By Tiffany Singer
In every way it was a typical baby shower: we played a few games, ate finger foods, and watched the mother open gifts. We admired a handmade baby quilt and cooed over adorable Baby Gap onesies, tiny booties, and the like. Eventually the planned activities gave way to chatter. I listened to the women of my ward talk of epidurals and episiotomies—the discomforts and indignities of giving birth. The general tenor of conversation seemed obvious, so I chimed in about Pitocin, IV’s, preeclampsia, and my own episiotomy. I could discuss engorgement and mastitis as well. I was just fine as long as I stayed within this realm. But eventually it happened.
I chose to speak not only of my first birth, but of the three that followed. These births all transpired without any pharmaceutical intervention—the final two by design. Furthermore, I had chosen to birth my fourth and final child at home in my bathtub. I knew from past experience that I would feel profoundly awkward as soon as I revealed these facts about my life. I also knew that despite my seat in the middle of the group, I would quickly metamorphose into an interloper on the fringes. But I did it anyway. I attempted to explain why I had wanted not to numb my body; I tried to make clear why I had wanted to feel my contractions, the urge to push, and the fabled “ring of fire.” Even before I spoke, I knew that I would most likely be greeted with reactions of “masochist” or “crazy.” And I was, and that’s okay. I don’t resent these women for reacting as they did, but I always feel a bit sad when my “natural” birth experiences are quickly dismissed. Having experienced both sides of the equation, I know how good the natural side can be.
How I came to be an outlier was accidental. As my due date approached with my first pregnancy, I had only the vaguest idea of what to expect. My parents were unable to-have children of their own, so my own mother had no personal birth experiences to share with me, an adoptee. I was the first of all my best friends to have a child, so none of them had anything to offer, either. I was about to embark on this monumental rite of passage without much information to go on from those closest to me—excepting Grandma Ginny. Sadly, all her reminiscences about birth were catalogs of male abandonment (her husband was an abusive alcoholic) and intense pain. Particularly vivid was her recollection of my Uncle Ron’s birth. She described her body as cracking in two, like a hen being dressed for dinner, with a pain so excruciating that her spirit left her body during labor to hover in the corner of the ceiling while she looked on. Over the years, she has shared this story whenever any of the women in our family are full-term. It’s a less than reassuring story at any time, but particularly disturbing at 40 weeks gestation.
I went into labor with Grandma’s bones cracking faintly in my ears and the tiny bit of knowledge I had gleaned from a free Lamaze class offered through the health department. Despite Grandma’s stories, I still toyed with the idea of not using drugs to birth. The Lamaze class didn’t make birth sound like that big of a deal. Pick an object to focus on, breath regularly, push when you felt the urge. That seemed straightforward enough. I reassured myself with the fact that Grandma did tend to the melodramatic.
When I felt a small gush of water on the exact morning of my calculated due date, I immediately phoned the group of midwives I’d chosen to birth with and informed them. They instructed me to go to the hospital. After a few obstetrical exams and several hours of waiting, I was told that an induction was imminent. My amniotic sac had sprung a small leak. Bacteria could have been introduced into the birth canal during the pelvic exam, and it was no longer considered safe to wait for my body to go into labor naturally.
I had no idea that an alternative existed to showing up at the hospital and handing control of my body and my child over to the hospital staff. I’d been taught that I should defer to medical experts in all matters relating to my body and my health, so I did. I officially checked into the hospital (even though by this time I’d already been there about seven hours) and was hooked up to an IV drip of Pitocin, a synthetic hormone used to induce uterine contractions. I chatted happily with my husband and the nurse midwife who would be delivering my child. Somehow over the course of all my prenatal appointments I’d never met her before. Fortunately, I discovered that I liked her. She was easy to talk to and had a kind manner.
About twenty minutes into our get-to-know-you, I had to cut the conversation short. The Pitocin finally kicked in and it hit with the force of a linebacker. Within minutes, I was hyperventilating, causing my extremities to go numb. I was terrified. I was no longer uncertain: yes, YES, I most definitely wanted drugs! The anesthetist came quickly. He was so skilled that I didn’t even notice the insertion of the epidural IV into my back. The dosage wasn’t so strong that I couldn’t walk after the delivery and I had no lingering neural problems like another woman I know. I am still grateful whenever I think on it. Once the epidural took effect, I was able to doze for the next several hours. Early in the morning I was checked and informed that I was now at a stage where I could push. I felt no different than I had for the hours before, but I dutifully pushed for about fifteen minutes and my child emerged—a child who promptly pooped on my leg while being handed to my waiting arms. (Seventeen years later, I’ve determined this act to be foreshadowing at its finest.)
