When near the 40 week mark, and sometimes before, many practitioners start talking about the risks of continuing the pregnancy.  There are many things that simply aren’t known, bu there is a neat document that puts it all together and it says:

“Based on the observed absolute risk difference in the meta-analysis, at least 500 inductions are necessary to prevent one perinatal death.”

You can read all about the ins and outs of the perceived and potentially real benefits of various induction methods, fetal testing and more at: Management of Prolonged Pregnancy

As this chart shows, the more prenatal care you had, the more likely you are to use epidural anesthesia. The lowest rates of use were women who had not received prenatal care, even when this is a known high risk group of labor complications. There are a couple of explanations, but one I’d like to explore is: Did more time in the “system” lead to a lack of confidence in one’s body? Did more prenatal care instill a fear of labor? Let’s talk about it.

Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. National vital statistics reports; vol 59 no 5. Hyattsville, MD: National Center for Health Statistics. 2011.

As a part of this class, we were assigned a hospital in the area to interview and find out their birth statistics. I had never thought of questioning the procedures being done because hospitals are a place that sick individuals go to, get treated, and feel better by the time they leave. These interventions are done to save individuals lives and are for the most part necessary. As I began researching the hospital, I found myself asking “Why are pregnant women, who are not sick, being treated the same way as people who have illnesses?” Doctors do not need to “save” women from their births, they should instead be supporting women and letting nature run its course.  This being said, I do understand that some women, and that percentage is a small one, need help in delivering a baby due to some complications. Many women however, have a body fit enough to deliver a healthy baby on their own and that right is being robbed away from them.

To further my research for this project, I decided to go on the hospital tour as a pregnant woman.  One of the first questions I had for the guide, who was also a nurse, was their c-section rate. With this, two women on the tour stated that they already had their c-sections planned and were so happy because they knew the definite day and time they would have their baby.  As I sat there stunned and feeling bad for these women, the rest of the group congratulated them and one woman was thinking of doing the same.  At this point I decided to ask about natural births and the tour guide stated that she sees plenty of vaginal births.  When I explained that I meant natural to be 100 percent intervention free, she looked at me like I was crazy. She said that when women first arrive they are hooked up to IV’s and fetal monitoring with an epidural not too far away.  My face must have said it all because she said that I didn’t understand how painful it was going to be and that many women need some kind of assistance. 

After my tour, I was very upset and amazed at how much these women and the tour guide didn’t know. And I do not think that the women are to blame.  Doctors should be spending some time helping to educate about birth and all its wonders. Instead, they are ordering everything from fetal monitors and pitocin to epidurals and c-sections when all of these are usually unnecessary.  As I said before, a hospital is a place for the sick to become healthy and not the healthy to be treated as if they are sick and need saving. 

This hospital experience has opened my eyes and made me realize that these hospital ways need to change. The only way that can happen is if women come together and fight against these unnecessary procedures that are being done to them before a completely natural birth is only a thing of the past.

(The following is a short summary of a clip from the show, found here, starting at 5:15.)

Rebecca tries to explain the concept to her mother, noting that the birthing center is one of the biggest on the east coast and that “they emphasize natural childbirth in a relaxed atmosphere with no painkillers.”  As expected, a number of jokes follow about the pain of childbirth and a comment by Sophia likening the birth center to a Disneyworld theme park.  Dorothy encourages Blanche to keep an open mind and at least visit the birthing center.  In the next segment, the women all tour the birth center.  Blanche and Sophia make disparaging remarks about the lack of “equipment” and even Dorothy, ever skeptical, takes a negative view.  The women are interrupted by a yell, and then another.  An unseen woman in another room is giving birth.  The women seem alarmed- especially Rebecca, who asks, “Why is she screaming?”  Sophia answers, “Because she’s conscious!” and the group heads for the door.

