Birthdays Are For Mothers

You may have heard me say it before: birthdays are for mothers. We're the ones that hold the memories, and we're the ones who were there. For. Every. Second.

So, memories of this day, eleven years ago:

After giving birth in the early hours of the morning, I was wheeled to a hospital room. The nurse insisted that the baby had to be taken to the nursery for washing or checking or who-knows-what, while my parents took Josh home for a shower and a rest. I protested, but truly, I was in no shape. After several days of early labor and a whole night awake doing the hard work that brought my girl into the world, I was beat. As soon as I laid down in the hospital bed, I fell fast asleep.

I woke up two hours later (at maybe 7 am) and couldn't find that nurse call button fast enough. I sat up, full of anticipation. Ready. The nurse came and put my beautiful red-headed, blue-eyed, rosy-cheeked baby in my arms. I held her, and stared at her, and nursed her, for the rest of that day. I felt so many intense emotions: accomplishment, pride, wonder, and love. I'd never felt love like that.

(Makes me think of Stevie Wonder, who got it just so right.)

It's strange watching her grow up, as it all happens so fast that I can remember, though she can't, exactly what she was like when she was 18 months, and three, and six, and nine, and now, eleven. I can see all of those stages in her face: her resourcefulness, her social acuity, her impatience and her kindness. I remember what it felt like to hold her pudgy baby body in my arms, even though now she is almost as big as me.

Watching your kids grow is like experiencing a time warp. They give you a perspective on the passage of time, unlike any that you could otherwise experience. I can't really remember myself eleven years ago. But I can remember Bella, in so many details.

Even a glimpse of someone else's newborn--their slumped bodies, their squinty eyes, their little, desperate yawns--brings it all back to me. I remind myself that grandparents and parents with older children were once smitten with love for their own helpless little sacks. All parents are newborn parents. Our kids may outgrow our nipples and our laps and even our homes, but they're still made out of the magic that we first saw that day when they showed up in the world, teeny tiny, but fully formed.

Photo copyright Julia Smith

Milo's Story

Last week, the following remarkable Facebook status flashed across my feed:

“I just learned that 64 percent of babies with spina bifida are selectively aborted after being diagnosed. That number is heartbreaking and we need to change that. Yes Milo has spina bifida, yes Milo (and all of us) have some really really hard days. But Milo is happy, Milo is thriving and best of all Milo is doing almost everything the doctors told us he wouldn't. Yes he has to work a lot harder, but he does it all with a smile and his strength and courage is an inspiration. October is spina bifida awareness month- if you have any questions about spina bifida or Milo's story, please just ask we are always happy to share and brag about our rock star.” --Tova Berger Nicholson

Tova and I grew up in the same Jewish community on Long Island. We have not kept in close contact, so I hadn't known that her son had spina bifida. I was struck by the honesty, sincerity, and joy in her post. Since I know very little spina bifida, I took Tova up on her offer to share Milo's story. I wanted to hear about the challenges and realities of raising her son, and I wanted to help her get the word out about the condition. But mostly, I wanted to hear more of her exuberance about parenting Milo. Below are Tova's answers to my questions.

How and when did you find out that Milo has spina bifida?

When I was 16 weeks pregnant I went in for the routine quad screening blood tests. A few days later I got a call from my doctor telling me the results were concerning: a 1 in 4 chance of a neural tube defect. We got the call on a Friday afternoon and there was literally nothing we could do--it was awful. We had to wait until Monday morning to go in for a level 2 (very detailed) ultrasound. We found out that morning, via ultrasound, that my blood results were not a false positive. Our little baby did in fact have a neural tube defect, spina bifida. It was a day we will never forget.

What was your reaction? Your husband’s? Your family’s?

The flood of emotions is hard to describe. In the moment we found out I was completely heartbroken and guilty. I can remember, very vividly, the doctor who gave us the results telling me over and over again that this wasn’t my fault. But as a mother, its hard to hear your baby is ‘broken’; how could I not be to blame? Alex, my husband, is always extremely optimistic, and in that moment his world shattered. Why us? Why our baby? We knew so many other people pregnant at the same time- why was this happening to our baby? The emotions changed over the course of the pregnancy (and they are still changing). I became really angry at points. I learned from some other families who we met through spina bifida connections, that you have to go through a grieving process to arrive at acceptance of the situation. It’s a weird thought to have to grieve, but it's true. You have to grieve over the idea of a ‘perfectly healthy’ baby and come to terms with spina bifida. Alex and I went through it together--when I had a down day, he picked me up, and vice versa. We never allowed both of us to be down at the same time. We spent the first week after the diagnosis in our apartment, watching movies and crying a lot. After that week we picked ourselves up and decided we needed to do whatever we could for our little baby, and that really helped get us through. We still have our down days, but they are so rare that when we have them, we allow ourselves to have a good cry and then move on.