When I looked into my baby’s face, I became a mother. Those tiny features stirred something primal in me. Exactly where the animating life-force came from I couldn’t say, but I had no doubt that I had been intricately involved in the alchemy that ushered this being across the evolution from single cell to the trillion-celled complexity I now held. Birthing awakened in me an organic sense of oneness with Mother Earth and all that grew out of her. I was awash with awe at the mystery of Life. I felt connected to another person in a way I never had before, in a way that felt like I was remembering a deep part of my own nature. This small creature resembled an elf and indeed I felt as if I had been handed something from an enchanted realm. It was one of those moments that felt out of time, otherworldly. It lasted for only a few seconds, maybe a minute, and then I was called back. Someone broke the spell to announce the gender of our child: a girl. The sonogram had been indeterminate, but I’d never envisioned anything other than a girl. Somehow I’d always sensed her.
Overall, my first birth experience was relatively smooth, and I remember it as mostly positive. Other than mild preeclampsia at the very end of my pregnancy, nothing too extraordinary took place. I had a healthy child and recovered quickly. But because my first labor had been induced, two years later when labor began with my second child, I had no idea what the normal progression should feel like. When my water broke around 11 p.m., I finished making grape juice for a house guest, then leisurely went upstairs to pack my bags. By the time I was done, I felt a little more urgency. As we pulled out of our garage for the 20-minute drive to the hospital, things had become more serious. I was anxious to get to the hospital and get an epidural.
But after being admitted, I was given a pelvic exam and informed that I was already eight centimeters dilated and fully effaced. There wouldn’t be time to get an anesthetist there before my son would arrive. With that news, I immediately began to hyperventilate. All my muscles tightened in fear as I recalled how incredibly painful my first birth had been before the epidural. I fought against every contraction. Finally a compassionate nurse suggested I move out of my supine position and onto my knees. She didn’t explain why, and I wasn’t asking. I just trusted her and did what she told me to do. I bless her every time I think on this birth. I bless her for sharing with me the wisdom of a woman who knows that gravity is your friend when birthing and for getting me out of the worst position to facilitate delivery and palliate pain. I had never much considered any position to assume besides being flat on my back. The overwhelming majority of TV and movie images housed in my brain were of a woman in a hospital bed, distressed and on her back. (From further inquiry after the fact, I think I understand why this is: it’s the easiest position for the birth attendant.) Once I moved to my knees, my son came minutes later. I felt positively exultant as I held him afterwards. I was glowing with the strength I had just witnessed rise from within myself. To actually feel my body widen and my muscles push him into the world was exhilarating.
As I planned for the birth of my third child, I strongly desired to birth again without anesthesia. My second birth experience had given me a glimpse of possibility, a peek at something I knew on a visceral level I wanted to re-experience with more awareness. I wanted to revisit the exhilaration of laboring and being able to feel what was transpiring within my body; only this time I wanted to be much more prepared. While my second birth was quite painful, I attribute this to the fact that I was fighting my body’s natural ability to labor. Rather than relaxing and allowing my body to do what it was designed for, I had fought against every contraction by tensing up. I would later come to understand that surrender is paramount.
My second birth experience taught me that an unmedicated birth was, in fact, a big deal. I set about to mentally and physically prepare for the next one. Knowing my intentions, my husband bought me Natural Childbirth the Bradley Way by Susan McCutcheon, and I began to cultivate the intuitive skills it espoused. One of the main arguments Dr. Bradley makes is that women have been conditioned to view birth as painful. I think he’s onto something. Western culture is steeped in the Biblical narrative of Adam and Eve. In Genesis, God himself declares: “Unto the woman . . . I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children” (Genesis 3:16). I have always heard these Biblical verses interpreted to mean that God intended birth to be painful, a consequence of the Fall that Eve set in motion. Dr. Bradley suggests that if women change the thoughts they entertain about birthing, they can change their birth experiences. Rather than always referring to contractions as “painful,” he advises learning to use new descriptors such as “intense” or “powerful.” This mental shift made a world of difference for me when labor actually started.
Beyond changing how I thought about contractions, I also learned to focus my attention on my breath and to consciously control the pace and depth of my breathing. This was the key to avoiding hyperventilation. The Lamaze class I had attended for my first birth had briefly touched on this, but there was no detailed explanation of how to actually do it. The Bradley book went into more specifics and gave me exercises to work on. I practiced conscious breathing over and over again before I went into labor. (If you are familiar with yoga, which I wasn’t at that time, it’s the same concept incorporated into that spiritual practice.) I also learned to mentally note when I was upset or anxious and to purposefully relax in the face of distress. I worked on pushing out fearful thoughts when they arose. I actively tried to tune into my own body and to learn to “hear” the voice of my own deep-seated intuition. I began to feel deeply that the one person who knew on a gut level what was best for my baby and myself was me.
