Guest post by Carol Keeley
When Lisa told me, joyfully, that they’d decided to have the baby at home with a midwife, I took a breath before chorusing support. Because I love her, I resisted blurting my worries. “But you’re forty-one and this is your first baby. Are you sure?” It was clear she was sure. And serene. And her confident faith persuaded me. I’ve known many strong women–including my mother, who had eight children–but I’ve never known a woman who gave birth at home. Lisa and her husband, Jacob, had selected a doula and a midwife. They were preparing their sunny Brooklyn apartment for the birth. I was blissed when they asked if I’d come and help. The due date was mid-December. Residents of their building became more interactive as her baby bump grew. Their Slavic super kept grinningly calling Lisa a “skinny chicken.” His wide-eyed wife whispered, “You not afraid?” when she heard they were having a home birth.
That fear isn’t uncommon. “The medical community believes that home birth is dangerous,” says Élan McAllister, president of Choices in Childbirth
, “which makes sense because doctors aren’t trained in the eighty to ninety percent of births where things go right. They train for emergencies.” As a nation, we’ve pathologized the birthing process. We’ve forgotten that it’s natural, that the body is exquisitely designed for it. In 1900, virtually all births in the U.S. were at home. By 1940, most births were in hospitals, the result of a damning campaign against midwives–depicting them as dirty immigrants–and the rise of antibiotics post-WWII. Through the lens of gleaming hospitals and obstetricians, what was natural had begun to seem unclean, even deadly. The number of home births has been fairly static since 1955: about one percent. This is largely due to restrictive legislation and the same mislabeling that worked in the Forties. Today, midwives and the women who choose them are often depicted as hippies, but the demographics for home births in New York include bankers, models, lawyers and Broadway theater producers.
Maternal health is the largest category of hospital care in the U.S.–about $86 billion a year–which is odd since pregnancy isn’t a disease. Plus maternal deaths have doubled
in the past twenty years. A recent report by Amnesty International
on maternal health in the U.S. calls it a “human rights crisis.” Our Caesarean rate is shameful–above thirty percent, though the World Health Organization
says five to ten percent is optimal and above fifteen harmful. These dismal statistics derive, in part, from liability-driven decisions, poverty, lack of health insurance, lack of prenatal care, and lack of access in rural and poor communities. Most of this could be remedied by a shift in perspective on midwives.
That shift began when The Business of Being Born was released in 2008. It met with an immediate backlash. The American Congress of Obstetricians and Gynecologists [ACOG] released a Statement on Home Births dismissing them as “fashionable” and “trendy.” While it seems a tad reverso-world to label “trendy” something we, by design, are able to do naturally and have done since the species began, I confess I’m glad I didn’t read this hair-raising statement before Lisa went into labor. It throttled my heart rate to read it again just now.
As I’m ignitable, I assumed the friction between OB/GYNS and midwives was economic, but Élan is both more informed and more gracious. She worked as a doula for years. “Economics are a factor,” she says, “but at the base there’s real fear, a real distrust of the process of birth and women’s bodies. And because you’re dealing with feelings and beliefs that deep, it doesn’t matter how much research you provide.” That the ACOG Statement reads like a horror trailer makes sense if that’s all you’ve encountered in medical school. “The midwives’ model of care is the opposite. It knows that birth works and looks at it as a holistic process instead of just seeing a contracting uterus that could explode at any moment.”
It softens me when she says this, because it lets me acknowledge my own anxieties about Lisa’s choice. It’s a choice women in New York may lose if the Midwifery Modernization Act
doesn’t pass soon. Since 1992, midwifery in New York requires written-practice agreements [WPAs] with hospitals or doctors. Since the incendiary statement by the ACOG, many doctors say they’d risk losing their insurance by signing a WPA. The recent closing of St. Vincent’s Hospital in Manhattan has created a crisis
. At least fifteen states, including Connecticut, don’t require a written practice agreement. It’s a premise that assumes health care providers won’t collaborate on their own–which they regularly do–or that a WPA insures a higher standard of care. Statistics belie this, but as Élan points out, this argument isn’t reason-based. “Many doctors are happy to collaborate, but not sign agreements,” she sighs. At this moment, New York midwives and their clients are in crisis.
