Two things in the mailbox today: a school district newsletter and the following, a birth announcement and thank-you letter from one of the women in my childbirth classes.
This young, Amish woman had a longish, tiring home birth with a sick baby who needed to transfer to a local NICU.
Her humble, self-sacrificing sentiments are, well, priceless.
I hope you see the beauty in what she writes, in her obvious transformation from young woman to *mother*.
~~~
August 30, 2010
Stephanie,
Hello! How are you doing? We are doing great. It's hard to believe that almost a week is past since baby [name, boy] was born. We came home from the hospital yesterday afternoon.
Thanks a lot for being here with us the other night. It helped me to not feel as much like giving up. I was so tired and worn out that I really didn't care much about anything, even when [midwife] told me how far I was dilated already. But it was all worth it. Thinking back, it just seems kind of like a dream.
[Baby Boy] was born at 10:13 a.m. - weight 8 lbs 8 oz, length 21". He has a nice amount of dark brown hair and bluish-gray eyes. Everyone says he looks like me or my twin brothers.
I had quite a time to get him started nursing. I wasn't allowed to breastfeed him till the second day, so I was pumping me out. He nursed real well the first two times, then after that he just pulled away and started crying. We tried giving him a bottle, but he refused that too. The doctor was very concerned then. They put a feeding tube down his nose and suctioned out his stomach and found out he wasn't digesting the milk. Now every time before I fed him, they would suction him out, then I would let him nurse as long as he wanted to, give him the bottle, and go pump me out. Usually by the time round one was done, I had to start all over again.
He was scheduled to eat every three hours, 24 hours a day, so I just about got no sleep. But I was determined to do it if that would help him.
On the fifth day, they let me feed him whenever he acted hungry, and I didn't have to give him the bottle anymore. He did good after that. :-)
Well, [Baby Boy] is taking a nap, so I should try to get one in, too.
Thanks again. I might call you once I am able to go to the phone.
Hope all is going well for you!
Your Friend,
Her Name
(Husband and Baby Boy too)
:-)
Thursday, September 2, 2010
Wednesday, July 28, 2010
Gender, Conducers and Decisions
First of all, that's not my belly. You might get to see my belly in future posts, but it won't be that flawless.
...
So.
It's an innocent enough question of an expectant mom: "Do you know what you're having?"
It's a question I fielded the other day.
Setting sarcasm aside - "Well, yes. I'm having a *baby*. You know, a human baby?" - the answer to the question just *compelled* me to first examine the question and its attending issues.
When most people ask that question, they're asking if the mom knows the baby's *gender* - boy or girl?
And so many expectant mothers know their babies' genders these days that you're hard-pressed to find much other than pink or blue in the Target baby section.
Well, how do we know - or guess - the gender of our babies?
[For the record, there's another compelling issue here: Do we *want* to know or *need* to know the genders of our babies? That one's for another day.]
In a "Little House on the Prairie" episode we have on DVD, a soothsayer swings Ma's wedding ring in front of Ma's belly and predicts, "Boy." (She's wrong, by the way.)
Here's what I read about that at babygenderprediction.com: "This is an easy baby gender prediction method to try. Take a pin, needle, or wedding ring and attach it to a thread or strand of hair. Hold the dangling item over mom to be's belly while she is lying down. If the needle or wedding ring swings in a strong circular motion, you will be having a girl. If it moves in a to and fro motion like a pendulum, you will be having a boy."
Whatever.
Still, there are other non-scientific ways to predict:
> Baby's heart rate. It's said that higher = girl; lower = boy. (The midwives for whom I work sorta cluck and roll their eyes at this one.)
> Drano? Yes. Mix it with a second-trimester pregnant woman's urine, see what color the *toxic* product turns. Darker = boy. Lighter = girl. (Please do not do this.)
> Plain-old mother's intuition. I've seen it work both ways. "I just *feel* like it's a girl," one mom says emphatically. She drapes the room in pink and, in her mind, has her "Hannah" in bows and patent leather. Then this big, obvious *boy* comes out screaming at her. (But there are intuitive others who have been simply *right on* - you know they really *did* know.)
An almost certain way to know would be to sample and screen amniotic fluid - getting genetic markers on the baby. Most care providers wouldn't order such an invasive test ("amniocentesis") *just* to determine gender. But if a woman's having that test anyway, she could find out.
Get on with it, right? I know you're all rolling your eyes and saying, "We *know* how to know the gender, Steph! We get an ULTRASOUND."
Ah, right. That's where I'm headed.
So I said asking "Do you know what you're having?" is an *innocent enough* question because most pregnant women in the United States at least have the opportunity to get a good guess at their baby's gender via ULTRASOUND.
They get, essentially, a sneak peek at their babies and trust the tech or the radiologist to decipher the images well enough to tell - labia or testicles?
In fact, in recent years, routine ultrasound has been rolled into most maternity care packages (not my maternity care package, but I'll get to that). Working women tack their ultrasound prints to their bulletin boards or computer monitors. Many e-mail them or post them on social networking sites for family or friends to play back or look at. I couldn't tell you how many births I've been to where, when I've gone for the second-stage apple juice elixir, I see an ultrasound print stuck to the refrigerator door.
And if I've seen one ultrasound Facebook profile picture, I've seen a hundred.
Ultrasound is not routinely done *just to* guess at gender, though. (And, yes, it is somewhat a *guess*. Techs are usually right, but not always.)
For the most typical maternity model of care, ultrasounds are offered (or "ordered") around 18-22 weeks for, according to ACOG:
Age of the fetus
Rate of growth of the fetus
Placement of the placenta
Fetal position, movement, breathing, and heart rate
Amount of amniotic fluid in the uterus
Number of fetuses
Some birth defects
Sounds about right. Have you ever had one or seen one? They're pretty cool. While the transducer's on your belly capturing images (with goopy gel in-between you and it), the tech rolls this ball back and forth on a computer keyboard, taking measurements of the little guy or gal. The tech measures everything from the simple length of the baby from crown to rump to the space inside the baby's head. It's fascinating.
(For a science nerd's hisory of ultrasound, check out this link.)
But what *about* ultrasound?
Getting an ultrasound is fun, there's no doubt. And it can provide some necessary medical information, sure.
In my second pregnancy, I had several, as my care provider was watching a bleed. I was grateful for the technology then, as it was reassuring to see a pinprick of a heartbeat at 6 weeks and an obvious baby boy - and no more bleed - at about 18 weeks.
But I had no ultrasound with my second baby. Not that I couldn't have. Home-birth CNMs can order them - midwives really do work by more than lamplight and incense - but together we just never could come up with a reasonable enough need to get one.
See, all those things listed above that ultrasounds look for are often either a) usually obvious in other ways (like twins or fetal position) or b) not really necessary to know prenatally (birth defects) or c) *inaccurately* assessed.