This isn’t to say that the knowledge and experience that seasoned medical professionals possess are not valuable or helpful, only that these shouldn’t automatically trump a pregnant mother’s intuition and self-knowing about her own body and the needs of her child. Unfortunately, it seems this is often the case. From stories I’ve heard, and as my own third birth experience would prove, many times in Western obstetrical practice a woman’s active involvement in deciding how her pregnancy and labor should progress is thoroughly unwelcome; too much questioning of authority is not appreciated. I feel heartened, however, to hear of more and more women refusing to be cowed. It was my third birth that finally triggered enough indignation for me to push back against the norm, to stop surrendering my autonomy at the hospital doors. It was also this birth that confirmed for me that even the best laid plans can all unravel when you step onto someone else’s turf.
As this was my third birth, I had a much better idea of what to expect. I had also formulated strong personal opinions about what I did and did not want to happen to my body. I knew I didn’t want to have an induction unless absolutely necessary as I knew that I would not be able to labor without an epidural if I was on Pitocin. I had learned that a Pitocin labor and my body’s natural labor felt nothing alike. The pain of the Pitocin contractions had been excruciating. The pain during my second “all natural” birth never came close. I also had learned that the small tear in the amniotic sac, cited as what necessitated my induction, would most likely have sealed itself, making an induction unnecessary if a pelvic exam had not been conducted. The problem with my first birth is that the risk of infection goes up exponentially with a pelvic exam and I had received one immediately upon arriving at the hospital. It was standard procedure. But the midwives could have monitored my temperature instead. If it had remained normal, it would have been safe to assume that no infection was present. If I developed a fever, then an induction could have been considered. I was neither offered nor informed of this option. I was simply told I needed to have an exam, and I didn’t know to ask questions. Had I been given more information at the time, I could have declined a vaginal exam and likely avoided the induction altogether.
I also knew that just because an episiotomy was routine didn’t make one needful. In hindsight, I realized that I was given an episiotomy during my first birth without even being told, let alone being asked my opinion about it or given other options. It was only when I was able to compare my first birth experience with my second that I realized how painful recovering from an episiotomy could be. I didn’t want to endure another one without good reason. I had no need for an episiotomy with my second birth. I had only the slightest tear, which healed on its own—it didn’t even require stitches.
Lastly, I didn’t want to be hooked up to monitors unless there was reason to believe the baby was in dire circumstances. I wanted to be free to walk and assume whatever position felt most comfortable, or to labor in the hot tub, which sounded absolutely lovely. By baby number three I was no longer the girl who would meekly walk into the hospital and turn all control over to the staff. I had spent many hours researching pregnancy and birth from several points of view. I felt deeply empowered and that it was my right to actively participate in the way my birth proceeded.
I did all I could to ensure that I would be allowed to birth on my own terms. Unfortunately, the moment I entered the hospital, I found my midwife kowtowing to the hospital’s policies and ignoring my wishes in favor of pleasing the powers who ran the establishment. I was livid, but I was in labor.
Despite the badgering I received, I refused to be permanently hooked up to a monitor. I allowed them to ascertain that all was well, and then I firmly asserted my wish to go to the hot tub. It was apparent that I would have to fight to be left alone. Until my husband and I were escorted to the small room where the hot tub was located, the nurses and staff kept bombarding me with questions and demands during the middle of my contractions. I would politely hold up my hand to let them know that I would be with them as soon as it was past. Finally alone with only my husband to support and encourage me, I was able to relax. I transitioned within about twenty minutes. As soon as I felt the urge to push, I told my husband to go find my midwife. I would have instinctively squatted right there by the tub and delivered; however, I was commanded to run down the hall to a delivery room and above all not to push until they could get me on my back.
After the fact, I realized that during an unmedicated birth I would automatically follow any instructions given once I hit transition. The overwhelming physicality took me to a place deep within, a very primitive and instinctual space. From this dimension I automatically heeded whatever voice I heard instructing me. For my second birth, it had been the wonderful nurse who got me to me knees; for my third birth, it was someone ordering me not to push yet but to run down a hall while in transition. I wanted to avoid another experience where the midwife seemed to honor all my wishes beforehand but allowed them to evaporate upon arrival in the hospital. I wanted someone whom I could trust implicitly to honor my desires, someone who understood my heart. I wanted an advocate. After my third birth, I knew I was done with having other people dictate how I would labor and how I would deliver. I knew there was really only one way to procure what I sought. I was finally ready to take a huge leap of faith. I stepped off the edge of the cliff, like a fledgling bird, to begin the exhilarating freefall of trusting my intuition.
