In my family there has been some controversy because, here, the nurse trained to deliver babies in a hospital is called a midwife. That word is terrible for too many people. I can hear the bad connotation, too, I’m not immune to it.

While I would have liked to have a midwife who delivers my baby at home, I’m not capable of that: I’m not trusting enough that something won’t go wrong, and I’m not solid enough in myself that I wouldn’t blame myself for the rest of my life if something did go wrong.

Birth is, I believe, not a medical procedure but instead it’s a life process. I think I stole that phrase from a million books, but it rings true. But it’s also a trauma, in that it pushes the body like a marathon does. And also, it might have to be a medical procedure if something goes wrong. That’s why I’ll be in a hospital in the labor and delivery wing with all the rest of the laboring women. We toured it this week — it’s ugly and uninspiring.

I chose a midwife because I believe that there is a lot outside of normal that still produces a healthy baby, and that she’ll trust my body (to a point) to keep a baby alive. I can trust that the midwife won’t give me pitocin if my labor has gone on longer than 12 hours (though she would if it has gone on longer than 24). I can trust that she will try her best to turn a breech baby up until labor (though if I were in active labor and the baby was breech, she would call for a c-section). I can trust that she wouldn’t misread a heart monitor (which has upped the amount of c-sections when the baby’s heart rate drops, but which has not upped the amount of saved babies — sometimes babies heart rates drop during contractions, and it isn’t necessarily a sign of danger). And because it’s in a hospital, and she’s a nurse specifically trained to deliver babies (and many of these ‘nurses’ have medical degrees), and because all the doctors and midwives are in the same wing, they could cut me open in four minutes and take the baby out, just as quickly as anyone in the next room over, cared for by doctor or midwife or what.

I think I am mistrusting of doctors, which isn’t a good thing, but I also have seen studies that show that, discounting high-risk births in order to balance the study, women who deliver with midwives have a lower infant and maternity mortality rate than those who deliver with doctors.

We are delivering in the dark. I have been trying to write about this for days, but I don’t know how to describe it except by using the word intuition. Doctors aren’t trained to intuit. They have machines that shine light in dark places. Midwives are trained to see beyond the machines, only using the machines secondarily. It’s so dark in the womb. There’s so much going on that no doctor or midwife can understand. So many answers are vague — sometimes it hurts when I press here, but no ultrasound could explain why; sometimes I feel tired, but no medicine can be given to fix that. The doctor I saw last week only shrugged at my pain and told me to go to bed. I could have fought with my health insurance for another ultrasound, but I was happy to pay only for my pee sample instead, because I’m fine now; whatever it was resolved itself with rest.

We are all birthing babies in the dark, and sometimes the machines tell us what we don’t need to know and what can’t help us. At one ultrasound, they saw twins, and they couldn’t tell me if the twins would be there the following week, and there was nothing they could do to stop me from bleeding when only one kept growing. Some say that there are lots and lots and lots of early twins, and I’m only grieving for one because I saw its heart beating inside the shape of a shrimp on a screen. At a later ultrasound, they saw a black tear in the gray of the amniotic sac, and so I went back for another ultrasound. I could only give friends and family vague reports because no one could say what it meant that there was a tear there or what would happen to it. My mother, who has birthed four children, assured me that it was fine — intuition — and that too many people get alarmed these days because we see problems that resolve themselves on their own, when before we didn’t have to know that there was ever an issue at all. My health insurance paid only partially for the next ultrasound, which showed the tear healed, and who knows what it was, certainly not the highest-trained doctors who read the images at one of the best hospitals in the country, but you could tell with a simple stethoscope and a tape measure across my belly that the baby was fine.

From Time Magazine:
About 99% of all births in the U.S. take place in hospitals, yet we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden.

My friend tried to get pregnant for six months, then, on her way to Denmark where she was planning to stay for a year, she found out that she was pregnant. I guess this baby’s meant to be born in Denmark, is what she determined. After four days of labor, her daughter was born. If I were in a hospital for four days in the U.S., there is no question, midwife or not, that I would be cut open, but her daughter is great.

I think about that with my mother, too. My older sister had to wear braces on her hips after a difficult entrance and a long labor, and these days I figure that my mother would have had a c-section whether she wanted one or not. We were next, twins, and twins these days are automatically sent into the high-risk labor ward and well over half come out by c-section. But my mother at the time didn’t even know that she was having twins until the day of delivery — and we’re fine. My younger sister was breech, I think, which is now an automatic c-section, and also she was born with meconium in her mouth. None of those births was easy, but if she had had a c-section with her first, it could have presented all sorts of problems for the rest of the births that followed.

Recently the midwife from The Business of Being Born was sued because she let a woman labor for three days who then gave birth to a stillborn baby with the cord wrapped too tightly around its neck. This is terrible and a tragedy, and I’m not willing to put myself or anyone inside of me or around me through that. And I also realize that many labor tragedies occur in the hospital each year, as well. The article that describes the lawsuit is short, but the comments that follow it are colorful and show the extremely different points of view we have in America about birth.

It seems we’re coming to a point in society where there is a shift in how we understand labor — we can birth, we can deal with the pain, millions of women have done it for millenia; believe in us, trust this process. In 2006, 31% of births were c-sections (up 50% from 1996 though our bodies hadn’t changed in that decade), but doctors admit that that drastic increase has done nothing to improve infant- or maternal-mortality statistics. In the countries where births are the least invasive (and where the countries are part of the developing world) are where the most babies and mothers survive. There is some muscle of intuition that they can flex, when our culture of lawsuits and rules and fears and germlessness may blind us.

But I will get a c-section if I have to. I’ll knock a lady off an operating table if it means I have a better chance of keeping me and the person inside of me alive. More than many people, we have been through hell to get to this point, and I’m not stupid enough to risk that. I just feel that I’m making the smarter choice by keeping my low-risk pregnancy in low-risk hands, cushioned by a Level 1 trauma center.

I don’t think that the way that my baby is born will define me any more than the way that the baby was created. I am positive that I could bond and recover from a c-section as fast as the next person. I think that babies sometimes come into the world with relatively little effort, and I hope that’s true for me, but as much as I want to claim my birth as my own and not as a doctor’s, I can’t claim it from my own body — my best intentions may come up against what my body needs in order to keep the baby alive — c-section or early labor or what — and then there will be a new birth plan. Like seemingly everything, it’s a balance based on intuition and flexibility and strength.

October 23rd, 2009 | Category: the baby thing | Subscribe to comments | Leave a comment | Trackback URL