Let me step aside for a sec and address "inaccurately assessed." You may never have heard this, but I have dozens of times: "The ultrasound showed I was having a big baby, so I had a c-section at 38 weeks." Only she had ... a 6-pound baby who had a hard time breathing.
Or another I remember: "The ultrasound showed my baby might have lesions on his brain. We worried through the whole last half of my pregnancy. But he was fine."
Needless surgery. Needless worry.
Wow.
Even docs (usually) readily admit ultrasound just isn't always accurate, particularly on sizing and dating.
So as I've considered an ultrasound for this pregnancy, I've asked two main questions:
1. Is what the ultrasound offers - mostly *information*, as ultrasound is for assessment, not treatment - greater than its risks?
2. Related: What are its risks, and has it proven to be safe?
Here's at least an informal party line from ACOG.
"Many parents enjoy having these moving portraits. However, not much is known about the effects of repeated exposure to ultrasound. It seems to be safe, but it is possible that problems could be found in the future.
Moreover, the workers at these centers often are not trained to interpret the images for you. Based on the ultrasound, you may be falsely reassured that your baby is doing well, when in fact there may be a problem."
[If you want to later, you can read the full text here.]
That line, "It seems to be safe, but ..." bothers me. I don't like buts.
I've seen babies visibly cringe at the ultrasound. It is, after all, a barrage of sound waves. (Note, ultrasound is *not* radiation.) I have to wonder if it hurts his or her ears - or other things.
I wonder if it's one of those things - like new drugs can be - that seems harmless. Only years later, as in *retrospectively*, we'll see it did a lot of damage.
In my own case, I would consider an ultrasound - for which I would pay cash out of pocket - to determine the placement of the placenta. After all, I have a cesarean scar, and placentas can stick to cesarean scars, causing hemmorhages.
But I'm not sure the benefit of *knowing* where my placenta is outweighs the risks of ultrasound, which are a bit unclear.
My *emotions* want an ultrasound. Ultrasounds really are fun, and it's such a pleasure for mom - and for dad, especially - to make a visual connection with a largely *conceptual* baby, eh?
Still, I can't see consenting *just* to know something that my midwife and I already know is possible (that the placenta *could be* on my uterine scar). We can just prepare for that complication in case.
And as for gender, well ... I read a study about Orthodox Jews who follow a certain set of Levitical laws regarding women's cycles and marital relations. See, those Jews were having more *boys* than girls, and someone wanted to know why. Turns out, most of the women conceived early in their cycles. I conceived early in my cycle - thus my surprise. Early conception = boy? Dunno.
Next time I'll write about *knowing* ...
Saturday, July 10, 2010
Expectations
Sadly, it's been nearly two months (*again*) since the last post. Hmpf.
We'll, I'm here now.
I've assisted at several exciting births, of course - a few older (my age - 35ish) Amish women having their ninth or tenth baby. They sort-of walk around and chatter until they decide they want to lay down. Then we hear a grunt or two - maybe a stifled yell - and leave our paperwork and sweetened garden tea at the kitchen table to catch the baby. I can't think of how these births could be more simple or beautiful.
I won't talk about one birth too openly except to say it was *spectacular* to watch. It endeared the midwife to me even more, though I hadn't thought that was possible. See, my midwife friends routinely spare women from surgery. THEY SAVE THEM FROM SURGERY. If you don't know what a big deal that is - to be spared from unnecessary surgery - ask me, and I'll tell you. Women in the United States get cesarean sections like they're the latest cosmetic procedure. It's awful because c-sections are MAJOR ABDOMINAL SURGERY and should never be done flippantly. To be spared from one because a midwife's willing to put a few more hours in or think creatively is simply *love in action*. (I won't get started.)
Despite the frightening state of the majority of maternity care in the United States, I remain pregnant with wonder, excitement and awe as I consider more birth work in our 1 percent of the birthing world. Oh, and I am also pregnant with child. Yes! I said that! At 38, with three super children already, and having just started school for an RN, I am pregnant.
About 8 weeks. (That's early and puts the baby due in February 2011.)
I decided to put it here because if this pregnancy will be anything, it will be a learning experience for me and others. In fact, that's part of the "vision statement" I put together with the help of colleague and pregnancy coach Deb Rhizal. I feel like a living classroom.
So if you're interested in learning as I go along, feel free to join me. If you have any interest in women's health, pregnancy or childbirth and want a live, willing mother to query, I might be she. In the mean time, I plan to do much querying myself. And when I have questions - the same issues about which I often teach in prenatal classes - I aim to get answers, deep answers, so I might better appreciate and understand this awesome thing happening inside of me.
You'll get to meet my midwife, Kate Shantz, CNM. She's a mentor and friend and a gentle midwife. (But she has short fingers, so we'll see about vag exams.) We'll be taping lots of visits - and the birth. We'll be addressing lots of issues.
So one of my first questions was about caffeine. I *really* like coffee. No matter how hard I looked, I couldn't find and rationale for having three or four cups of strong coffee a day when pregnant. (Don't get on me about it - I know caffeine isn't all that good for you in large quantities no matter what.) Seems the caffeine issue for pregnancy is two-fold: vaso- constriction for mom, which reduces blood flow to important places (like the placenta) and the baby's inability to metabolize caffeine sufficiently. Sigh. So I'm down to one cup a day and have purchased decaf.
Check out this article.
I'll be looking a lot at diet in the next few weeks. I'm curious about the *optimal* pregnancy diet, one that has virtually no sugar and few carbohyrates in it. I'm all for weight gain but not as excited about *fat* gain, and I want to learn the chemistry of how to avoid that and still get the baby what he or she needs. If you have resources you want to share, share!
In the mean time, I'm waiting on two babies. Both are "overdue" ... whatever that means ... and both will probably come within the same day, as I've found birth comes in clusters. I'm anxious to see how I'm affected by attending others' births while I'm pregnant myself. I'm hopeful to be ever-more mindful and compassionate.
I'm expecting big things, here.
Thursday, May 13, 2010
She let down her hair
It's been a gazillion years - two months - since I've posted. I've been ramping up. You see, I really *am* a writer. Seriously. By training. By trade. But it's been way too crazy busy to write with any quality - or even consistency. I anticipate that will change.
Some major transitions these days: geographical move, fewer births likely as I start ... SCHOOL. College, that is. (It'll be my first official college class since 1994. I'm easing in gently with a 6-week sociology course and then - yee-ikes - a chemistry class I hear is, well, challenging in its accelerated format. Here goes relearning how to study, discern and PASS TESTS. I need As - straight As - if I'm to go on the way I anticpate doing so.)
Anyway, I hope to write more often and better.