I think our families all put on a brave face at the time. No one wants to hear something is wrong with a family member, especially an unborn baby. But they all stood strong and gave us the support we needed. They cried with us when we needed them to, but more importantly they picked us up when we needed it most. They reminded us over and over again that this little baby was ours and we would ALL get through this together. They are still a very integral part of our support system and a major reason why Milo is doing so amazingly.

What is spina bifida? What are Milo’s symptoms?

Spina bifida is a neural tube defect. Normally, the neural tube forms early in the pregnancy and closes by the 28th day after conception, when most people don’t even know they are pregnant yet. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord.

There are various forms of spina bifida ranging in severity. Myelomeningocele is the most severe form, but also the most common. In this form, the baby's spinal canal remains open causing nerves to be exposed. When a baby is diagnosed with myelomeningocele, surgery is performed usually within 24 hours after birth to close the back. Hydrocephalus (an excess of cerebrospinal fluid on the brain) is unfortunately something that goes hand in hand with spina bifida; I think about 80% of children born with spina bifida will also need a shunt to control the hydrocephalus. A shunt is placed in the brain to help drain the excess fluid, usually into the stomach.

Milo was born with myelomeningocele and does require a shunt. He was born, via c-section, three weeks early because the hydrocephalus was increasing faster than the doctors liked. Milo had his back closure surgery 24 hours after birth as well as his vp shunt placed. It was really, really hard--Milo was born in the morning, and I didn’t even get to see him until that night. As soon as he was delivered they had to take him to the NICU to protect his open back and monitor him.  Alex and my parents were able to meet him, but I had to wait since I was recovering from surgery. It was the longest 12 hours. We couldn’t hold him until he was three days old. 

But, from the beginning Milo shocked everyone. He was released after only one week; two major surgeries and he bounced right back. When Milo was eight weeks old his shunt malfunctioned and we ended up back in the hospital to get it replaced, so another surgery. But again, he literally came out of surgery as Milo 2.0.  

The opening on the spine causes nerve damage; which nerves are damaged depends on where the opening is on the spine. The lower on the spine, the better for walking, but more issues arise with bowel and bladder. Milo does have a few issues in that area, but we will keep that private for his sake. Milo's ankles are pretty weak, so he uses little ankle orthotics to help him walk, although he can walk without them as well, which is amazing. The hardest thing about spina bifida is not only is it a wait-and-see game, but each case is literally so unique. We know several other people with the same level opening as Milo, and they each function so differently.

Think back to the time when you first found out that Milo had spina bifida. How does life as Milo’s mother compare to what you imagined it would be?

When you first find out your child has some sort of disorder, your mind runs crazy. When you have doctors telling you the absolute worst outcomes, it's really hard to think about life being normal. We were told our son would be a vegetable, have a low IQ, not be able to walk, wouldn’t be able to go to the bathroom, and would be in and out of hospitals and doctors' offices. We were ready to accept whatever we were handed, but, my god, life is completely different to what the doctors told us. Milo is incredibly smart--no one can get over his vocabulary and social skills--he may be behind in some physical aspects, but he more than makes up for that in cognitive development. 

Don’t get me wrong, it's not a walk in the park: no parent of a child with spina bifida will say it's easy. We have a different normal and while the first year of Milo’s life was hard and took a lot physically and mentally, it was our learning curve and we now are in our groove and we make it all work. I wish, when I was pregnant, we could have had a glimpse into our life now--we would have been able to enjoy the pregnancy so much more!

What is the most surprising thing about parenting Milo?

Milo has taught us so much. I never realized how much it's possible to learn from someone at such a young age. He has taught us to stop and slow down and really appreciate every little thing. When Milo wiggles a toe, that’s a huge deal--we celebrate that and I remember the first time I saw him do it--it's something so many people take for granted. But he has taught us to never take for granted even the smallest thing. Alex and I had a pretty strong relationship before we got pregnant with Milo, but through pregnancy and these last 2+ years he has made us such a strong force; very little can get in our way.