On December first, I get a call from Lisa and Jacob. She’s due for a sonogram in the afternoon, but woke pre-dawn with light contractions. “It may just be Braxton-Hicks,” she says, but she seems to know it isn’t. We scramble to reschedule my flight for the next morning. When calls and emails go unanswered the rest of the day, I ricochet between shopping for immediate flights, pacing and prayer. I’m agonized not to be there. But these two are a calm and powerful team, and they’ve built bonds with their doula, Megan
, and their midwife, Tioma
. My panic gives way to inexplicable peace sometime around dusk. They call near midnight, milky with love as they hold their newborn son.
Later I learn that Tioma came to examine Lisa around noon, as the contractions had been steady for hours, but she was less than three centimeters dilated. It wasn’t time yet. So she and Jacob settle in to greet the experience. They discover that none of the positions or techniques they’d learned are comfortable because she’s so nauseated. They improvise. Jacob joins with her to breathe, to moan. They draw on their deep mindfulness practices. It helps, as she’s read
, to think of the physical experience as surges
, instead of the more violent-sounding contraction
. Jacob begins setting up the pool. Megan arrives at five, just as Lisa is tiring. The hot shower Megan suggests feels good; so do her massages. Tioma returns around seven and helps to ferry water from the stove to the pool in the living room. The building’s hot water quit suddenly. But no one’s stressed. Lisa obeys the wisdom of her body, moving as she needs to, bathed in warm water and attended by the deeply calm Tioma, the womanly strength of Megan, and the man she’s loved for lifetimes, Jacob. It is intimate, quiet, focused, intense. After fourteen hours of labor, Lisa reaches to feel her son’s head as he emerges, so eager to arrive he’s swimming out elbow-first.
Eighteen hours after Luke’s birth, I am stunned by how alert and strong he is. Their home is moonlit with the love that pulses around newborns and the dying–that otherside love, soothing and luminous. Lisa glows from the bed and Jacob is dazed by the doubling of his heart. I don’t notice the faint plume of red on their walls until they show me: an arc of blood from the placenta, a bowl spilled in the wonder-struck aftermath
. It blends with the room’s art and ardor. This room filled with friends and family for their wedding ceremony–a feast of shimmering colors and cushions, rituals and prayer, a Turkish song of friendship, a duet with a kalimba, and waves of food, including a lovingly homemade Hungarian stew. A celebration of true connection. This room has been christened twice.
Tioma comes to check both mother and child, bringing her swaying calm and deep expertise. She came to midwifery after giving birth to her first child at home. “The experience was formative in a way you want to share, to enable other women to experience.” Well-versed in herbs, she gives guided tours of Prospect Park’s medicinal plants. Gorgeously thick, gray-threaded hair and a lyrical Jamaican accent. She also has Ivy League degrees, including one in philosophy (she favored Heidegger), and has assisted in more than 1,700 safe home births. It is hypnotizing to watch her patiently hold a bowl of warm water near Luke’s stretching foot, gently introducing the two without any coercion. She guides his heel to the water to draw blood surfaceward, toward the quick tiny prick that produces a droplet for the screening test. The moment imprints me with its compassionate patience.
Imagine this moment transposed to a hospital’s schedule. I still recall leaving the hospital in Chicago with my sister’s first child fourteen years ago. We went from softly lit private rooms to a world that bristled with manic hostility. Every pigeon and paper scrap and truck seemed life-threatening. The drive home felt ruthless. A newborn transforms everything in her radius. I’m so grateful that Lisa can stay cozily home with her son. Tioma and Megan come to check the baby, Lisa’s vitals, his umbilical cord and her stitches, to do blood tests and paperwork, to tend to any questions or anxieties. The continuity of care has been effortless and precious.