ON to more interesting topics. Here are a couple of morsels from a recent birth experience:
I had the super privilege of attending a hospital - yes *hospital* - VBAC with midwife extraordinaire Laura and her sweet, if not slightly eccentric, Old-Order Mennonite client who let down her entire head of NEVER-CUT hair for her husband to brush and her to repin as she sat upright in a hospital bed. Her uterus contracted - little of which she felt, thanks to one of those when-it-works-it-works-wonders epidurals - and her hair was superbly redone. She even wore her white covering (you who don't know about "Plain folks" call them "bonnets") until she started sweating too much.
Certainly her hair wasn't the cornerstone of the experience. Her VBAC was. Her gentle but firm tenacity was. I likely could have cried when she so politely said, "Well, I really want to have a vaginal birth" to the doctor who would have cut her a c-section at the slightest murmur of such.
A couple more thoughts about this birth:
One, this experience simply cannot be mentioned without mentioning the tightie whities. Yep, underwear. (Hey, it's all part of the homebirth experience. This client was a homebirth transfer to the hospital, but we started her care in the old farm house down the looooong lane.)
This dad was especially sweet, caring and supportive. But he was such in his *tightie whities* and "#1 Dad" T-shirt *only* and did not, apparently, care that we were there to witness him that way. Thankfully, he kept dressed at the hospital AND nothing fell out when we got too close for comfort kneeling down to get heart tones.
Secondly - and I wished now I'd taken a picture - I'll fondly remember the midwife and the doctor sitting Indian-style on the floor while the mom pushed on hands and knees on that dreaded hospital bed. (I really dislike hospital beds as a general rule. I wish they weren't so highly revered in the birthing room.) You have to hand it to this mom. She had an epidural and near "dead-weight" legs but flipped over to her hands and knees, "if you think that will help," she said to me. (I'm tellin' ya, VBACers are usually highly *motivated*. I would have stood on my head had my midwife told me to and it meant not having surgery again. Oh wait - I did. My daughter was breech for a while, and I did handstands in the high school pool.)
Oh digressions!
Anyhow, seeing the doctor and midwife sitting and watching this precious woman working her baby down was cool. I *soooo* wished the OB would have walked in and seen them. It was as birth should be: a room full of women - we just happened to all be mothers about the same age, too - treating this birth with the casualness that says, "This is good. This is normal." I loved that the care providers weren't jumpy or anxious, and I enjoyed a mild amusement at what likely was a little surprise on the nurses' part. (Um, they just don't typically see doctors in street clothes sitting Indian-style on the floor while anesthesized women who've declined a repeat c-section in favor of the vaginal experience push on their hands and knees.)
I.Loved.It.
I hear no one wants to read long blogs, so I'll stop now and hope to start shaping this writing into interesting, relevant works in the future.
Catch you later.
Wednesday, March 3, 2010
Happy to report the baby born in my previous post is healthy and happy, though she's not receiving breast milk thanks to trauma to the mother.
ALSO, the client's twin sister, who's expecting her first baby in a few weeks, has decided to change her care provider and setting for birth. (She'd been planning the same as her sister.)
I was thrilled to visit them today at home and find them talking, crying, laughing and loving on the baby.
Mother is also resigned to never-again seek out the care and services of this provider - and if that's as far as she ever gets (along with potentially sparing her own sister from disaster), that'll be a great gain.
There are blessings in pain.
Friday, February 26, 2010
Here's Why
So when you're a home-birth birth junkie sort-of type - like me - it's safe to say people assume you just don't like hospitals. Or maybe you just don't like doctors, male doctors more specifically.
They might conclude you had some bad experience in your childhood and can't get over it. Or that maybe you're a femi-nazi type whose fist is raised at the patriarchal establishment of the women's health arena.
Maybe they think you're a ridiculous hippy type trying to turn childbirth into some incense-and-music spiritual experience.
Well, none of those fits me. And I don't really care too much what people think.
But here is one birth's worth of why I hate hospitals and the attending practices for birthing babies:
> Day before birth: Clients arrive *not* in labor. No one suggests - save me - that they might go home instead of succumb to a bunch of medical stuff done to a perfectly healthy woman who's not going to have a baby any time soon and needs only to sleep if she can.
Thankfully, the clients go home.
> Clients arrive at the hospital the next day in decently active labor after an office visit with her doctor, who didn't ask who I was or introduce himself to me. (He also performed a visibly rough vaginal exam, likely stripping her membranes without her consent.) The nurse is friendly enough, though she doesn't acknowledge the dad or me - never asking or saying our names at any time during her shift. This nurse literally ignores my questions completely, perhaps feeling threatened or otherwise uncomfortable with someone asking for anything outside their standard protocol - like an explanation of risks and benefits, even.
> Wait - the nurse did answer me once. It was a terse "No" when I asked if the client could wear her own nightgown. She didn't explain why not.
> The client is informed - not asked or given counsel so she can offer her informed consent - of what will be done to her. That includes vaginal exams, continuous electronic fetal monitoring and the inability to eat or drink anything beyond ice chips. [Aside: It's estimated the average labor and delivery burns 32,000 calories. Sure, it makes *complete* sense to not eat or drink. Sarcastic eye roll.] This is a completely healthy mom with no risk factors.
> The nurse does not explain why continuous EFM is now ordered when before it hadn't been. The client is confined to bed or to the two feet around it. Well - except when she uses the bathroom, which I'm now thinking she should do quite a bit, locking the door behind her. Studies show there's a higher likelihood of cesarean section in women forced to be on the continuous EFM.
> After a gazillion questions - asked and attempted to be answered through painful contractions - the nurse gets IV access with ease and starts running antibiotics after explaining how scary Group Beta Strep is but offering no explanation about any risks of antibiotics or alternatives. Nothing is presented as optional.
The nurse introduces her shadowing nursing student, who looks terrified.
> Finally, the clients and I are alone - and for a decent amount of time. At first I think, "Wow, they're not even checking on her." And then I think, "Cool. They're not even checking on her." (The more they "check on" people, the more likely interventions become.)
> I step out to get the dad a cup of awful hospital coffee. As I'm pouring it, I overhear the nurse teaching her student how to watch a woman in labor. They're staring at a computer screen that monitors contractions and fetal heart tones - a computer screen at the nurse's station. Let me say that again: They're staring at a *computer screen* to learn about women in labor. I almost cry as I realize this nursing student is not going to learn how to feel a woman's belly or look into her face to assess labor. Instead, she'll learn how to read squiggly lines on a computer monitor. So sad for the student and her future clients.
