Tuesday, September 29, 2009
It's no secret that my preference for place of birth to occur is home. I had three of my children in my own bedroom. I have worked at a home-like Birth Center and that is a good alternative. And I have come away from Lily's hospital birth with my place-of-birth beliefs only more firmly held.
Let me say right away that our nurses, especially the one you see there, were terrific. We were blessed with that woman as our nurse. She was incredibly kind and patient and hard-working and she knew what our philosophies were and she did everything in her power to make Lily's birth as un-intervened with as possible in the setting we were in. I wish she had delivered Lily's baby because I think she would have done a fantastic job of it. She, like we, believed that Dr. Brickler was the best and when he was on the floor, she always announced that with sweet smiles. "Thank-you Dr. A.D.," she would say when he left the room. And when Dr. B. went home and residents appeared, she assured us that the head nurse on duty had been a midwife in Iran and had delivered thousands of babies so that even if a fumbling just-got-his-white-coat doctor was in charge, there would be someone looking over the resident's shoulder to make sure all was well.
I wanted to take that nurse home and baptize her in the holy waters of the Church of The Batshit Crazy because I think she would have fit right in. She worked 7 a.m. 7 p.m. on Friday and was back again at 7 a.m. on Saturday and was with Lily up to and through the birth. She was our touchstone and our comfort. I would look at her and say, "Elizabeth, what do YOU think?" when we would get to places where decisions had to be made. And she would tell us and we trusted her.
BUT, BUT, BUT- although I would personally love to have that woman with me or any of my loved ones when they gave birth, I would so much rather that she do that in a place other than the hospital.
I think it is harder to give birth naturally in a hospital than it is for a camel to pass through the damn eye of a needle. Everything and I do mean EVERY thing, is set up against allowing a natural process to proceed on its own.
Now a lot of things have changed in a hospital when it comes to birth. The family is allowed to be present at all times. There is great respect for the family and that means more than anything. Countless times one of us would say, "Here, let me get out of your way," and the medical person would reply, "Nope. You're fine," and then figure out a way to do what he or she needed to do from another angle. I not only noticed this fact, I was impressed with it. Tremendously.
But my god, there was so much going on. Lily was in the hospital to be begin with because of her blood pressure. She was monitored for that no more than any other birthing mother would have been and it never got so high that any measures had to be taken to bring it down. A midwife could easily have done the same.
Owen's heart rate was monitored for twenty minutes every few hours, up until she got an epidural and pitocin at which point it had to be monitored continuously. And his little heart (bless it! bless it!) did exactly what it was supposed to do, going down during contractions, coming right back up. Again, a midwife could have monitored those heart tones with a doppler instead of those darn monitors which are strapped on and slip easily and cause great consternation when they do. Her contractions were also monitored. In the picture above, you can see Lily looking at the screen to see when one was coming. This was after her epidural and when she was pushing so the screen gave her the information she needed to use the power of the contraction which she would not have had at home or a birth center but there are no epidurals at a birth center or at home. Contractions in those places are monitored by the midwife's hand on the mother's belly, by the mother saying, "Here comes another one."
And the thing is- if Lily had been allowed to go into labor on her own, I think she would not have had to labor for so long. Although the ultrasound doctor was encouraging her strongly to get a C-section three weeks before the induction because he believed her baby was so big and although everyone involved (except Lily) was so damn worried to get him out before any more time had passed, Owen did not appear to be a post-dates baby. And his size- although hefty- was not anywhere near dangerous. I have seen fat babies and Owen is not a fat baby. If Lily had taken his advice, Owen would definitely have been born early and Lily would still be recovering from major surgery instead of walking around like a woman who's never given birth.
So all that technology, all those millions of dollars worth of machinery and scanners and devices were not as accurate, in the long run, as the midwife's hands and if we had just been allowed to let nature take its course, I think Lily would have been saved days of agonizingly slow labor.
