Birth on a Wire
How I Learned to Stop Worrying and Have a Baby on the Couch
by Shannon Floyd
I hadnt thought much about the process of birth until I was facing itmost of us dont, I suspect. Once it loomed on the near horizon, however, there is very little that could compete for my fascinated attention. The great unknown, and only nine months to prepare for it.
Most of my pregnancy passed with only the normal discomforts and complications. (As things progressed, I saw how different normal and natural could be from one another and how subjective both terms were.) I was six weeks away from my due date when I was diagnosed with a breech baby; the head was up and the bottom presenting at the opening of the uterus. I began a four-week marathon of turning attempts, everything from external version (a doctor tries to push the baby around) to moxybustion (Chinese herbs smoked on the little toe), from lying inverted to acupuncture, from meditations on turning to Raoul Dahl read aloud near my pelvis to attract tiny ears. None of it worked. Baby was where he/she wanted to be. Despite a healthy pregnancy, a CAT scan showing an ample pelvic bone, and a fabulously steady heart rate, I was having no luck convincing my care providers that I could have this baby the old-fashioned way. A study had come out, I was told, the results of which seemed to say that breech babies did better when delivered via cesarean section. Hefty critiques of the data and the method used in the study were also available but it was not enough to change the situation. Birthing breech babies vaginally was no longer the standard of care.
My OB/GYN, whom I liked and respected, had not been taught in medical school how to deliver a breech baby except abdominally, by cesarean. My midwife, with whom I was planning a home birth, and with whom I still remain friends, told me that if something went wrong with a breech, it could go very wrong and neither of us wanted that to happen. My husband was supportive but nervous enough about a home birth without the complication of a breech. I knew he would respect my decision, but it was beginning to seem like I had no options.
Breech birth is delivered by c-section in the United States approximately 97% of the time now. This, although it is relatively common for an outside the ordinary situation, being 3-4% of all pregnancies. What did people do in the hundreds of thousands of years before cesarean was common?, I wondered. I began to do some research.
I found many sources on the Internet, and through talking to people about their experiences. I printed off studies and chatroom discussions, medical papers and lists of sources. I found a consensus that breech birth was possible, but merely required a specialized knowledge. I watched videos showing breech birth, read books about it, and was given articles from magazines about midwifery. In trying to negotiate a natural delivery in the hospital, I spoke with a couple of doctors who asserted that any sources not from peer-reviewed medical journals could not be trusted. This dogma didnt convince me; I dont believe valuable knowledge can be limited to an official canon. Going off-road is where it starts to get interesting.
So one evening I turned to the off-road enthusiast I know best to be my sounding board. In a long winding conversation with my father I laid out all the arguments, pro and con, hospital and home, fore and aft.
Some stats about cesarean: Almost 1 in 4 babies will be delivered abdominally in the U.S. this year. This is up from about 10% just a few generations ago. The inherent riskiness of birthand we never can fully escape that riskhas been made more risky by the slew of interventions that are now routine, including induction, administration of Pitocin to speed contractions, loss of movement due to fetal monitoring, epidural or other pain medication, and the use of forceps or vacuum extraction. Many labors run into difficulty due to any combination of natural and technological factors. Cesarean is seen as a last resort and a fail-safe solution for a healthy baby. But my research showed that risks of breathing difficulties, infection and problems with breastfeeding rose with cesarean. My cousin told me about how she could neither climb up into her own bed nor lift her newborn daughter out of her crib after a cesarean. These very likely risks of an abdominal birth I compared with the unlikely but tragic risk of a serious problem with a home birth that could deprive my child of oxygen or result in nuchal shoulder dystocia, either of which could be fatal. What could I live with? What felt right? Where did my faith lie for a healthy baby?
At the end of the conversation, during which I confirmed that I was again leaning toward a home birth, my father gave me the great gift of a simple agreement. Someone thought I might be doing the right thing and not completely out of my mind! I talked to my mother a few days later and, although I know it cost her, she was able to say that she knew whatever decision I made it would be the right one. This from a woman who had been horrified from the beginning at the idea of not having the baby in a hospital. Having my parents blessing and understanding meant a lot. But it wasnt a decision. That I still had to make on my own.