> And so the clients and I labor. The client's getting distant. She looks like a woman in labor but with an added dimension - like a woman who's been through some kind of trauma. She's withdrawing, I can tell, and I'm not sure, precisely, how to help her. I'm struck - and not for the first time - about the differences how a woman is treated and the environment around her can make. At home, this woman would feel safe. I can tell that here, she does not. Her fears later prove valid.
> The client endures several more announced - not asked-for - vaginal checks and is told she's making some progress but not very much. It's a subtle detail, but in reality she had labored very well and made fine progress, slipping a bulging bag down through a cervix whose dilation number - only *one* factor to assess "progess" - hadn't changed much. When the nurse leaves, I give this precious, young, first-time mom my best pep talk ever.
> The unspoken tension begins to build. We all know the *doctor* - who has had no contact with his client since the rough vag exam in his office many hours ago - is coming shortly. If there's not more change, he's "not gonna be happy about it," something he'd told the client earlier. Now I'm thinking about my midwife friends. Never in a million years would they put that kind of expectation on a woman, recognizing the processes of labor and delivery are not about pleasing anyone - least of all the baby catcher.
> A half hour before shift change, the nurse announces she'll be doing a vag exam because she has to give "report." Just for kicks, I firmly ask the client, "Is that OK with you, M?" The client breathes out a resigned, "OK." The nurse ignores me.
> Once the nurse leaves, I tell the client I think we should work on a couple of positions to encourage the bag of waters to break. She's quiet but compliant. She's tired. I simply unhook the monitors - Just let them come running in! - and walk her around the room. She collapses into a hanging squat into her husband's arms during contractions.
> New nurse! She's perky and friendly and I know we need to like each other. Of course she needs to do a vag exam. I downplay the invasion by explaining to the client that each person's assessment is different and this nurse needs to get her own baseline. And yay and yay! That movement helped, as the mom's now a nice 8 cm. The client offers the briefest of smiles on her flushed face. It's the first one I've seen in a long time. Wryly: I'm so glad to know we'll make the doctor happy.
> But when he - the *doctor* - comes in, I can't tell he's if he's happy or not. HE SAYS NOTHING TO THE CLIENT. He goes directly to the computer, dons a glove, asks for an amniohook, plops himself at the end of her bed and breaks her bag of waters without even *telling* her what he's doing except to say, to no one in particular, "Let's get this done." I notice she jumps whenever someone touches her "down there" without telling her, and I get a sick feeling inside. He peels off his glove and leaves the room.
> In fact, everyone leaves us alone again. I'm glad but struck by the fact that this is transition, one of the hardest parts of labor. At a home birth, we'd all be next to the mom's side, as this is when she'll likely start to feel scared and doubtful - among other things. The client lays in bed and labors. I tell her husband to talk to her and tell her she can do it. I'm leaving for a few minutes to let them be alone.
> When I come back in after a few painful minutes, I notice both mom and dad are crying. It's not really the time to process it, but I wonder if they're feeling violated - not feeling just the normal transition stuff. This doctor, after all, had delivered this woman 21 years ago. I had hoped he might show her extra care because of it. My hopes were in vain.
> The client labors through. She's doing well, and I'm so glad no one's coming in.
> Alas, they do come in, and I'm again disgusted how no one has *ever* asked the client if she wants a vag exam, only announced that's what they'd be doing. So the nurse - though she's friendly - announces such and commences. She doesn't tell the client what she finds, either, only says she needs to contact the doctor to see what he wants to do. Argh. In midwifery care, we consult the mother's *body* to see what it wants to do. Then we follow *it*.
> A couple minutes later, the nurse pushes back in the room and announces, "Dr. So-N-So wants you to start pushing." I frown, holding back my sarcasm. I'm thinking, "Who gives a flip what he wants? She doesn't have the urge to push." The nurse's declaration means the client is likely completely dilated, but she doesn't tell her so, which would have been a great encouragement. So I tell her so, not even sure I'm right. (But who would suggest she push unless she were completely dilated, right?) Then I say, boldly, "I think she should get up to use the bathroom one more time before she starts." I'm buying time and hoping she'll get the urge on the toliet. See, she doesn't have the compulsion to push yet, and I think she could have benefitted from the "rest-and-be-thankful" stage I theorized she was getting. Further, they'll chart the onset of pushing too early and - heaven forbid - won't "let" her push too long. As she sits on the toliet, I stand between her and the staff chattering on about the break she's getting and how there's no rush and (to the client) you don't have to push if you don't want to. I go on and on about how her bladder should be empty to make room for the baby. I probably talked about the weather.
> But I only buy about 10 minutes until the nurse is ansty and wants the client back on *the bed* to start pushing. And so she does. Right away I catch on that - though she's nice - we have a "purple pushing" nurse. Crap. The client is so tired, and I'm suspicious she doesn't really have the urge to push. TURNS OUT, after the doc comes to check her, THAT MY CLIENT WAS DOING ALL THIS AWFUL PUSHING AGAINST A CERVICAL LIP. I want to *scream* when I hear that. My sweet client was too tired or too naive or too traumatized to speak up about what must have been excruciating pain. Dammit! Once the doc - who heretofor had been reading the sports section at the nurse's station (not kidding) - pushes back the lip - also without permission or explanation - she makes progress. By now the client is so battered I'm trying not to lose her and praying hard she gets the strength to get done before things go south.
> So she pushes. It starts to feel a little more normal. She passes stool (yay!) and there's obvious progress, typically slow for a first-time passage through those bones. The doctor peeks in and, apparently, sees enough head to want to stay. I'm just wishing they'd all get called to an emergency or something and I could accidentally catch the baby while they were gone. Maybe I and the nursing student - who looks ever more terrified.
> There's this big awful flurry and the doctor dons his HazMat suit, joking, "You know it's serious when I put this on." At first I think, "I much prefer jeans, a T-shirt and bare feet," but after the third-stage hemmorhage he likely caused, I get why he needed it.
> Mom does some great pushing. She's found that last surge of strength and she's doing it. The doctor keeps reaching over and touching all his instruments (um, they're supposed to be sterile), and I'm especially eyeing his scissors. If he starts to cut her, I'm going to cry out. I don't care what they say. She's stretching beautifully, in spite of the fact that she could have used a hot cloth and some oil. I wanted to touch her so bad, and I prayed that her good nutrition will be enough to keep her tissues intact.
> Finally, a head. Routine suctioning on the perineum, but I expected that. Then the baby. Not given to mom, but held in the dirty-gloved hands of the doctor who says, "Don't worry that she's not breathing." He actually said, "She'll breathe when I make her breathe." I've worked with a lot of doctors and often joked about the "God Complex" some of them have. Oh, doctor, you might have caught 3,000 babies, but it is not you, sir, who authors the breath of life. There is One Who has All Power, and you are not he. So the doctor roughs up the baby, finally making her cry. I said in my sweetest baby voice, "You tell that doctor how mean he is. You tell him."
