerfor- two and Jacuzzi bathtub.
As we walked, the midwife said, “You can deliver on the bed, in the birthing chair, on the floor, standing up, on your side, in the shower or in the bathtub. We only ask that you not lie on your back; the pelvis needs room to expand as the baby descends. Not to mention, it’d be painful for you and a risk to your baby.”
“Is it difficult for you when the mother chooses to birth in an unconventional position?”
“No,” she smiled. “This isn’t about my convenience and comfort; it’s about yours.”
That night, we came to our decision. At long last, I knew I was no longer running from the birth I sought to avoid, but running toward the birth of my dreams. From then on, I held every remaining prenatal appointment at the birthing center, cheerfully driving an hour each way through the cold winter season.
The Myth of My Second Trimester: Childbirth Must Be Painful
To strengthen my resolve, I began telling everyone—social acquaintances, business colleagues and relatives—that I was planning a natural delivery with midwives. All the while, I quietly nursed the hope that I would come across another woman who had experienced her own natural birth.
Initially, it was a discouraging process—not just because natural labor was rare, but because there was occasionally some confusion as to what “natural” meant in the first place. Some women told me they gave birth naturally because the epidural didn’t numb them completely. Still others thought natural meant vaginal. A woman in my prenatal yoga class told me how glad she was to have had a natural birth with her first baby, until she clarified: “Wait a second—I had an epidural, and all. I’m just saying I didn’t end up with a C-section.”
Aside from my own parents and brothers, who had unanimously respected our decision, the general lack of encouragement I received—particularly from other women—was confounding. Good friends at work said I was out of my mind and showed no interest in discussing it further. A neighbor of ours enthusiastically told me she was in such agony during her own labor that she and her husband prayed, out loud, to spare her from death during the delivery. Her description horrified me until she went on to explain her labor had been initiated with a heavy dose of Pitocin at her own request, given that her parents were visiting and she wanted them to see the baby before leaving town.
Each night, I recounted the day’s negative comments over the phone to my mother, relying on her to help me regain my determination. What struck us most was that so many women seemed to relish in the dramatic story-telling.
To overcome my anxiety of natural birthing, my husband and I took a HypnoBirthing class, whose philosophy asserts that fear and tension is the key driver of labor pain. A single fearful thought in the mind of a birthing mammal immediately ceases the production of oxytocin and releases adrenaline in its place, which causes the cervix to constrict and the blood to rush from her uterus to her extremities. This is nature’s brilliant way of ensuring the baby doesn’t arrive amid danger.
It occurred to me that all other mammals are relaxed during birth; there are no cries of pain, no fear in the eyes, no bodily tension. Therefore, my job was to develop a deep trust in myself and this process. Just as the brain is the most sexual organ, so too is it the primary birthing organ. The female body can close or open; soften or stiffen. I needed to keep my cool, first and foremost, and reconnect with the knowledge that all females carry at a cellular level: My body and my baby would instinctively know how to birth, even if my conscious mind had no idea how I would ever pull it off.
The Myth of My Third Trimester: Birthing Requires Assistance
As it turned out, I did not ease gradually into labor like many women: The first sensation was intense enough to bring me to my hands and knees for back relief, and the second followed within four minutes. I was six centimeters dilated when we arrived at the birthing center an hour later. It was just before dawn, and my midwives were cheerful upon seeing us. One of them wrapped an arm around me as we walked to the birthing suite and exclaimed, “Just imagine, Cynthia, you’re going to meet your baby today!”
I eased into the heavenly warmth and weightlessness of the Jacuzzi, where I found my place between control and surrender. Without a single tube, needle, or machine in the room—not even an identification bracelet around my wrist— there was no sense of being an ailing patient rather than the healthy woman I was. There was hardly a sound in the room as I labored, and I was able to turn inward as nature demanded. I envisioned my baby and reminded myself that the more I kept myself in a state of absolute trust, the faster I would dilate.
The HypnoBirthing techniques suited me well, because I was at 10 centimeters about an hour after we arrived. I took long drinks of water and spoke in relaxed conversation during those brief, merciful moments of total reprieve between contractions. Soon I felt an unbelievable force of energy making its way through me. Our doula knelt as she held a cool washcloth to my forehead, and whispered her only words during the entire birth: “Look outside, Cynthia. The sun is rising.”
Her comment brought me from the internal present to the external. It was a clear morning in early March, with shades of red and orange across the horizon. What a beautiful day to be born, I thought. Then, precisely when I knew I was birthing the next baby into the world, I was overcome with gratitude for the serendipitous course of events that had occurred to allow our baby to emerge from a mother who felt calm, safe, and loved.
With the final surge, our baby was lifted from the water and placed on my chest. My eyes were squeezed shut in that instant, and everyone saw the gender except me. In those first sublime moments of contentedness and relief, I held our newborn to me tenderly and completely forgot to check. My husband waited for the cord to stop pulsating before cutting, and the midwives helped me to the bed and layered warm towels over my body as we initiated breastfeeding. Despite my small frame and our baby’s hefty weight of 8 pounds 14 ounces, the entire labor had lasted just three hours since its onset at home.
When the post-birth examination was complete, we were encouraged to take a few hours of private family time to rest in bed. Nestled snugly between mother and father, our son, Alexander, gazed contentedly into my eyes.
We walked into our home as a family within eight hours of Alex’s birth. Whether it had been good planning or good fortune, I ended up with the beautiful, natural birth I longed to experience. I was proud of myself for pursuing the dream that had exposed my fears.
And yet, I was humbled. I had once believed newborns to be frail and helpless, dependent on the rest of us to push, pull, or cut them free from the womb. As much as I had relied on my husband and our birthing team, I realized I could now look into the eyes of my true birth partner. Alexander had worked as intensely as I had, and he, too, needed nourishment and rest to regain his strength from his own achievement. I marveled to consider that, without the supportive and loving presence of all the others, Alex and I still would have attained his beautiful birth. The respect I instantly felt for my newborn son was the most enduring of all my lessons learned.
How to give birth is a choice that women need not surrender to others. At times, our preparation was arduous: My husband and I had conducted countless hours of research on the host of decisions that come along with birthing and parenting. We challenged one another with complicated questions ranging from logistical to moral, and we consistently faced opposition from a misinformed but well-meaning society. We replaced fear with trust, and misconception with fact. Empowered as individuals and as a couple, we eventually quieted the outside noise and heard our own articulate voices.
And this is what we learned: We learned what it meant to take full responsibility for ourselves and our baby. We learned how to make informed decisions, consciously and carefully. We learned to stop explaining ourselves. And in the end, one truth spoke clearest: Whether she chooses to birth at home, a hospital, or a birth center, it is the right—in fact, the responsibility—of every woman to plan her own baby’s birth with the information, honor, and freedom to which she is entitled.
This article appeared in Pathways to Family Wellness magazine, Issue #24 and #64.
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