With My Wits About Me: The Story of a Planned Home Birth
• • •
The story my mom told me was true: if doctors had not performed a cesarean, she and I might have died. I was a feet-first breech, and the umbilical cord was wrapped three times around my neck.
But the story of my first son's hospital birth is also true. I was what you call "low risk": young, healthy, lacking pregnancy complications; and as my due date approached, my baby pointed head-down. I'd talked to my OB about what I wanted--pain relief only if absolutely necessary, the ability to use a "birth ball," to walk around, to squat, to use gravity to my advantage--and she assured me that all this was possible. But as soon as I got off the elevator to the maternity ward, all of these options disappeared. On my back with an epidural, I had lost control. I didn't have the strength to push back against the system, on my surroundings. It's very easy, in a hospital setting, to just do what doctors and nurses expect you to do.
When I arrived I was in the most painful part of labor, what my childbirth-class teacher had called "transition." I cried out in pain, I was offered an epidural, and I said yes. I was shaking and I could hear the anesthesiologist behind me say "I can't do this. She's moving around too much." After a few more contractions, I was ten centimeters dilated, but she tried again, and succeeded. By the time the numbness washed down my legs I was pushing. I listened to the nurses for their cues: "Push," "Stop pushing," "Push." I had no feeling from the waist down. A doctor I did not know came in for what felt like three seconds to do a routine episiotomy, catch the baby, and stitch the incision. My husband and I were so happy--our first child had arrived and was healthy! After the nurse cleaned him up I was able to breastfeed him, and then they placed him in a bassinet.
On the one hand, the labor and delivery went easily, and I had little to complain about. My family and friends listened to my birth story with delight: my labor was only eight hours long. The delivery was uncomplicated. The baby was born healthy.
On the other hand, I must have felt some lingering discomfort with what had happened, because a few months later I was thrilled to find out that someone I knew made a living as a home-birth midwife. Her name was Audra. She had an easy smile and a genuine warmth. I had met her at a "tot shabbat" service at our synagogue. As our babies played on the carpet in one of the classrooms, I asked her about a hundred questions about her job: How long had she been a midwife? How many births had she attended? How did she feel about birth centers? What did she do when something went wrong at someone's home?
Audra answered all my questions, pointed me to online resources, and told me that our mutual friend Linda had hired her as a midwife for her second child's pregnancy and birth at home a few years before. The main reaction I had to Linda's story was to think, this decision to have a baby at home is not a crackpot-hippie idea. Above all, I respected Audra's intelligence and experience, her warmth, wit, and confidence.
According to Soranus of Ephesus in the 2nd century,
a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips...the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child[1]
Although judging a contemporary midwife along 2,000-year-old criteria might be ridiculous, I found myself agreeing with Soranus of Ephesus, and thought Audra actually did possess these attributes. (Layman's source of least resistance: Wikipedia's article "Midwifery.")
I thought to myself, going to the hospital (a place I associate with sickness and death) does not seem necessary for a low-risk case like me. Plus, what better way to support my little community than to hire a member of it to be my midwife.
Then I watched Ricki Lake's documentary, The Business of Being Born. I was struck by the interviews with maternity nurses, all of whom admitted to never having witnessed a birth "without medical interventions," whether it was induction, epidural, episiotomy, or the more drastic foreceps, vacuums, and c-sections. For millions of perfectly healthy people across the U.S., a natural process (vaginal birth) had been turned into a medical event, and the beneficiaries were not women and their newborns; they were hospitals, doctors, and insurance companies. By the end, I was fully convinced. My next baby would not be born at a hospital unless something was going wrong and required medical intervention.
• • •
Take a short walk with me down decision lane: my mom's experience leads to fear of birth, and the hospital becomes an inevitable decision; my loss of control in the hospital leads me to think harder about my choices; I meet a midwife in my community; I watch a documentary.
When I became pregnant with my second child, I asked Audra to be my midwife. Although my insurance wouldn't cover the cost, it was worth the $3,500 to support Audra's livelihood and to push back--symbolically if nothing else--against a system that encouraged the monetary incentives hospitals and insurance companies have to medicalize birth through ubiquitous use of interventions, drugs, and so on.
The decision was only hard because I knew how my mom would react. In all other ways, it was easy, because I knew I would be in good hands, that statistics were in my favor, and that times had changed.