> After what seemed like days later, mom finally gets to hold her baby, which they've already announced is a girl. (At home births, we don't announce it but let the couple have that special moment of discovery themselves.) The doctor bullies the dad into cutting the cord. The dad had said ahead of time he didn't want to. I spoke up and said so. The doctor said, "Come on! No, really! Come on!" The dad did it reluctantly while everyone clucked and cooed. I just hoped he wouldn't faint. The staff didn't know this dad had witnessed a bloody death of a friend after an accident and was not interested in cutting the cord. I wonder if they would have cared. Besides, not everyone wants to do it - it's not that big of a deal - and it floors me why they would push it so.
Here's where it gets awful.
> I watch the doctor drain the umbilical cord of the rest of its blood and think, "That should be going into the baby. Why is it going into the trash?" Whatever. He reaches for a hemostat and clamps the cord, and I just know he's going to pull on the placenta. He starts telling the nursing student he learned not to pull on the cord because the cord could break. And I throw in, "Yeah, and you can cause heavy bleeding if you pull on the placenta." I don't think he hears me. AND YET, the doctor says, you *can* pull lightly with steady pressure. I'm thinking, "Yes, if the placenta's separated." But if it's not ...
> So he's does his steady pressure thing, sometimes known as controlled cord traction, and Mom starts to bleed. I ask her, loudly, "Are you having a cramp?" Turns out she was. So he pulls and pulls and out comes the placenta. Mom's already been given pitocin in her IV (without her knowledge). He reaches in. Nurse pushes hard on her belly - all with no one explaining what they're doing, why or why it hurts. She's obviously in agony.
> So she bleeds. And bleeds. And bleeds. He quick does a single-stitch repair with no anesthesia and without telling her. (I had to tell her.) I'm sick. She might have opted for no stitches. She might have liked a little lidocaine, which the doc later said takes too long to wait for to work.
> She keeps bleeding. He announces, "You're not making me very happy." If I hear that one more time, I might smack him, but I realize I need to keep my cool to help mom, who's heart is beating 150 times per minute (twice as fast as it should be) and whose blood pressure is 80/64. The nurse is looking nervous and asking, "Should I start her IV?"
> The doctor then does things I can only describe as horrendously painful. He reaches in the mom, scrapes and scrapes, pulls out blood clots and placental tissue. He uses instruments, barking at the nurses to find larger ones so he can really get in there. He must have done, essentially, a D&C (without the "D" as she was already dilated). It was awful. And he had dirty gloves (like dirty with baby poop). Apparently, pieces of the placenta were retained. The doctor ruminates about a septum, a bicornate uterus, tough uterine wall and, basically, everything but the obvious: He'd pulled on the placenta, which likely left some of it sticking there.
> The mom tolerates this as best she can. It's like having surgery without any anesthesia. I'm cringing. The nurse is cringing. The doctor's babbling on. The mother is about to pass out. When I comment about how much it hurts, the doctor actually says, "Well, my hand is a lot smaller than that baby, and she just pushed the baby through there." Even in retrospect, I think, "Does this man *really* not understand?" Bizarre.
> In the mean time, another nurse has taken the baby. I see her giving it shots, administering antibiotics to her eyes - all without consent from the parents. Dad is a bit shell-shocked, roaming from baby to mom, not sure what to do. I'm holding mom's leg, which, on top of the other torturous things happening to her, is cramping up.
> Finally, the doctor announces he's "happy" with mom's bleeding, or eventual minimalization of. She's lost 1,000 ccs, he estimates. (That's a lot.) I'm thinking about her recovery, her ability to produce milk. Dammit.
> The doctor turns to the nursing student. "Usually I'm long gone by now," he says. "This one's just giving me a hard time." Mom, whose eyes are puffy and who looks simply awful, gives a trite smile.
> Oh, one more thing, he says. With all his "messing around" (his words), he's busted open the stitch he'd put in and needs to redo it. He figures he could wait a long time for a little lidocaine to kick in or just get it done quickly without it. By now, I believe my client was so traumatized she didn't care what he did to her. "Do whatever you need to do," she croaked out. I want to scream. With a little common-sense prevention and compassion, he likely wouldn't have needed to do a lot of what he did.
> Back when he'd been tugging at the placenta, I'd been working to get the baby latched on to no avail. I thought again of the quiet, gentle home births I'm more likely to be at. We're at least 90% successful at helping babies latch in the first hour - with or without some "management" of third stage. Now the baby was alert and in the arms of her father, but mom was so wiped out, I whispered in her ear, "Wait until a little later. Ask C. [the nurse] to help you. See the lactation consultant in the morning."
> I got my things and excused myself quietly. I needed to get my children and get home. The dad looked at me, his dark brown eyes pooling. He shook my hand, his grip lingering a bit, and said, "Thank you for all you've done."
We have so much to talk about.
> I walked briskly past the nurse's station, where the doc was back to the sports section. He didn't look up. I didn't strike him.
> But I did hit my midwife friend's number on my cell phone before I left the building, knowing she was at a home birth right then. "Hi," I said to her voicemail. "I hope you're in the middle of a great delivery. I have so much to tell you."
They might conclude you had some bad experience in your childhood and can't get over it. Or that maybe you're a femi-nazi type whose fist is raised at the patriarchal establishment of the women's health arena.
Maybe they think you're a ridiculous hippy type trying to turn childbirth into some incense-and-music spiritual experience.
Well, none of those fits me. And I don't really care too much what people think.
But here is one birth's worth of why I hate hospitals and the attending practices for birthing babies:
> Day before birth: Clients arrive *not* in labor. No one suggests - save me - that they might go home instead of succumb to a bunch of medical stuff done to a perfectly healthy woman who's not going to have a baby any time soon and needs only to sleep if she can.
Thankfully, the clients go home.
> Clients arrive at the hospital the next day in decently active labor after an office visit with her doctor, who didn't ask who I was or introduce himself to me. (He also performed a visibly rough vaginal exam, likely stripping her membranes without her consent.) The nurse is friendly enough, though she doesn't acknowledge the dad or me - never asking or saying our names at any time during her shift. This nurse literally ignores my questions completely, perhaps feeling threatened or otherwise uncomfortable with someone asking for anything outside their standard protocol - like an explanation of risks and benefits, even.
> Wait - the nurse did answer me once. It was a terse "No" when I asked if the client could wear her own nightgown. She didn't explain why not.
> The client is informed - not asked or given counsel so she can offer her informed consent - of what will be done to her. That includes vaginal exams, continuous electronic fetal monitoring and the inability to eat or drink anything beyond ice chips. [Aside: It's estimated the average labor and delivery burns 32,000 calories. Sure, it makes *complete* sense to not eat or drink. Sarcastic eye roll.] This is a completely healthy mom with no risk factors.