What is the hardest thing?

It has gotten easier, but it's hard to see what other children Milo’s age, and younger, are able to do, and without any thought. In the playground they are running, jumping, going up and down the steps alone. When we go to the playground, Milo can do it all, he just needs his mama or daddy right there to help him. It doesn’t bother him, which makes it a bit easier for us, but it does still break my heart a bit. Milo knows a different normal than we do and it's hard to remember that. We do try to make sure he doesn’t feel different--we want to make sure he knows he is like everyone else. Instead of needing glasses to see or hearing aids to help hear, Milo needs braces to help walk, and that’s ok. And we want to make sure he always knows that.

What is the best thing?

The best thing is seeing how happy Milo is. Milo has worked so hard to get to where he is today--he started walking at 25 months and he hasn’t looked back. He is so proud of himself with every thing he has achieved with his own hard work. There is nothing more heart-warming than seeing your child achieve something they have been working so long and hard on, but then seeing how proud he is of himself is just the best. Milo has the most amazing attitude and literally just goes with the flow and it really has helped him overcome so much. His happiness is everything to us and when we do have that rare down day, seeing him happy really helps put things into perspective.

What else would you like people to know about your child, your family, or this condition?

Milo is a normal 28 month old. He is doing everything a two-year-old is supposed to do: he goes to a two’s program, he loves to color, play with trucks, and yes, he has his tantrums. Milo has spina bifida; he always will. But it's just a part of who he is, it is not WHO he is. We are always happy to talk about it, but we don’t make it the first thing people know, as we don’t want him treated differently from anyone else. People have said, how great he looks and you would never know anything was wrong. And I know they mean well, and who knows, I might have said something similar to other families as well, before we were in our situation. But the truth is, there is nothing wrong with Milo. People hear a diagnosis and they shudder and apologize. There is nothing to apologize for. If you have met and know Milo, you know that he is more than OK. I keep going back to it, but his happiness is everything. Yes, we will have bumps down the road, but his attitude will help overcome those bumps.

Milo is a normal 28 month old. He is doing everything a two-year-old is supposed to do: he goes to a two’s program, he loves to color, play with trucks, and yes, he has his tantrums. Milo has spina bifida; he always will. But it's just a part of who he is, it is not WHO he is.

One other thing: if you are ever in the unfortunate situation of receiving a diagnosis for your child, no matter what it is, do your research. Doctors are the experts on some things, but not everything. Find families who are dealing with it every day and talk to them; they will know best and tell it like it is. If we had listened to what the doctors told us, who knows where we would be today, and the thought honestly makes me sick. There are always families out there that would love to share their stories and help others.

What resources (websites, organizations) have helped you the most?

While I was pregnant I found a spina bifida kids group on babycenter. Those families saved us during our pregnancy. Hearing their stories and seeing their children really helped keep our spirits up. In the last year I joined a few groups on Facebook, and it's really amazing what a tight-knit community it is. It's really refreshing to be part of community where everyone "gets it". It's a place where people come to share and brag when their child gets up on all fours, or sits unassisted, or takes their first step, and everyone is excited, as we all know that feeling.

What do you do professionally?

I am a stay-at-home mom. It’s so cliche, but so true: being a stay at home mom is the hardest job I have ever had, but by far the most rewarding.

My Best Birth

Earlier this week we celebrated Ruby's 9th birthday. I find, with all my children, that I start calling them by their coming ages a month or two before their birthdays ("almost-9"), so that when they actually reach the milestone day, it hardly feels like a change. Ruby has always had a certain maturity about her, maybe it's her second-child status, that makes her new age(s) seem inevitable, earned, and not too big of a deal.

I'm still in the first year of blogging, and I've committed to telling each of my children's birth stories on or near their birthdays. The second post that I wrote, last January, was about the importance of birth stories, and the unfortunate tendency of society to devalue those stories. I believe that hearing honest stories about birth is the best way to prepare a woman for a positive birth experience. I also think that these stories can serve as reflections on what we humans are doing here in this world: we are physical beings who live to love.

When I found out I was pregnant, I needed a local healthcare team, and I decided to see a midwife, because I wanted someone who shared my personal view of birth as a normal event. I was also excited to give birth at an in-hospital birthing center. My dream for Ruby's birth was to have minimal interventions, no separation from the baby, and be home as soon as possible after to be with Bella, who was only a year old when I became pregnant.