• • •
The experience itself was very different from the hospital birth--so different, in fact, that when asked, I could hardly compare them. From my hour-long appointments with Audra to ordering the "birth kit" online to the birth itself--controlling the physical position I took depending on how I felt and the phase of labor I was in--having a baby at home was a whole new experience. In a few of our conversations, Audra and I discussed possible reasons to switch to hospital care. If any signs of distress in the baby or me had occurred, either before or during labor, we would have gone to a hospital--where doctors and nurses have the equipment and knowledge to do surgery under anesthesia. I knew I could trust Audra to make smart decisions under pressure: There's a rationality and a calmness about a good midwife that Audra has in droves. (She herself had planned on giving birth at home to her daughter, but ended up transferring to hospital care after she developed complications.)
The night I went into labor there was a fantastic snow storm, and I was so relieved that my midwives would be traveling to me instead of me getting in a car and fighting rush hour toward the hospital. Audra and her assistant monitored my blood pressure and the baby's heart rate at intervals throughout, but they let me labor on my own. This was hard for me. I didn't know what to do with myself, and the pain was incredible. At around 7 am, my neighbor came over to pick up my son (who had woken up, eaten breakfast and watched TV for an hour) and keep him occupied at her house. She stamped her snow-covered boots in the doorway, hugged me, and rubbed my back as I went through a rough contraction. I climbed the stairs to my bedroom, and after another hour or so of pacing the hallway, got down on my knees and put my elbows up on the birth ball.
Instead of a hospital gown, I wore my husband's orange Mogwai T-shirt. I breathed deeply, holding his hand. I took a warm shower. I squatted on the wood floor, the pads of my feet bearing my weight as I rocked back and forth. After about six hours of labor and an hour of pushing, I gave birth to a beautiful baby boy (his fist touching his pink cheek) and collapsed on my bed, exhausted.
I began to breastfeed my baby before his cord was cut, before the placenta had even come out, during what's considered the third stage of labor. This was a practice I had read about in researching home birth, and it was more intense than I had imagined. As my uterus contracted to push out my placenta, what I can only describe as level-ten cramps clenching me from inside my abdomen took hold of me. And I could feel the slick bumps of the umbilical cord on my belly as I propped myself up on my elbows to bring my minute-old baby's mouth to my breast. It was a bizarre moment: He was still, literally, attached to me. Yet he knew what to do right away--and as this was my second child, so did I. It felt so good to feed him; I was overwhelmed. The contrast of the searing pain below and the soft, quiet newborn suckling above brought me to tears.
After the baby had nursed for the first time, Audra measured and weighed him. She examined him, and examined the placenta closely for rips or signs of hemorrhage (the likeliest reason we'd have to transfer to the hospital). Everything was perfect. We all cried and hugged and took pictures. Because I had torn a bit, Audra stitched me up.
• • •
Being with the new baby at home during the first few postpartum days, I was surprised at the ease of sleeping in my own bed and taking care of my own recovery--but also of how hard it was to do it all ourselves. My mom and dad and sister came to visit, and they helped be my nurses and aides. It felt lovely to be taken care of by my family rather than a swarm of anonymous medical staff, but it was also difficult to demand help from my family when I needed them. I found myself calling downstairs, "Hello, anyone there? Can you get me a glass of water, please?!"
Audra visited me the next day and three days after and a week after that; then we had a six-week postpartum checkup. We did find that I needed additional sutures. I made an appointment with my old OB and as she put in the two stitches, she said that she sees this all the time (with hospital births) and that my midwife had done a fine job. I healed up in no time.
• • •
I'm often asked, "Would you do home birth again?" I would. It's hard to explain, but as my home-birthed baby comes up on his third birthday, I am starting to realize that it is both the oddness of home birth and the naturalness of it that has stuck with me. It's earthy and it's real--but it's not stupid.
I've read several anti-homebirth articles, seen horror-story clips from the evening news, and listened to radio shows purporting to show both sides of the issue--that begin and end with dead babies. The reason the sensationalist stories get air time is obvious: more eyeballs equals more ad money. People enjoy getting incensed and they love tragedy. The truth is that babies die in hospitals, too--of infection, complications, mistakes, and for all kinds of other reasons. Where's the eyeball-popping coverage there? Sure, there are unqualified midwives--just as there are plenty of bad doctors. And there are hundreds of hospitals that are only now starting to crack down on bacterial infections due to lack of basic hand washing.
When I finally got up the courage to tell my mom I was planning a homebirth, I got the reaction I was expecting all along. She was worried and thought I was making the wrong decision. She started sending me dead-baby stories by email. Audra offered to talk to her on the phone. My mom, who has been a doctor for over 30 years and has never witnessed a natural birth, had to ask her about contingency plans, tests, ultrasounds, lighting, and what we'd do with the placenta. At least some of what Audra told her allayed her worst fears, but my mom did not want to be with me this time. And maybe because of all the one-sided media coverage, I think she was still picturing me in a black-and-white movie, with someone yelling for hot water.
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