> The nurse does not explain why continuous EFM is now ordered when before it hadn't been. The client is confined to bed or to the two feet around it. Well - except when she uses the bathroom, which I'm now thinking she should do quite a bit, locking the door behind her. Studies show there's a higher likelihood of cesarean section in women forced to be on the continuous EFM.
> After a gazillion questions - asked and attempted to be answered through painful contractions - the nurse gets IV access with ease and starts running antibiotics after explaining how scary Group Beta Strep is but offering no explanation about any risks of antibiotics or alternatives. Nothing is presented as optional.
The nurse introduces her shadowing nursing student, who looks terrified.
> Finally, the clients and I are alone - and for a decent amount of time. At first I think, "Wow, they're not even checking on her." And then I think, "Cool. They're not even checking on her." (The more they "check on" people, the more likely interventions become.)
> I step out to get the dad a cup of awful hospital coffee. As I'm pouring it, I overhear the nurse teaching her student how to watch a woman in labor. They're staring at a computer screen that monitors contractions and fetal heart tones - a computer screen at the nurse's station. Let me say that again: They're staring at a *computer screen* to learn about women in labor. I almost cry as I realize this nursing student is not going to learn how to feel a woman's belly or look into her face to assess labor. Instead, she'll learn how to read squiggly lines on a computer monitor. So sad for the student and her future clients.
> And so the clients and I labor. The client's getting distant. She looks like a woman in labor but with an added dimension - like a woman who's been through some kind of trauma. She's withdrawing, I can tell, and I'm not sure, precisely, how to help her. I'm struck - and not for the first time - about the differences how a woman is treated and the environment around her can make. At home, this woman would feel safe. I can tell that here, she does not. Her fears later prove valid.
> The client endures several more announced - not asked-for - vaginal checks and is told she's making some progress but not very much. It's a subtle detail, but in reality she had labored very well and made fine progress, slipping a bulging bag down through a cervix whose dilation number - only *one* factor to assess "progess" - hadn't changed much. When the nurse leaves, I give this precious, young, first-time mom my best pep talk ever.
> The unspoken tension begins to build. We all know the *doctor* - who has had no contact with his client since the rough vag exam in his office many hours ago - is coming shortly. If there's not more change, he's "not gonna be happy about it," something he'd told the client earlier. Now I'm thinking about my midwife friends. Never in a million years would they put that kind of expectation on a woman, recognizing the processes of labor and delivery are not about pleasing anyone - least of all the baby catcher.
> A half hour before shift change, the nurse announces she'll be doing a vag exam because she has to give "report." Just for kicks, I firmly ask the client, "Is that OK with you, M?" The client breathes out a resigned, "OK." The nurse ignores me.
> Once the nurse leaves, I tell the client I think we should work on a couple of positions to encourage the bag of waters to break. She's quiet but compliant. She's tired. I simply unhook the monitors - Just let them come running in! - and walk her around the room. She collapses into a hanging squat into her husband's arms during contractions.
> New nurse! She's perky and friendly and I know we need to like each other. Of course she needs to do a vag exam. I downplay the invasion by explaining to the client that each person's assessment is different and this nurse needs to get her own baseline. And yay and yay! That movement helped, as the mom's now a nice 8 cm. The client offers the briefest of smiles on her flushed face. It's the first one I've seen in a long time. Wryly: I'm so glad to know we'll make the doctor happy.
> But when he - the *doctor* - comes in, I can't tell he's if he's happy or not. HE SAYS NOTHING TO THE CLIENT. He goes directly to the computer, dons a glove, asks for an amniohook, plops himself at the end of her bed and breaks her bag of waters without even *telling* her what he's doing except to say, to no one in particular, "Let's get this done." I notice she jumps whenever someone touches her "down there" without telling her, and I get a sick feeling inside. He peels off his glove and leaves the room.
> In fact, everyone leaves us alone again. I'm glad but struck by the fact that this is transition, one of the hardest parts of labor. At a home birth, we'd all be next to the mom's side, as this is when she'll likely start to feel scared and doubtful - among other things. The client lays in bed and labors. I tell her husband to talk to her and tell her she can do it. I'm leaving for a few minutes to let them be alone.
> When I come back in after a few painful minutes, I notice both mom and dad are crying. It's not really the time to process it, but I wonder if they're feeling violated - not feeling just the normal transition stuff. This doctor, after all, had delivered this woman 21 years ago. I had hoped he might show her extra care because of it. My hopes were in vain.
> The client labors through. She's doing well, and I'm so glad no one's coming in.
> Alas, they do come in, and I'm again disgusted how no one has *ever* asked the client if she wants a vag exam, only announced that's what they'd be doing. So the nurse - though she's friendly - announces such and commences. She doesn't tell the client what she finds, either, only says she needs to contact the doctor to see what he wants to do. Argh. In midwifery care, we consult the mother's *body* to see what it wants to do. Then we follow *it*.
> A couple minutes later, the nurse pushes back in the room and announces, "Dr. So-N-So wants you to start pushing." I frown, holding back my sarcasm. I'm thinking, "Who gives a flip what he wants? She doesn't have the urge to push." The nurse's declaration means the client is likely completely dilated, but she doesn't tell her so, which would have been a great encouragement. So I tell her so, not even sure I'm right. (But who would suggest she push unless she were completely dilated, right?) Then I say, boldly, "I think she should get up to use the bathroom one more time before she starts." I'm buying time and hoping she'll get the urge on the toliet. See, she doesn't have the compulsion to push yet, and I think she could have benefitted from the "rest-and-be-thankful" stage I theorized she was getting. Further, they'll chart the onset of pushing too early and - heaven forbid - won't "let" her push too long. As she sits on the toliet, I stand between her and the staff chattering on about the break she's getting and how there's no rush and (to the client) you don't have to push if you don't want to. I go on and on about how her bladder should be empty to make room for the baby. I probably talked about the weather.
> But I only buy about 10 minutes until the nurse is ansty and wants the client back on *the bed* to start pushing. And so she does. Right away I catch on that - though she's nice - we have a "purple pushing" nurse. Crap. The client is so tired, and I'm suspicious she doesn't really have the urge to push. TURNS OUT, after the doc comes to check her, THAT MY CLIENT WAS DOING ALL THIS AWFUL PUSHING AGAINST A CERVICAL LIP. I want to *scream* when I hear that. My sweet client was too tired or too naive or too traumatized to speak up about what must have been excruciating pain. Dammit! Once the doc - who heretofor had been reading the sports section at the nurse's station (not kidding) - pushes back the lip - also without permission or explanation - she makes progress. By now the client is so battered I'm trying not to lose her and praying hard she gets the strength to get done before things go south.