In the next clip, Rebecca has changed her mind about the birthing center and decides to have her baby in the hospital.  She mentions she has a Lamaze coach and says there’s no reason she can’t have a natural birth in a hospital.  When she wakes up in the middle of the night wondering if she’s in labor, Dorothy has her get into bed to start timing contractions.  When Blanche and Rose wake up, the group heads to the hospital, where Rebecca is put flat on her back on a gurney and the obstetrician who arrives makes a number of snide remarks.

The  final clip has just about every cringeworthy stereotype about birth shown in popular culture.  Rebecca is in the delivery room, covered in all sorts of gowns and drapes, while everyone in the room is in scrubs.  Blanche at least gets to forego the mask over her face.  Rebecca is supported with her knees up around her ears, holding her breath while Blanche and the doctors loudly exhort her to push as they count to 10.  Between pushes, she’s nearly flat on her back on the delivery table.  (She’s probably only tilted up because otherwise the camera wouldn’t be able to capture her face in the shot.)  After Rebecca births the baby, the doctor immediately cuts the cord and hands her a perfectly clean, blanketed baby, and then the credits roll.

Granted, the original airdate of this show was in 1990.  But how much has truly changed in the intervening 20 years, in real life and in the mainstream media?  In many hospitals, women are still delivering in drapes, still in the lithotomy position, still being directed to push by doctors, nurses, birth partners, and whoever else happens to be in the room.  Certainly this is how birth continues to be portrayed on television and in the movies.  (see: Knocked Up)

I think the result is that we are stuck in a vicious cycle of expectations.  The general populace expects birth to be a horror show of screaming and sweating and laying flat on one’s back because that’s what is portrayed in the media.  The obstetric system expects that women (and men) will just accept their status quo.  And everybody expects movies and tv to depict birth the way it happened to them, further cementing the status quo and beginning the cycle again.

The birthing community has done a lot of work to break the cycle, especially in the arena of changing the status quo for births, both in and out of the hospital.  But if we continually portray birth in the popular culture as something that “happens to you” on the doctor’s or hospital’s terms, what lessons are we imparting to children, teens, and young adults who consume this type of media?  What stereotypes have those of us who advocate for choices in birth had to confront?  And most importantly, what can be done to turn the media tide?

We live in a time and place where in the media violence is recreated with painstaking authenticity, where we can watch any number of surgeries and medical procedures on television, where “reality tv” is a killer app.  And yet birth is treated alarmingly unrealistically.  In order to re-normalize birth in hospitals, perhaps it must first be re-normalized in pop culture.

Our society does not allow birth to be a peaceful, natural and beautiful experience.  It is something to get over with and don’t talk about.  The pregnancy is praised and the newborn is praised, but why doesn’t anyone talk about the life changing experience?  It does not need to be this way.  I feel that if all women (and men) were educated about how birth could be, and given the facts before they were in this fragile state they would be able to make much more educated and safe decisions for themselves as well as their baby. 

My high school teacher had good intentions showing her students a beautiful natural birth, but I believe that there is one necessary intervention that needs to happen to correct this society’s way of thinking, and that is to insert birth into the health and sex education classes for high school students.  With the rising rates of teen pregnancies, we cannot ignore the fact that these are the ages that should become more educated.  Preventing pregnancy and protecting from STD’s are not the only important topics to talk about.  Talking about birth and how to have a more comfortable experience without the use of epidurals and cesareans, should be discussed even just for a few classes a semester. Birth education in high school would allow young minds to think of their options when they get to that point in their life.

                Almost about two weeks ago today I took part in a tour of the mother/baby and Labor & Delivery rooms at Vassar hospital. As part of the total grade for a Birth class that I am attending one requirement was to get “informed” of statistics and birth cultures at local hospitals. I took the liberty of telling the hospital that I was pregnant (3 months) and wanted to view the hospital as a possible birth site, and my findings were infuriating to say the least!

                When I arrived at the hospital I met the other women and men who were taking the tour in the lobby. Our group was greeted by the tour guide whose first statement to the group went something like this: “I am here this morning to show you around the labor and delivery birthing center, and to answer any questions that you may have, but I am not a medical professional so I cannot answer any medical questions you may have”. That definitely set the tone for how this tour was going to proceed. As we moved through the tour the guide had pointed out the “lovely photographs on the walls” and “the great view of the Hudson river” that you get to enjoy when you deliver at the hospital. She also added in that the phone is completely free for the mother’s first night after having the baby and that if you have your baby on a Sunday you and your husband can watch football for free as well.