At my first prenatal visit with midwife Sylvie Blaustein, I was relieved when she asked me to tell her the story of my first birth and about my hopes for this birth. I was amazed by how much time she spent with me; throughout the pregnancy, the visits were emotional check-ins, not simply medical ones. I loved going to see the midwife, even though I had to shlep uptown with baby Bella on the subway.

As with my pregnancy with Bella, I went a week past my due date. I was anxious to get the show on the road and have the baby. For the first time in my life, I had acupuncture, and lying on the table in that tranquil East Village basement, tiny needles sticking from my ankles and wrists, I felt the first real contractions. The familiar pain, like menstrual cramps, made me smile. It was like my baby was waking up and getting ready to say hello. The next day, I had a pedicure in the afternoon, and that's when I was able to start timing them: ten minutes apart, then seven. Later that evening, when I started to have to "om" through the contractions, we called our doula and good friend, Allison, who came over to support us. We also called Josh's sister, Nina, who lived downstairs, and who agreed to come and stay with Bella when it was time for us to leave.

There was some concern that I might have a very quick labor, because of how the end of my first birth had gone. Since I was group-B strep positive, I had to make it to the hospital in time to get antibiotics before giving birth. So around midnight, with contractions 3-4 minutes apart, we went to the birthing center. I remember sitting between Allison and Josh in the back of a yellow taxi, "om"'ing like I was in yoga class. No taxi driver ever likes to hear that, let me assure you. He got us there fast.

We were quickly brought to a birthing room. The midwife on call that night was Barbara Sellars, at that time a 25-year-veteran midwife, with a wise and quiet presence. She checked my dilation, and announced that yes, I would have the baby tonight (phew!). A nurse put in an IV (actually, it took two nurses to get this done--I have small veins--I remember this as the hardest part of the whole labor--being stuck repeatedly, and having to hold still), and I sat on a birthing ball while the antibiotics poured through me.

After that, the labor was, as it often is, a blur. I walked, I danced, I rocked in the rocking chair. Allison and Josh rubbed my back and encouraged me. As I was well supported, Barbara got a few hours of sleep. At some point she came back, and asked if she could check me, and offered to break my water to speed things along. I agreed. The contractions picked up pace and intensity almost from that very moment. I got into the bathtub, which I had been looking forward to, as one of the privileges of being in the birthing center. But once in the water, my discomfort seemed to increase. I vomited (sorry, birth ain't pretty), and I felt like I had nothing to lean on. I had to get out.

(This goes to show that you really don't know what you will like and need as comfort measures in labor, until you are in it--which is why it's helpful to have lots of options available).

I went back to the rocking chair, and "om"ed through several very long contractions. Between contractions, I opened my eyes, and discovered that a cadre of beautiful people had gathered at my feet, watching and waiting, quietly: Josh, Allison, Barbara, a nurse, and a nursing student (whom I had given my permission to be present). No one was rushing me. No one was telling me what to do.

After one particularly intense contraction, I said, "I want an epidural." I saw concerned eyes. Then I said: "just kidding," and went right back into the hard work of the next contraction. (You see, it's a truism that all women will ask for an epidural during labor at some point. I knew this, and I didn't want to disappoint.) I made everyone laugh. In the middle of my labor!

Not long after, Barbara said, quite to my astonishment, "Where do you want to have this baby?"

I was surprised because I didn't know that it was time, and I didn't see how she knew. (Throughout the entire labor, she only checked my dilation twice: the first time when I arrived at the hospital, the second when she broke my water.)

Barbara really exemplified the caregiving philosophy that puts faith in birthing mothers' innate knowledge of what they need to do to give birth. She was so quiet, so patient, and allowed me to lead the way. She knew it was time because of the intensity and length of my contractions, indicating I was going through transition. (Note: she was watching me labor, not watching a print out or a machine.)

I moved to the large queen-sized bed, but once again, like in the tub, I felt uncomfortable. It was my prerogative to move, so move I did. I sat on a birthing chair (like a toilet seat without a toilet), with Josh sitting on the bed behind me, and supporting my back. My attendants, who were all sitting or kneeling in front of me on the floor, told me to push when and if I felt like it. So that is what I did.