At our final prenatal exam with her, my midwife gave my husband Josh and I some good advice: You already have enough information, maybe too much. Go away for the weekend and listen to your heart. Then decide what to do. And so, at 37 weeks, we went to the Deschutes River, all sunshine and water and reedy banks, and listened to the river and napped and talked very little. And still I felt sure that scheduling a surgery was not the right way for me to become a mother to this baby.
I decided I had faith in the evolutionary process of birth. We had connected with a new group of midwives who were willing to take us on, head-up baby and all. We were back on for a home birth. I informed my OB/GYN, thanked her for her efforts on our behalf, and got a copy of my records. We were starting over toward the end but it felt good to be no longer hanging in limbo.
I went into labor at midnight two days before my due date. I was so ready. Josh, beside me and only just asleep, woke disoriented and amazed. Youre sure? I was sure. These contractions felt nothing like the gentle tightening I had felt for weeks. This was the real thing. He built a fire and moved the furniture around for maximum space. Here we go!
The labor was 18 hours, during which I stood, walked, lay and kneeled in the living room or hot bath. Josh and my friend Pamela, who served as my doula,* were my constant companions. My dog watched over me. The midwives came after a few hours, checked my progress, encouraged me, left and came again in the afternoon as the time for birth grew near.
I went inside and wrestled with the pain. I had to fight the urge to tighten against it; I had to invite it in. I had made my choice; now I had no choice but to go through each and every contraction until the baby came out.
My daughter Hana entered the world walking, as an African tribe says of breech babies, at 5:40 p.m.; her 8 lb 6 oz body unfolded bottom, then legs, then arms, and finallywhat an unbelievable joy!her head. My body opened and my baby was born; and I began to be born as a mother.
I did wind up in the hospital when Hana was a few hours old. She stayed with one of the midwives while Josh and I traveled with the other midwife to our local hospital, the site of so many tests and anxious moments, to be treated for a retained placenta. There was a part of the birth that wouldnt come on its own, not in the normally accepted time frame. I believe now that I was so focused on safely birthing my child that I had nothing left to give once I felt her move outside my body.
The doctor on call was the one I had met with in trying to attain a natural delivery in the hospital. She was disapproving of the homebirth at first, but unbent to ask about the baby. She treated my medical needand very skillfullywhen I came to the hospital needing help. That is all Id ever wanted from the hospital; they simply defined the need too broadly for me. And so it happened that the birth came around again to include the wider circle of all who had participated in the pregnancy.
People asked me in the final weeks of my pregnancy why it was so important to me to have a natural birth. I found it hard to answer; the answer was to me so obvious and so multi-faceted that I couldnt find the words to speak it in a concise way. The birthoutcome and experiencewas to be the first step this unknown child and I would take together. I wanted that step to be aligned with natural systems as much as possible so that we would reap the benefits of working with those systems rather than outside of them. Go with the flow, some would say.
In making the decisions that come along now in the course of being a mother, an activist, a woman, the balance of needs shifts frequently and flexibility is a valuable tool. Whether to vaccinate, to attend demonstrations with my child in tow, to fly across countryit all carries new weight as I ponder the risks. I use caution where I once would have jumped into the fray. But caution is not the same as fear, and fear is not a virtuenot even when it is fear on anothers behalf.
Choice in birth comes with a profound responsibility. Making an unusual choice took away my ability to lay the blame on anyone else should the birth not have gone well. But perhaps that blame, should there be any at all, was never mine to give away in the first place. Even non-choices are choices. I grieved going into birth. Grieving the loss of your old life as a self-contained maiden is a part of every first birth. Grieving the potential loss of the child is also a part of this leap into the void. I had healthy baby and a beautiful birth. I was lucky and I am grateful.
It is a wonderful privilege to be able to choose not only whether to have a child, or when to have a child, but also how to have a child. We walk a highwire of seemingly conflicting needs of outcome and experience, technology and nature, culture and biology. When the balance is right, the seeming dichotomy can be simply complementary pieces of the puzzle.
In any event, from now on I will be congratulating every mother I know on the anniversary of her childrens births. Starting with my mother.
Shannon Floyd is a writer, organizer, administrator, activist, singer, hiker and mediator who lives in NE Portland with her family. You can send her your comments at firstname.lastname@example.org.
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