                Besides feeling like this tour guide was trying to sell me the hospital rather than a positive birth experience I also noticed something else that felt off to me: not one person on the tour asked a single question. I had many questions and going into the facility as a “pregnant woman” who was interested in delivering in their hospital I demanded some answers. At first the tour guide tried to answer some of the questions, for example I asked what percentage of people within the last year who labor there had received some type of augmentation of labor. The women seemed quiet confused and said that she would introduce me to someone better equipped to answer my questions.

                I was then introduced to the head nurse for labor and delivery, who at first was very warm and inviting of my questions, though she soon became defensive and hesitant in answering them. The answers that she gave me as a “consumer” of the “product of birth” were astonishingly different than those listed on their state mandated report of statistics. One example: I had asked the woman what percentage of women receive an unplanned epidural when then come in with a birth plan specifically stating that they do not want one. Her answer to this was “unfortunately around 20%-30% of then NEED it”, after researching public records actually statistic the actual statistic was closer to 60%!

                I do not mean to speak badly about this hospital or any other, I just wanted the truth, and this is what I got. It makes me angry to think that one of the women who holds a specialist position in the labor and delivery room did not answer my questions correctly. It infuriates me to think that she may have lied and makes me very disappointed to think she just may not have known!

Yesterday my midwife must have seen into my soul and understood what my mind and body were going through. She offered to stir things up a bit to my relief. I took two homeopathic remedies rotationally (Caulophyllum and Cimicfuga) every hour since our noon visit until 10 at night and she stretched my cervix a bit and performed what is called a “membrane sweep”.http://www.birthingnaturally.net/birthplan/intervention/induction/membranes.html

After this meeting, I experienced some spotting for the rest of the day and some light cramping. I continued to take the homeopathic remedies throughout the day into the evening. At about 6:30 pm, I experienced some pretty strong contractions. These came sporadically at about every hour and a half to every 10-15 minutes apart. At about 8 we put my daughter to bed (she’s 14 months). Strangely enough, when we thought she was fast asleep at about 9:00 she woke up and started crying for her momma. When I went upstairs to cuddle her, she seemed to be aware of what was going on. She usually curls up next to me but that night, she laid her head on my belly and fell asleep cooing “mama”, like she knew it would be our last bedtime together before her sister arrived. It brought me to tears. I think that even though she is so young she had some sort of sixth sense about it all.

After my daughter was securely in bed, my husband and I sat down to watch a movie and I chose to sit on the exercise ball to manage the contractions. My intention was to keep going what had started so I moved around quite frequently throughout the movie. At about 10:30 we went up to bed to try to get some rest and to my dismay, my contractions had quieted down to about 45 minute intervals.

I was in and out of bed, anxious and still experiencing contractions when they grew more intense and started lasting over a minute in which I had to hold my breath through the waves. They were now about ten minutes apart and somehow I knew that I should wake my husband up to start the labor preparations such as blowing up the tub and getting the bed labor-proofed.

I followed him downstairs and while he was blowing up the tub, and getting the bed ready I first attended to him by giving him vitamins and making him tea (he was feeling ill that day and he NEVER gets sick). When my contractions got stronger I was walking around and counting the minutes on the clock. They were still 10 minutes apart but very strong (I was instructed to call the midwife at 5 minutes apart).

During this time, I spent a lot of time in the bathroom, because the toilet with the hole for a seat was the most comfortable since it didn’t put any pressure “down there”. I started bleeding and to me it looked like a great amount. My contractions got to 5 minutes apart and I calmly called my midwife. She said that I seemed so calm on the phone that she’d make herself some tea to wake up and then head over there. I also texted my friend who had agreed to come get my daughter and told her about what was going on.