Another thing- although the hospital encourages walking during labor, there is no place to walk except the hallway. We made loop after loop after loop of that hallway during the dead of night and not one nurse or tech looked up from what she was doing to smile encouragingly. Not one. In fact, they looked at her askance, if anything. We saw no other mothers walking, no doubt because they all had epidurals going and were asleep while their bodies labored. When dawn broke and Lily's uterus finally reached its limit and labor stalled completely, Lily had no desire to get back out there and walk. She didn't want to see those same people, and say what you will- walking down a hallway in a hospital gown and having contractions is not something you want to do in front of strangers. It just isn't.
Which brings me to another point- Ina May Gaskin says that labor is not unlike going to the bathroom in that you really need privacy and to feel safe to get the job done properly. And in the hospital, you have no idea who is going to walk through that door, introduce him or herself and stick their hand inside of you. You may like the person or you may not, but it's not up to you to decide. The stranger's vibe and touch may be great and inspire trust or may not be. And don't you laugh and call me a mad old hippie because I KNOW for a fact that touch and vibe have a lot to do with feeling safe. So do you. The mind-body connection in labor is strong and we can pretend that it's not but that doesn't make it so.
When Lily's labor stalled, I thought back to a home birth I'd been to once where the same thing happened. The mother had been in labor for a long, long day and then through an entire night and at dawn, she stalled. I listened to my gut (I was not the midwife, but an assistant) and realized that we needed to turn off the cozy lamps, open the curtains, open the windows, let the new day's light into the room, and get things moving that way. It worked. The baby was born soon thereafter.
Lily's room didn't even have a window in it. It was like Groundhog Day. Time passed like in a movie- theater. The clock on the wall gave the hour, but one wasn't sure whether it was the hour of the day or the night.
And again, I think that if Lily had been allowed to go into labor in her own time, I don't think her uterus would have reached that point of exhaustion, causing the need for the pitocin, the epidural. She was so vastly relieved by that epidural and so was I. I had reached the point where I couldn't stand to see my baby in pain anymore, especially knowing that although the contractions hurt horribly, she was too exhausted to deal with them properly and they really weren't doing much good. And then, because she had labored for so long and because she'd gotten pitocin, after the birth she bled A LOT. I always bleed a lot after I give birth, too but it's never been a life or death situation. By my third and fourth babies, the midwife knew what to expect and had a shot of methergine available and ready to give me. Lily required a huge dose of more pitocin to get her uterus to contract properly and it's so easy to say- well, if she hadn't been in the hospital, she might have bled to death. But perhaps, if she hadn't been medically interfered with to begin with, she wouldn't have had the complication.
Same with Owen. There was some meconium in the fluid and they had to suction him before his body was born and because Lily's water had broken early in the labor (which she reported but which never got noted or charted) he had that fever at birth. But- if the process had been on Lily and Owen's timeline, perhaps he wouldn't have had to go through such a prolonged and stressful labor.
And the waste- my god, the waste at a birth! The amount of disposable stuff. Everything is disposable now and several large bags of trash were collected and disposed of during and after the birth.
Here's another thing- although family is encouraged to be with the laboring mother, there is nothing done to provide for their comfort. AT ALL. No place to lay down and rest. No place to get food except for the machines or the cafeteria which was a very long walk away in another building. Mothers are encouraged to eat and drink during labor but Lily was offered nothing except for juice and water. We were expected to bring food in. Which we did. But still- that's ridiculous! How is a woman supposed to labor for three days without food? What if we hadn't been there to bring her food? And after she gave birth, there was no food offered to her. None. Again, we had to go out and get her some. Same in the family care unit- the mother gets a hospital meal, the father gets a long walk to the cafeteria.
I think it all boils down to this: birth in our country is still considered very much a medical event. Yes, they do give lip service to the needs of a woman to be able to walk, to eat, to be with people she loves and trust during labor but no real considerations are offered to make those things easy. The staff was indeed considerate of the family but our presence was more tolerated than encouraged. Lily was told to walk but there was no real place to do that except for the artificially lit hallways of the floor. Lily was told to eat to keep her strength up but no nourishment was offered.
