Friday, June 5, 2009


Like I said, it’s been hard to write lately. The main readers of this blog are family members, who I feel must have come to expect that the tone of my writing will be perky, upbeat, and cute. That I’ll write amusing little anecdotes and funny observations I make about pregnancy, all the while going on and on about how wonderful this whole experience is. Though I may smile and nod and otherwise act pleasant when face to face with people, in reality, this couldn’t be farther from how I feel.

For the most part, it seems like it’s me and Fig against the world. Maybe there are a few people out there who are actually not considering calling child social services because I don’t want to give birth in a hospital, but it seems like those few are definitely outnumbered. I generally just try to stay quiet on such controversial topics as home birth and cloth diapering when I’m in mixed company, because I feel that the general consensus is that I’m a first time mother—a newb as it were—and I really don’t have the right to have an opinion on things I haven’t experienced. Which is probably true. But trust me, I have an opinion. A very, very strong opinion. On everything.

The current system of maternity care in this country—and particularly in this state—infuriates me beyond reason. And what is even more infuriating is that people buy into it. There is this idea out there that women’s bodies are so inferior, so incompetent, so completely deficient and inadequate that giving birth is a medical crisis only made possible through the use of synthetic hormones and narcotics and a man (invariably) in a white lab coat that hooks you up to all sorts of machines and makes you lie flat on your back. And then he has to heroically intercede with a surgical procedure, forceps, or vacuum extractor when these interventions make it otherwise impossible for you to get the baby out. So you’re left thinking that being in the hospital with this doctor saved your life and the baby’s life and that newbs like me are crazy hippies who just ought to shut the @#$% up.

“Trust your doctor” seems to be the refrain people say to me, and even if they don’t say it, I swear can hear them think it. I feel this is naïve. I’ve heard and read stories of what the era of twilight sleep was like. You go to the hospital in labor, your husband is not allowed in the room, the doctor gives you anesthesia and you are rendered completely unconscious. You wake up at some point later with a giant episiotomy and are told, “It’s a boy,” or “It’s a girl” and eventually when you are able to move again, you are taken down to the nursery and shown which baby is yours. Maybe the doctor gives you an injection to dry up your milk, or maybe you are just told not to bother with breastfeeding because formula is just as good, if not better. I do not know what the pain of labor is like, but I don’t see how it outweigh the horrifyingly empty and hollow disconnection (not to mention anger) I would feel at being subjected to this process.

Maybe in some ways though, twilight sleep was better than what seems to be the typical hospital birth experience for women today. It seems like hospitals routinely use pitocin to control or speed up labor—to the extent to which people regard it as harmless or even necessary. What the doctors don’t tell you is that pitocin makes contractions artificially strong, and the strength of these contractions (as opposed to normal uterine contractions) disrupts oxygen flow to the baby and can cause fetal distress. Moreover, the ramped up pitocin-contractions makes having some kind of pain relief—mainly, an epidural—almost mandatory. Sure an epidural will take away the pain (for most people at least) and I am routinely told that it is a lifesaver and that I will want/need it. But it can also cause your blood pressure to drop, which in turn causes both yours and the baby’s heart rate to drop (which is apparently not a good thing). It can slow the process of labor, which is not good, since most doctors put women on a strict timeline to deliver and will just cut them open if they’re not progressing fast enough. Even if labor keeps on moving, an epidural can prevent the baby from getting into a good position to be born. I suppose this is mainly because getting the baby into a good position often requires the mother to move—such as squatting or being on all fours—which is rendered impossible when you cannot move from the waist down and you are hooked up to an IV and various fetal monitors. Because of this it’s hard to get the baby out, so apparently the result is in increased use of forceps, vacuum extraction, episiotomy, and even emergency c-section.

Oh, and the fetal monitors. Mandatory in most hospitals, I guess. They put these bands around you that monitor the baby’s heart rate and your vital signs and that pretty much force you to lie immobile. The idea is that they will show any type of heart rate anomaly in the baby that indicates it is in distress. But when used continuously (rather than intermittently), these monitors can apparently show problems that do not really exist and what results may be an unnecessary emergency c-section (and all the complications that come with that, which is way beyond the scope of this post). The whole idea behind continuous fetal monitoring was that it was supposed to reduce infant deaths and instances of cerebral palsy, but apparently this practice has caused neither of these things to happen. Mainly just an increase in c-sections. In my case, if I tell them I want intermittent (instead of continuous) monitoring, they will allow this (supposedly), as long as there are no signs of fetal distress. But if I do get the epidural like people tell me I will, then I am pretty sure the monitoring will have to be continuous. And if they decide they’re going to put me on pitocin, the monitoring has to be continuous as well.

