Taking Charge of Giving Birth
|Taking Charge of Giving Birth|
|The Myth of My Second Trimester|
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 that 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 thirty years ago 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 deliver into the world another human being, 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, drug-free 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 numb the sensations of childbirth with an injection or an IV—surely I should consider myself among the luckiest women 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 that doctors were held to revenue targets at hospitals; a cynicism grew within me. Natural birthing meant low revenue for medical providers. Far more disturbing were the risks and adverse outcomes associated with each money-generating intervention. Even seemingly innocuous and routine procedures were exposed as significant threats to the mother’s and baby’s safety. Moreover, each intervention increased the odds, often dramatically, that a subsequent, more radical procedure would be required, purely in response to the risks and side effects it introduced.
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 FDAapproved for the elective induction of labor, yet countless women followed their doctors’ recommendations to use it for that very purpose. Were women provided with a full disclosure of the risks and side effects? Were they aware they could refuse? Knowing that revenue targets were hanging over obstetricians’ heads, I realized that birthing mothers had fallen victim to a powerful conflict of interest in the medical community.
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 pressing her relentlessly, she finally admitted it was at least 40 percent.
Incredulously, I asked whether she truly believed life and death 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 place on earth should exceed a rate of 10 to 15 percent.
“Some cesareans are elective,” she began. “Many women feel they would prefer to have their own doctor perform a cesarean rather than take the chance of delivering vaginally with a less familiar doctor from the same practice.”
And you actually give merit to that choice? I wanted to ask. Major surgery, unnecessarily performed as a matter of familiarity and convenience?
“As for emergency cesareans,” she sighed, “we don’t like if the mother is too old, too heavy or too thin, or if the baby is premature, too big or overdue. Other concerns are low amniotic fluid, multiples, placenta previa, breech positioning, gestational diabetes and failure to progress—that is, we’d like to see you dilate at least one centimeter per hour.”
I was 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. In fact, I had read that birthing, on average, lasts 12 to 14 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?
“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 over vaginal birth.
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 even the smallest bikini would hide 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 a 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 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 think it’s worth all that money,” she said. “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. After a lengthy, enjoyable consultation with the midwife director, we 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-and-breakfast. We walked through the bedroom and into the large, marble bathroom, complete with a free-standing shower-for-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 Jacuzzi bathtub. We only ask that you not deliver lying on your back—it would be painful for you, risky for the baby, and makes birthing far more challenging because it compresses the pelvis.”
“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 allowed my fear of natural birth to subside as my fear of medical intervention maintained its firm hold. From then on, I held every remaining prenatal appointment at the birth center, cheerfully driving an hour each way through the cold winter season.