For my fourth and final birth, I chose a lay midwife. I had wanted to birth my third child at home because I was concerned about precisely the sort of interference that ended up occurring, but fear and self-doubt had won out. I had expressed my desire only to my husband and a few very close friends. They were hesitant about the proposition, and in the end, I had opted for the “safer” route of a hospital birth. My fourth time around, with the full support of my husband, we faced the expected insinuations about our foolishness and negligence and forged ahead. I was endangering my unborn child, people told me, when a hospital was a mere ten minutes’ drive from my house. The implication was that only uneducated, backwards people would birth at home when the miracle of modern medicine was readily available. I felt instinctually that all of this was not true, given proper education and preparation, but I still hadn’t trusted myself enough by birth number three to refuse to be bullied. Fear exerts a powerful influence on behavior. However, by baby number four, fear took a back seat, and trust in myself took the wheel. I felt I had enough woman’s wisdom to recognize that these messages of guilt, shame, and fear surrounding my strong inclination to birth at home were just echoes of a paradigm I no longer wished to embrace, a paradigm I felt was strongly tinged with patriarchal messages.
In the same Genesis verse where God speaks of sorrowful childbirth, the patriarchal overtone is clear: “thy desire shall be to thy husband, and he shall rule over thee” (Genesis 3:16). The idea that men are divinely appointed to rule over women is woven into the fabric of cultures that embrace this book as scripture. It has taken millennia to begin to shift this mode of thinking. For ages, it seems the only place this mentality didn’t infiltrate was the arena of birth. For most of history, this was the one realm where women were left to their own devices and men did not intrude. Women either birthed confidently alone or were assisted by other women. And all of these births occurred “at home.”
During the Middle Ages, a gradual shift began. Midwives were burned as witches and heretics by the indictment of a male clergy. Along with them burned knowledge of herbal and folk remedies arising from Mother Earth herself. These women who knew of the deep power invested in the feminine were routinely disposed of and maligned. The medical profession, belonging to men, grew up in midwifery’s stead and began to replace it. By the early 1900s, modern medicine had so effectively infiltrated how Western women birth that they were routinely admitted to hospitals and drugged as a default, generally with men rather than women as their main attendants. I feel the shift to hospital births caused a shift in the collective consciousness towards birthing. Hospitals are associated with illness, disease, dying, and a dire need for medical intervention. Pregnancy, however, is neither a disease nor an illness. Birth-related deaths have greatly diminished in the West all on their own due to more readily available nutrition and enlightened prenatal care. Given an optimal environment, the need for medical intervention during pregnancy or birth is the exception rather than the rule. When an exception presents itself, medical intervention is a blessing that can and frequently does save lives. But unnecessary intervention, which often has come to be standard procedure, can cause needless problems.
I worry that too many women entrust their bodies and those of their children to medical authorities simply because they’ve been conditioned to do so. Western culture has groomed women for centuries to defer to authority through patriarchal messages like those found in Genesis. I know this was the paradigm that informed my first birth. I’m pretty sure that would have proven true of all my births were it not for the unplanned turn my second birth took. This is why I share my experience, even if it is awkward and often puts me on the outer edge of social acceptability.
By birth number four, I knew I wanted what had been relegated to the fringes. I wanted a female birth attendant who understood the ancient wisdom. I wanted someone who respected nature deeply and who had knowledge of herbs and ways of dealing with complications that did not involve overly intrusive medical procedures. I interviewed several midwives until I found one I felt was the best fit for me. She was in every way respectful of my wishes, perhaps even too respectful for my own good. Because I harbored such a strong desire to allow my body to proceed on its own timetable, she allowed me to go two weeks past my due date. At a week overdue, she wanted to try kohosh, an herb that can induce contractions, or else strip my membranes. (Stripping membranes is a manual procedure that entails entering through the cervix with a finger to separate the amniotic sac from the uterus. This causes the release of hormones that aid in inducing labor naturally.) I staunchly refused. Looking back, I realize that I was still coming from a place of fear. I reacted so strongly against the idea of an induction because I associated an induction with Pitocin. I didn’t want that experience again. She let me go another week, closely monitoring for signs of trouble, with the caveat that come the next Monday she was putting her foot down. All indications were that everything was fine.
A baby girl arrived Monday morning about 5 a.m., all on her own. It was a beautiful, serene labor and delivery. It is a sustaining memory. I was able to have the dreamed-of water birth in my own bathtub, with my husband supporting me and nary a monitor beeping or a single soul demanding I do anything other than what I felt I should. It afforded a placid calm before the storm that followed over the next several days. I have always felt grateful for those peaceful hours beforehand.