Each time I emerge from their apartment with laundry or grocery lists, the other tenants ask after mother and child. A boy or a girl? How big? Eight pounds! How’s Mom doing? Everyone speaks in whispery smiles, even the squat guy down t
he hall who served time for Murder One–or so he claims during hollered hall arguments. He has tiny, yappy designer dogs named Momma and Punk. He scoops them up and holds the door for me, asks about the baby in a hushed library voice. One day the house-coated Haitian woman who lives downstairs got fed up waiting for me to get the laundry out of the basement washing machines, so removed them herself. “But then I notice all the baby things,” she rushes to apologize when I arrive. So she carefully washed the top of the dryer with a clean
rag–which she shows me–then wrapped all the baby clothes in one of our clean towels. Every time I leave the oxytocinated cocoon of their apartment, I encounter this kindness.
At the garbage bins, I get ambushed by a gelatinous tenant with long grey hair and a bad ear. “You new in the building?” she asks, sucking on a cigarette and squinting at me suspiciously, tapping her good ear as I explain. “Oh, you mean 3A? They had the baby? Boy, right? I knew it. Knew she was having a boy because it was all right here in front. With a girl, the fat pops out over here and back here, you name it. Friend mine asked me, ‘You carrying that baby in your belly or your ass?’ Swear to God, you couldn’t tell.” And then she’s off, reliving the birth of her daughter, now seventeen. Three days of labor, in and out of the hospital. “So finally they give me Pitocin or whatever it is that brings on contractions. And I saw this nurse I thought was Debbie Harry. I know Debbie, so I go, ‘So how’s Chris doing?’ And she’s like, ‘Oh he’s fine.’ Then I turn to the chair next to me and say, ‘Did you do the laundry?’ Man, that is one crazy drug.”
Back upstairs, we take turns holding the baby, amazed at his expressive engagement. I’ve never seen a child born without drugs. The difference is compelling. His pure attention and fluid emotions. A tiny scowl, a splash of a smile, turning intently toward his mother’s rich songs, his father’s voice as he walks the floors cradling him late at night, telling the story of how his parents fell in love. He’s instantly rapt the first time Bach fills the room. And I marvel daily at the body’s wisdom: how breastfeeding contracts the uterus; how the baby throws his head back and opens his mouth wide enough to suckle.
Hospitals are filled with equipment for emergencies and disease. For a low-risk pregnancy, the only instrument a baby needs is the mother’s body. Midwives, by the way, do bring oxygen, dopplers, IVs, Pitocin, stethoscopes, antibiotics and plenty of other medical supplies–a fact that surprised many at a recent Health and Hospitals Corporation meeting. Megan, the doula, had her first child in a hospital and her second at home. After her home birth, four of her friends made the same choice. She tells me this is common. The fear around this issue is entrenched and orchestrated. Even the facts fail to melt it.
But nature and science aren’t rivals. Though I’d never say what another should do, I would now make the same choice Lisa and Jacob did. Every woman should have the freedom to choose
. In Europe, midwives are the norm. Obstetricians are trained for complications, so used for those circumstances. There, like here, midwives refer whenever it’s necessary, whenever it’s best for the mother and child. The WPA is just a deliberately prohibitive hoop.
“They used to burn us,” Tioma laughs, implying that this is progress. “You can tell me it’s illegal to practice without this piece of paper,” another midwife says, “but I will tell you that it’s immoral for me to abandon my patients.” Midwives of New York have so far refused to abandon the women they’ve been caring for pre-natally.
This is Carol’s seventh post for Get Behind the Plough.
Images from: http://www.hps.cam.ac.uk/visibleembryos/s1_1.html, http://www.savingadvice.com/images/blog/baby-hand.jpg, and http://freeourmidwives.org/the-photography-project/participate-learn-more/