It was a beautiful birth. Lily and Jason learned more about their strength than they ever could have imagined, which is the perfect preparation for being parents. But this happened because of Lily's will and desire to birth naturally. No one, from Dr. Brickler on down, believed that she could do it. And I have no idea why. She is a strong, young, healthy woman and her baby was a reasonable size. She had unending support from her family and from kind nurses. Without all of this, she would NOT have succeeded in having a vaginal birth.
I keep thinking of how every time Lily got a contraction, Jason would jump up and be with her, to hold her, let her lean on him. She wanted HIM. The rest of us were okay, but it was Jason she wanted. How could this be anything but the best lesson their relationship could ever have? He was her main support, both physically and emotionally. He knew she really needed him and she really wanted him to help her. He was an integral part of the success of Owen's birth. He was there for his wife and his baby throughout the entire process. If Lily had gotten a C-section or even an epidural during an earlier part of the labor, he would not have this information, he would not know how much she truly loves and depends on him. As they danced together during contractions, it felt holy in that room. The three of them working together to bring Owen out.
And that's what I'm thinking about this morning. My brain feels a bit less mush-like and I am have so much to do. My house and my yard need attention. My chickens need their morning scratch and their crazy-chicken-lady love. I need to start baking bread, a cake, and to make that delicious salad which is going to nourish my daughter and her beloved, strong husband. I just called Lily but her phone goes directly to voice mail. I hope this means they are sleeping. I hope they had a good night. It takes a lot of will power not to jump in my car and go over there RIGHT NOW to see how they are doing, but I'm going to leave them alone. They are doing something very, very important which is being alone together as a family in their own home.
And it occurs to me that nowhere in this long discussion did I talk about the actual delivery. It's hard for me to do that because the resident did deliver and I do think it was his first delivery. The real doctor stood over him and advised him but it was a lesson in how it is the mother who delivers the baby- the attendant only helps guide and catch. I was mostly at Lily's head during delivery but part of my attention was down there and I saw some fumbling. I think she would not have torn if there had been a more experienced attendant. I saw the resident pull on the cord so hard that it broke, and blood spattered all over his face. This is the second time in my life I have seen a cord break- the other time was also in a hospital. I think there is a sense of panic during a hospital birth I have never seen in a home or birth-center birth. As if the whole culmination of this medical event is something to be scared of. At the very end of the pushing stage, it is difficult to get the fetal heart tones of the baby because he is up under the pubic bone. The doctor recommended that they put the electronic leads which screw into the baby's head to keep track of his heart and I had to laugh because Jessie, Lily, and Jason all looked up with alarm at these words and said, "NO!"
And really- at this point with the birth so imminent, what good would they do? The nurse, bless her, assured him that if she kept having trouble hearing the baby's heart, she would do that. And it ended up being unnecessary and Owen was born without tiny wires screwed into his scalp.
Ah yah. Owen was born through the power of his mother's pushes, through the determination and strength of her. The man who caught Owen will never forget that birth, even if he goes on to deliver thousands and thousands of babies.
And that's nice, in a way. He will remember our crazy family, the joy, the tears, the happiness, the support. He will remember that strong mother, that hefty baby boy.
He will also remember the way a cord can break and spew blood when pulled too hard.
I am so grateful for the way everything turned out because everything turned out fine. I still believe, though, in my heart, that if Lily had been allowed to go into labor when her body was ready, things would have gone easier for her AND for Owen.
And I think we can safely say that about hundreds of thousands of other mothers and their births. But until things change in this country, we'll never really know.
Until then- we have to keep asking the questions. We have to keep questioning the experts. And we have to keep trusting our instincts.
And we have to remember to bring food to the hospital because they sure ain't gonna give you any there.
A sleeping bag wouldn't be a bad thing to bring either.
And we have to keep being grateful for the people who are part of the process who have faith, who have patience, who are the ones who truly help the mothers in this greatest of all transitions- the nurses with the tender touch, the knowing eyes, the smart brains, the beautiful faces. The ones who, in the very midst of this very much medicalized event, keep it real, keep it human, keep it holy.