In a span of about 10 minutes, I yelled at my husband to hurry up and start filling the tub, and to call my midwife back and tell her to come NOW because 1) I was bleeding A LOT and 2) My contractions suddenly were on top of one another with about a half a minute break. He also called my friend and told her to come NOW. I think I said “Call Suzanne, get Ellen OUT of the house! (Because I was screaming at this point through every contraction they were so intense).

Instinctually I thought to myself “I have to get up now and move to the tub because if I don’t I’ll be stuck on this toilet” and I was right. Somehow I managed to lift myself out of the bathroom and into the tub, which was set up in the dining room, which was only a quarter of the way full. Doing awesome tub management, my husband was concerned about the temperature and kept checking it but I really didn’t care if it was too hot, it felt better than being dry and dealing with those waves.

As soon as I got in, I started moaning loudly with the contractions. They were still right on top of one another. After about only 5 minutes I felt something “pop” which was my bag of waters breaking. Right after the pop, I yelled to my husband that she was going to come NOW and that I “don’t want to push”. I was scared. We were alone. What if the baby came out not breathing or what if I was bleeding too much like I thought?

I yelled for him to find the bulb syringe because I knew that if she wasn’t breathing, we might have to suck water/ mucous out of her mouth to help her. He got on that task right away and before he was done washing the syringe, I felt a huge urge to push, screamed that I didn’t want to push but my body had other intentions.

She was out in two pushes, back to back with no break in between. I felt for her head in the water and cupped it while her body slid out. I took her out of the water immediately and onto my chest. I looked at her face and my husband emerged from the bathroom with the clean bulb syringe. We waited for her to cry and she let out a wet little peep. One tiny cry. She opened her eyes and looked around. I held her close to me in the warm tub and instructed my husband to get a towel. I couldn’t really move because she was attached and I didn’t know how long the cord was so I just held her there, close to the water with a towel that got soaked. After a few minutes I said, “I think with this wet towel, she may get cold”. We need to try to get the placenta out and get her detached and warm.” So I carefully stood up onto my knees in the tub and handed her to my husband while I pushed the placenta out. He handed her back to me and got a bowl to put it in so it wouldn’t just be floating around in the tub.

I then asked him to get some scissors to cut the cord since the placenta was out and it had been about 5 minutes. He found some kitchen scissors and again, cleaned them off the best we could in limited time and then he cut her cord.

This is the time my midwife and my friend arrived. I was sitting in the tub; holding her, cord freshly cut. We explained what had just happened and that we had just cut the cord. “Did you clamp it?” she said. “No I didn’t even think about that, I just thought we needed to get her warm and in a dry clean towel.

So my midwife, a bit stunned that this had all just happened in the 15 minutes she was in route, quickly dug into her bag, found a clamp, put it on, and then cut the cord to a proper length (we were smart for cutting it long).

I told my friend thank you for coming but our daughter had slept through the whole thing.

My midwife then took on the grandmotherly role helping us manage self- care, and we passed the baby to daddy so that I could get out of the tub and we could get her bundled.

I arose from the tub dazed. Did that all just really happen? Did I deliver my own baby?

I was not bleeding profusely as I had believed, I have two TINY hairline tears that stitches would cause more damage to then good, so it’s not needed, and the baby latched on right away and is rosy cheeked and healthy as an ox.

Certainly if I was not planning to give birth at home, she would have been born in the car on the way to the birth center or the hospital.

Thank god for my husband, my birthing tub, my daughter for sleeping through the whole thing, and my baby for entering this world so swiftly.

It was a crazy ride and I’m so glad that I was on it.

Oh AND while I’m blogging away because I’m still high on love hormones, can’t sleep, and want to record this to the best of my memory, my husband made me breakfast in bed (banana pancakes, and bacon), is cleaning up all of the mess, and taking care of our older daughter. Life is good.