After my daughter’s birth, my midwife cleaned her up, weighed and measured her, then quietly left us to ourselves. She was worried a bit by the dusky coloring of my baby and left an oxygen tank with me in case she showed signs of difficulty breathing. She told me to phone immediately if I felt something was wrong. I chalked the baby’s reddish color up to laboring in the warm water. My previous baby had been rather red at birth from the same thing. But as the day wore on, I could not shake the nagging feeling that this was more than just coloring from the heat of the water. Every time I tried to nurse her, her color would deepen to purple and I could tell she could not breathe. I would grab the oxygen tank and pass the hose under her nose. She would calm right down and go back to sleeping. After the fourth occurrence, I called my midwife who came immediately. As she tried to assess the situation, my baby went into respiratory distress again. My midwife gently soothed her and passed the oxygen under her nose. Then she declared that we needed to get help right away and accompanied us to the pediatricians’ office.
My own pediatrician was off duty, so we met with a stranger. At one point, my daughter went into respiratory distress yet again. The staff could not locate an infant’s oxygen bag—and we had not brought our oxygen tank in with us. Utter mayhem ensued, everyone yelling and panicking. I silently prayed in the corner of the room, clinging to my husband, that my daughter would not die. Someone called for an ambulance. Mercifully the hospital was just a few blocks away, but she was without oxygen for several minutes. She was rushed to the emergency room and intubated. Afterwards, she spent ten days in neonatal intensive care unit to finish out a round of antibiotic treatment. The physician assigned our case said his best guess as to why she was struggling to get enough oxygen was a partial breakdown of the placenta in utero due to being at 42 weeks gestation. This caused her blood to thicken and made it more difficult to transport oxygen.
Completely unrelated, but discovered from testing done while in the NICU, was the revelation that my child would not develop normally. Initially she was diagnosed with CMV, a virus that causes a host of problems. Years later we could tell the diagnosis didn’t fit her situation and learned her real condition is Williams Syndrome, a non-inherited chromosomal anomaly. Regardless of the initial diagnosis, within days of her birth we realized that our baby might never leave our home or be able to live independently. It was a lot to digest. Her home birth remains the glimmer of peace I hold onto when I remember those first years of her life, which proved to be intensely difficult physically, emotionally, and mentally.
I’ve often wondered if I should feel guilty because of this. Others have sometimes intimated that I should. But I find that I don’t feel guilty for any of the decisions I made surrounding any of my births. I made the best decisions I knew how to make with the information I had at my disposal at the time. Life is a learning process, mostly involving trial and error. I did copious research before I made the informed decision to birth at home. I went deep within to arrive at that decision, and once I did, I have never doubted it. All birth scenarios have inherent risks involved with them. Hospital births present problems that home births do not; home births present problems that hospital births do not. Any decision surrounding birth is about weighing options and trying to choose the one that seems best. There was absolutely nothing in my birth history that would have precluded me from being a great candidate for a home birth. If I were to have another child, I would chose to birth at home again if all indications were favorable. So I forgive myself the mistakes I did make. Perhaps that is part of woman’s wisdom as well.
My friend Brenda called me one day to tell me that she had just been subjected to a hysterectomy. We have shared many life experiences together, both have seven children of similar ages, have four names common to both families; and though we have yet to find a common ancestor, we even share the same maiden name. And now, without desiring it, we have shared another experience. How could I best acknowledge the invasive violence and her possible anger at this loss?
I decided to make a small piece of art for Brenda, something to bring our shared experiences to mind and address her loss as well as my own: a womb triptych.
Lilies have been used for centuries as symbols of life and fertility; they are in the foreground of at least one painting of Christ being laid in the tomb, symbolizing knowledge of his coming resurrection. The Pennsylvania Dutch painted tulips, a variety of lily, as a symbol for God. My carved lily draws upon these ancient symbols to portray life, beauty, and the ability to bear what needs to be born.
The womb block, similar in form to the bodice of a wedding dress, brings to mind a heroic woman standing on a hill, silhouetted against the sky.
The cut of the baby in the womb shows the placental circulatory system as sprigs of leaves, symbolizing the life-giving force that allows growth and development to take place.
But there was also a fourth print: the womb torn out of its page. I printed it on thick paper so that the violence of the tear would be obvious.
I hope this offering helped my dear friend remember our shared times of joy and sorrow. I hope that she was able to tell from the torn page that I understood her loss. I hope it helped us both deal with the physical outrage so that we could move forward in life with strength and optimism.