> So she pushes. It starts to feel a little more normal. She passes stool (yay!) and there's obvious progress, typically slow for a first-time passage through those bones. The doctor peeks in and, apparently, sees enough head to want to stay. I'm just wishing they'd all get called to an emergency or something and I could accidentally catch the baby while they were gone. Maybe I and the nursing student - who looks ever more terrified.
> There's this big awful flurry and the doctor dons his HazMat suit, joking, "You know it's serious when I put this on." At first I think, "I much prefer jeans, a T-shirt and bare feet," but after the third-stage hemmorhage he likely caused, I get why he needed it.
> Mom does some great pushing. She's found that last surge of strength and she's doing it. The doctor keeps reaching over and touching all his instruments (um, they're supposed to be sterile), and I'm especially eyeing his scissors. If he starts to cut her, I'm going to cry out. I don't care what they say. She's stretching beautifully, in spite of the fact that she could have used a hot cloth and some oil. I wanted to touch her so bad, and I prayed that her good nutrition will be enough to keep her tissues intact.
> Finally, a head. Routine suctioning on the perineum, but I expected that. Then the baby. Not given to mom, but held in the dirty-gloved hands of the doctor who says, "Don't worry that she's not breathing." He actually said, "She'll breathe when I make her breathe." I've worked with a lot of doctors and often joked about the "God Complex" some of them have. Oh, doctor, you might have caught 3,000 babies, but it is not you, sir, who authors the breath of life. There is One Who has All Power, and you are not he. So the doctor roughs up the baby, finally making her cry. I said in my sweetest baby voice, "You tell that doctor how mean he is. You tell him."
> After what seemed like days later, mom finally gets to hold her baby, which they've already announced is a girl. (At home births, we don't announce it but let the couple have that special moment of discovery themselves.) The doctor bullies the dad into cutting the cord. The dad had said ahead of time he didn't want to. I spoke up and said so. The doctor said, "Come on! No, really! Come on!" The dad did it reluctantly while everyone clucked and cooed. I just hoped he wouldn't faint. The staff didn't know this dad had witnessed a bloody death of a friend after an accident and was not interested in cutting the cord. I wonder if they would have cared. Besides, not everyone wants to do it - it's not that big of a deal - and it floors me why they would push it so.
Here's where it gets awful.
> I watch the doctor drain the umbilical cord of the rest of its blood and think, "That should be going into the baby. Why is it going into the trash?" Whatever. He reaches for a hemostat and clamps the cord, and I just know he's going to pull on the placenta. He starts telling the nursing student he learned not to pull on the cord because the cord could break. And I throw in, "Yeah, and you can cause heavy bleeding if you pull on the placenta." I don't think he hears me. AND YET, the doctor says, you *can* pull lightly with steady pressure. I'm thinking, "Yes, if the placenta's separated." But if it's not ...
> So he's does his steady pressure thing, sometimes known as controlled cord traction, and Mom starts to bleed. I ask her, loudly, "Are you having a cramp?" Turns out she was. So he pulls and pulls and out comes the placenta. Mom's already been given pitocin in her IV (without her knowledge). He reaches in. Nurse pushes hard on her belly - all with no one explaining what they're doing, why or why it hurts. She's obviously in agony.
> So she bleeds. And bleeds. And bleeds. He quick does a single-stitch repair with no anesthesia and without telling her. (I had to tell her.) I'm sick. She might have opted for no stitches. She might have liked a little lidocaine, which the doc later said takes too long to wait for to work.
> She keeps bleeding. He announces, "You're not making me very happy." If I hear that one more time, I might smack him, but I realize I need to keep my cool to help mom, who's heart is beating 150 times per minute (twice as fast as it should be) and whose blood pressure is 80/64. The nurse is looking nervous and asking, "Should I start her IV?"
> The doctor then does things I can only describe as horrendously painful. He reaches in the mom, scrapes and scrapes, pulls out blood clots and placental tissue. He uses instruments, barking at the nurses to find larger ones so he can really get in there. He must have done, essentially, a D&C (without the "D" as she was already dilated). It was awful. And he had dirty gloves (like dirty with baby poop). Apparently, pieces of the placenta were retained. The doctor ruminates about a septum, a bicornate uterus, tough uterine wall and, basically, everything but the obvious: He'd pulled on the placenta, which likely left some of it sticking there.
> The mom tolerates this as best she can. It's like having surgery without any anesthesia. I'm cringing. The nurse is cringing. The doctor's babbling on. The mother is about to pass out. When I comment about how much it hurts, the doctor actually says, "Well, my hand is a lot smaller than that baby, and she just pushed the baby through there." Even in retrospect, I think, "Does this man *really* not understand?" Bizarre.
> In the mean time, another nurse has taken the baby. I see her giving it shots, administering antibiotics to her eyes - all without consent from the parents. Dad is a bit shell-shocked, roaming from baby to mom, not sure what to do. I'm holding mom's leg, which, on top of the other torturous things happening to her, is cramping up.
> Finally, the doctor announces he's "happy" with mom's bleeding, or eventual minimalization of. She's lost 1,000 ccs, he estimates. (That's a lot.) I'm thinking about her recovery, her ability to produce milk. Dammit.
> The doctor turns to the nursing student. "Usually I'm long gone by now," he says. "This one's just giving me a hard time." Mom, whose eyes are puffy and who looks simply awful, gives a trite smile.
> Oh, one more thing, he says. With all his "messing around" (his words), he's busted open the stitch he'd put in and needs to redo it. He figures he could wait a long time for a little lidocaine to kick in or just get it done quickly without it. By now, I believe my client was so traumatized she didn't care what he did to her. "Do whatever you need to do," she croaked out. I want to scream. With a little common-sense prevention and compassion, he likely wouldn't have needed to do a lot of what he did.
> Back when he'd been tugging at the placenta, I'd been working to get the baby latched on to no avail. I thought again of the quiet, gentle home births I'm more likely to be at. We're at least 90% successful at helping babies latch in the first hour - with or without some "management" of third stage. Now the baby was alert and in the arms of her father, but mom was so wiped out, I whispered in her ear, "Wait until a little later. Ask C. [the nurse] to help you. See the lactation consultant in the morning."
> I got my things and excused myself quietly. I needed to get my children and get home. The dad looked at me, his dark brown eyes pooling. He shook my hand, his grip lingering a bit, and said, "Thank you for all you've done."
We have so much to talk about.
> I walked briskly past the nurse's station, where the doc was back to the sports section. He didn't look up. I didn't strike him.
> But I did hit my midwife friend's number on my cell phone before I left the building, knowing she was at a home birth right then. "Hi," I said to her voicemail. "I hope you're in the middle of a great delivery. I have so much to tell you."