I came to realize that I was always fascinated with water birth. Just a few weeks earlier I had seen “The Back Up Plan” with Jennifer Lopez and realized that in that movie there was a water birth. I have to admit it was a bit scary to watch. I decided to research water birth and found out Igor Tjarkovsky in 1960 introduced the idea of giving birth underwater. In 1977 Michel Odent introduced mothers to a pool of warm water so they could relax and not feel inhibited. I also learned that it wasn’t introduced until the 1980s in mainstream America, when Erik Sidenbladh wrote his book “Water Babies”.

 “The Back Up Plan” did not show water birth in the best light: it was chaotic, stressful, overcrowded and noisy. This is not typically the case- water births are meant to sooth and calm the mother in labor. The warm water allows the mother to move freely and allows her and her muscles to relax.

 The American culture is a culture that embraces technology that affects how childbirth is being viewed today. The American culture views childbirth as having a need for high level of medical intervention. As America continues to develop technologically, the negative views towards water birth will continue. Water birth is viewed as experimental with no benefits to the baby, only risks. While not every one is a candidate for water birth, it has many benefits, including: increasing comfort, pain relief/control, shorter duration of delivery, reducing the need for episiotomy, and reducing or eliminating the need for anesthesia. Giving birth in water may help women pursue the goal of natural child birth, and allows for greater acceptance of labor pain.

The American culture lives on a fast paced, tight schedule – we need to slow down and take a moment to inform themselves about child birth and what is beneficial for both mother and baby.

So I sat in misery for a few days until I went to biopsych of birth class which always makes me feel better. This particular day we were talking about a father’s place during labor and the topic struck a chord with me. My daughter’s father was there when she was born and was supportive in his own way, but it was not something he really wanted to witness or had any interest in learning more about in fact he almost fainted twice. Let’s just say that does not help when you’re in the middle of trying to push a baby out.

Sometimes I feel like his reluctance and disengagement from the thing that I consider to be the most important thing I will ever do in my life should have been a sign that that attitude would translate into fatherhood. The more I think about it the more I feel that a man’s reaction to the birth of his child says a lot about him. I could be wrong, and I’m open to hearing from other people with different perspectives.

I just know that the man that has stepped up to be a “father” to my daughter wishes he could have been there to support me when I needed it the most and is the guy that actually discusses the topics we touch upon in class with me. He is totally fine for trying a natural approach if we were to ever have a child of our own and that’s got to count for something. I don’t believe fatherhood necessarily has to begin with the birth of a child but I do think that if a man is fortunate enough to be present for it then he should be educated as much as the woman in order to truly appreciate the miracle of birth. I wonder how other women’s partners have reacted to the births of their children or even throughout pregnancy and after. Having a baby is a huge deal, not only for the mother but also for the father, and it’s interesting to me to hear other people’s accounts. Maybe classes like this and a blog like this one can answer those questions for me, but until then I’m going to catch up on Little Bear with my little girl.

But what is the role of the father? He is not the one with a belly bigger than a watermelon attached to him, feeling hiccups and kicking throughout the night or pushing that baby out of them in a short nine months. So what should the men do to prepare? What is the right thing for them to do during the labor? No one asks them about their fears or curiosities. 

After reading about how much the male’s role has changed throughout history and across cultures regarding pregnancy, labor, delivery and post partum, I’ve come to the conclusion that there is no right or wrong way.  The male role has changed almost as many times as the female’s.  One decade the mother is enjoying birth as a natural process and the next she is strapped down and pumped with medications for the doctor to do all the work.  My own opinion is that women should have the choice of any style they would like, if this includes the father’s presence than it should be allowed.  In order to keep this safe though, communication is still the most important characteristic. 

Men should be more educated about birth, ask questions, and challenge the answers.  Just like mothers should! My personal belief is that the father should be willing to do anything for the soon-to-be-mother.  If it would keep her comfortable and relaxed for him to be there and just hold her hand, it should be allowed.  If she needs him to be as involved as her, taking classes, reading books and willing to catch the baby himself, that is his role.  But if she feels uncomfortable with him in the room, feels it will destroy the sexy woman he sees her as, then tell him to find his friends and go bowling until he’s ready to meet his son or daughter.   The soon-to-be-fathers role is willingness and open communication.