Oh, and the food and liquid restriction. Maybe some hospitals allow you to eat and drink while you’re in labor, but the one where I have to give birth does not. Once you walk in those doors, you cannot eat or drink anything until after the baby is born. God forbid they should need to do an emergency c-section on you because of a malfunctioning fetal monitor and you should aspirate on some undigested food. Even though this is only possible if they give you general anesthesia rather than an epidural, which is apparently exceedingly rare. At any rate, they give you a mandatory IV instead, to keep you hydrated (but does nothing to replenish your energy). Having an IV contributes to your lack of mobility (again preventing you from getting the baby in a good position), plus too much IV fluid in the mother can apparently cause the baby to have low blood sugar, low blood sodium, respiratory problems, or even seizures when it is born. But they don’t tell you that. And they don’t tell you that involuntary fasting makes you exceedingly weak and may even lead to an emergency c-section because you just don’t have the strength to get the baby out (particularly because you are completely unaided by gravity, hooked up to things and lying down). People tell me this won’t be too big of a deal because during labor I won’t be hungry anyway. This is probably true. During marathons (which only last around 4 hours) I am usually not hungry. But if I don’t eat or drink during a marathon, I know what happens. Me, sobbing on the side of the road saying, “I can’t do this, I can’t do this, I can’t @#$%^&* do this.” If I eat and drink during a marathon—even if I don’t want to—I’m still smiling at the finish line.

Many will be aware that I have mentioned I am seeing a midwife rather than a doctor. This is true. She is a Certified Nurse Midwife (CNM), which is the only kind of midwife legally allowed to practice in the state of Illinois. CNMs are only allowed to practice in hospitals, under the supervision of an obsetrician. My CNM wears a white lab coat. She is not a little old lady wearing a babushka who will chant over me and sprinkle herbs on me when I am giving birth. She is a nurse practitioner who has had additional years of training in delivering babies. If anything goes wrong (as I am so frequently cautioned that it will), she will call in the OB, who will cut me open without a moment’s hesitation.

Certified Professional Midwives (CPMs), those who attend home births, are not legally allowed to practice in the state of Illinois. It is not illegal to have a home birth, it is just illegal to have anyone attend you. There is this sort of underground home birth community in various parts of the state; apparently there are CPMs who practice illegally, but so far I have been unable to get any names. It’s all very secretive because the CPM risks going to prison if found out.

Birth centers are also illegal in the state of Illinois. I have no idea why.

I do have a doula, which is the one shred of hope I am clinging to at this point. I pretty much hired her on the spot because within 5 seconds of meeting, she told me that (so long as there was no meconium and I didn’t have a fever) she would lie about when my water broke (so I wouldn’t be subjected to the hospital’s artificial countdown to c-section time clock), she would sneak me food and drink in the hospital, and she would keep visitors out of the room during the delivery and as long as I needed to afterwards to bond with the baby. She can come to my house and support me in early labor but ultimately, we must transfer to the hospital because it is illegal for her to assist in home births. We only live like 10 minutes away from the hospital (if that even), so I hope that I can just wait it out at home until I feel like pushing. It may ruin Rob’s plans for us to ride the tandem bike to the hospital though. Plus, we might have to get a tarp for the Prius, just in case I misjudge the timing. (But not the good tarp, I want Fig to get married on that tarp. [That is a modified quote from the Simpsons]).

I imagine that everyone who typically reads my blog is duly horrified at my irreverence right now. Most of the information from the diatribe I’ve written above comes from various books I’ve been reading on natural childbirth. The most recent is Ina May’s Guide to Childbirth, published in 2003. Ina May Gaskin is a CPM who was a founder of community called The Farm in the 1960’s. In 30 years, midwives at The Farm have attended 2,028 births, over 95% of which were completed at home (less than 5% involved transfer to a hospital, only around 1% were actual emergencies). Their c-section rate is 1.4% (compared to the over 30% c-section rate in the average US hospital). Almost 70% of these mothers gave birth without any perineal damage. Forceps were used 0.5% of the time, and vacuum extraction just 0.05%. I don’t see their statistics on episiotomies, which leads me to believe I’ve either scanned the material too quickly, or they just don’t do it. The Farm has a 99% rate of initiation of breastfeeding. They let women eat and drink at will during labor. Zero maternal deaths have occurred. Eight infant deaths have occurred (a rate of 0.39%). It is difficult to come up with comparable neonatal death statistics in US hospitals, but from my best judgment, it seems to be roughly equivalent. I will keep looking.

And I also imagine that everyone is shaking their heads, going “tsk, tsk, tsk” and thinking “She needs to keep an open mind.” Believe me, I’ve been told. Everybody and their brother tells me to keep an open mind. Because childbirth is a crisis and you never know what might happen. You need to just accept what the doctor tells you because the doctor knows best. Both doulas that I interviewed (including the one I hired) told me to keep an open mind. My response to this is a clenched jaw and gritted teeth. Keeping an open mind is kind of bullshit. If I had kept an open mind about any of the 8 marathons I’ve run, how many of them would I have finished? None. Even the ones when I didn’t eat or drink and was sobbing on the side of the road, quitting wasn’t an option. I wasn’t sure how I was going to do it, but eventually, in all 8 of them, I did. It was just really freaking hard. I wish that running marathons would somehow prepare me for having a baby. In fact, a lot of people compare childbirth to running a marathon. Most of these people have never run a marathon, or even 3 continuous miles in their life. I think the two things are essentially incomparable. Marathons have not taught me how to deal with pain, per se. Just how to endure.

My mother tells me that when she had me, she was in labor for something like 26 hours (I’m sure she remembers the exact time frame). When she got to the hospital, they made her lie flat on her back. It made things take forever. She kept telling the doctors, if they’d just let her get up and scrub the floors, she’d have this baby in no time. They wouldn’t let her move. Eventually I was born in spite of gravity and obstetric stupidity. And I was reasonably healthy. That’s all that matters, right?

Wrong. It’s also about the journey.