Tuesday, December 22, 2009
Humiliation
Fat tears dropped onto her belly, rolling down over the enormous bump and onto the floor. Some drops stayed, pooling there above her ribs. I stared at them. The midwife stared at them. Mother-to-be squeezed her eyes shut and wept, her taut belly bouncing with every sob.
We expect that during some births. Mom cries. She wails, even. She might even shriek. Or scream. Often she just weeps quietly, gently, like a tired kitten mewing for its mother. I remember a sweet, young Amish woman named Esther whimpering pitifully. It’s all part of it.
It.
The “it” I mean, in childbirth, is *humiliation*. As odd as it might sound to some, “it” is the part I love the most about birth — this bittersweetness taking hold of me somewhere deep inside as I watch it, even sometimes shepherd it — or shepherd the mom, really, as she surrenders to it. Man, it’s beautiful.
Most of us would aspire to be humble. But humility comes from a place we *don’t* usually like so well: humiliation. A simple-but-deep concept, humility includes the renunciation of one’s self, the surrender to something bigger and greater than us, to something more powerful. And if childbirth is anything, childbirth is big
and great
and powerful.
You see, once you’re pregnant, the baby *has* to come out; there is no way around it. And even with the most gentle, lovely, natural births, there’s still just a certain sheer and raw power, an all-consuming wrenching and heaving that requires — here’s the key to it all — surrender.
But if you look at childbirth practices in our allegedly “developed” nation, you won’t see surrender. What you’ll see is countless women trying to *avoid* it or control it. They sense the naked power of birthing, and it scares them. They think they won’t be able to handle it. It’s too scary. It’s too gross. And they are, frankly, far too self-absorbed to consider the idea of enduring pain for the sake of something greater. (And, jeesh, I love working with the Amish. They’re not like that and have amazing outcomes to show for it.) But today’s typical woman: Natural childbirth? You mean feel it? No way. Why would I want to do that? After all, I am a modern woman. I am so special, so important I should never, ever have to suffer that way. Why, if I can have a catheter inserted into my spine and drugs pumped in that numb me from the ribs down, should I have to endure the hardship of childbirth?
Oy.
I would like to — and often do — answer that very question, but for many women it’s just a rhetorical question anyway. (They’re not really asking, though the answer is quite logical and settles in as truth when one is really seeking it.) So I’ll save that answer for another day. Suffice to say for now: If you only knew what you were missing, what you were trading for a few hours of pain relief. It’s big. Big big.
So back to weeping mom.
There’s usually a turning point or two during labor where a woman senses she has nowhere to go except *through* — and she gets scared.
“But it hurts,” she says. “Yes,” we say, “it hurts.”
“But I can’t do it,” she says. “We know it feels like that,” we say, “but you *are* doing it. You can do it.”
And then we sit, quietly mostly, and watch her surrender and allow it. And then, usually not terribly long later, she’s cooing over her baby a truly transformed woman. (Aside: Let me just tell you how completely addictive this is to watch.)
But surrender, oddly enough, requires a certain resolve. It is that willingness to set aside one’s self, one’s comfort, to “count the costs,” if you will, for the benefits that come later with it. Often that willingness comes with age — or, better, life experience. And it’s a necessary trait for good parenting, for what is parenting but self-sacrifice?
Once in a while, though, that resolve is just not there.
And I’m grappling with that, with my role in helping a woman when that resolve is just not there (or there yet). I already know I'm not the doula for the get-me-my-epidural-at-4cm woman. There is a doula for her -- love that doula -- but I am not she.
I'm still thinking.
We expect that during some births. Mom cries. She wails, even. She might even shriek. Or scream. Often she just weeps quietly, gently, like a tired kitten mewing for its mother. I remember a sweet, young Amish woman named Esther whimpering pitifully. It’s all part of it.
It.
The “it” I mean, in childbirth, is *humiliation*. As odd as it might sound to some, “it” is the part I love the most about birth — this bittersweetness taking hold of me somewhere deep inside as I watch it, even sometimes shepherd it — or shepherd the mom, really, as she surrenders to it. Man, it’s beautiful.
Most of us would aspire to be humble. But humility comes from a place we *don’t* usually like so well: humiliation. A simple-but-deep concept, humility includes the renunciation of one’s self, the surrender to something bigger and greater than us, to something more powerful. And if childbirth is anything, childbirth is big
and great
and powerful.
You see, once you’re pregnant, the baby *has* to come out; there is no way around it. And even with the most gentle, lovely, natural births, there’s still just a certain sheer and raw power, an all-consuming wrenching and heaving that requires — here’s the key to it all — surrender.
But if you look at childbirth practices in our allegedly “developed” nation, you won’t see surrender. What you’ll see is countless women trying to *avoid* it or control it. They sense the naked power of birthing, and it scares them. They think they won’t be able to handle it. It’s too scary. It’s too gross. And they are, frankly, far too self-absorbed to consider the idea of enduring pain for the sake of something greater. (And, jeesh, I love working with the Amish. They’re not like that and have amazing outcomes to show for it.) But today’s typical woman: Natural childbirth? You mean feel it? No way. Why would I want to do that? After all, I am a modern woman. I am so special, so important I should never, ever have to suffer that way. Why, if I can have a catheter inserted into my spine and drugs pumped in that numb me from the ribs down, should I have to endure the hardship of childbirth?
Oy.
I would like to — and often do — answer that very question, but for many women it’s just a rhetorical question anyway. (They’re not really asking, though the answer is quite logical and settles in as truth when one is really seeking it.) So I’ll save that answer for another day. Suffice to say for now: If you only knew what you were missing, what you were trading for a few hours of pain relief. It’s big. Big big.
So back to weeping mom.
There’s usually a turning point or two during labor where a woman senses she has nowhere to go except *through* — and she gets scared.
“But it hurts,” she says. “Yes,” we say, “it hurts.”
“But I can’t do it,” she says. “We know it feels like that,” we say, “but you *are* doing it. You can do it.”
And then we sit, quietly mostly, and watch her surrender and allow it. And then, usually not terribly long later, she’s cooing over her baby a truly transformed woman. (Aside: Let me just tell you how completely addictive this is to watch.)
But surrender, oddly enough, requires a certain resolve. It is that willingness to set aside one’s self, one’s comfort, to “count the costs,” if you will, for the benefits that come later with it. Often that willingness comes with age — or, better, life experience. And it’s a necessary trait for good parenting, for what is parenting but self-sacrifice?
Once in a while, though, that resolve is just not there.
And I’m grappling with that, with my role in helping a woman when that resolve is just not there (or there yet). I already know I'm not the doula for the get-me-my-epidural-at-4cm woman. There is a doula for her -- love that doula -- but I am not she.
I'm still thinking.
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