Very naturally, and by naturally I mean without any coaching or assistance, and with the normal amount (i.e. quite a lot) of effort, Ruby came into the world. When she was almost out, Barbara directed my hands to her body, and told me to lift her up. I like to say that I delivered Ruby. I picked her up onto my chest, and I cried. Together, we moved to the bed and Josh and I discovered that she was a girl, and stared at her in amazement. It's always amazing to see the face of your child for the first time.

Right there in the room with us, the nurse weighed Ruby and cleaned her up a bit. Soon after, everyone left us alone. We rested, Ruby nursed, and Josh and I each took showers, and about six hours after the birth, we all went home. Ruby was born at 11:11 am, and we were all home for dinner.

Ruby is my middle child, and she came so soon after Bella that she sometimes thinks she gets short-shrift (certainly, she wears her share of hand-me-downs). But she knows, because I've always told her, that her birth was the best one.

The Girl We Lost

There was a time, not too long ago, when I wouldn't have been able to read an opinion piece called End of Life, At Birth. The title alone would have kept me away. Too liable to scratch away at the scab that has finally begun to harden over my wound.

Written by Dr. April Dworetz, a neonatologist, the piece examines the moral quandary of sustaining life in very premature infants.

Earlier this year, I shared my children's birth stories, on their birthdays. But last month, I let my third child's birthday come and go. She was born July 8, 2009, though she never took a breath.

When my water broke at 22 weeks, 4 days, I knew it was very bad. I knew that where we were living, in the UK, newborns would not get any medical care before 24 weeks gestation. But I also knew that even if we crossed that shaky line, it wouldn't guarantee anything in terms of her health. Unlike the parents of 23-week baby "Miracle", described in Dworetz's piece, Josh and I are scientifically-minded and well-informed; we knew the many risks associated with extreme premature birth.

I knew that babies need amniotic fluid to grow, and that mine was going, fast, along with worrying bloody show. I knew that there was no way to stop the leak, nor to put substitute fluid back inside. But there was so much I didn't know. No one at the public hospital where I was admitted ever looked me in the eye and told me that I was going to lose my baby. I understand, completely, why Miracle's parents allowed their child to be resuscitated. The opposite choice is so shocking, it hardly registers.

Our baby was going to die? But we had just picked up a hand-me-down crib from a friend. Our daughters, ages 6 and 4, had attended the 20 week ultrasound, and were thrilled to learn they would have another sister.

I would have to birth the baby. For some reason, I thought the doctors could spare me from this; rescue me from the baby dying inside me. But day followed day, as my body depleted itself of amniotic fluid, but refrained from going into active labor. I've since learned that it can be hard for a woman's body to go into labor before the hormones are right and ripe. If I had been more comfortable with death, and if anyone had given me frank choices, I might have gone home and waited, however many days or weeks it might have taken, until my body was ready to give birth. But I was not comfortable with death, and no one said a thing.

Also, there was that unspeakable fear hanging over my thoughts: if she, by some unlikely "miracle" made it past 24 weeks, they might put her on machines; keep her alive. And, as Dr. Dworetz explores in detail, there were many reasons to question that course of action, for the affliction she might have experienced, and for our own.

I forbade my daughters from coming to see me; I didn't even speak to them on the phone. It was like a state of purgatory, in which I couldn't explain what was happening, so I chose not to try. After one ultrasound, in which I held my gaze away from the screen, terrified of seeing both the technician's face, and my baby's, I wanted it to be over. I knew that our baby did not have a future, and I felt like I was in hell. I couldn't continue to live until this was over.

I asked for, and was given, drugs to bring on active labor. I had to sign a piece of paper, as technically I was choosing to end the pregnancy. (If I had been in Texas, following the passage of recent laws, my desperate pleas to bring this suffering to an end would have been ignored.)

A neonatologist, the most compassionate and straight-talking caregiver I encountered in my five-day ordeal, told me what to expect. She said that it was possible that the baby would be alive when she was born, but that because her lungs were not fully developed, she would not live more than a few hours. She told me that either way, I could hold the baby.

I gave birth the regular way. Though she only weighed 1 lb. 8 oz., the birth was more painful than any of my three full-term births. There's a difference between pain and suffering, I learned recently in a childbirth educator course. All my births were painful, but with the others the pain was tempered by intention and joy and excitement. This birth was replete with suffering.

A nurse wrapped her in a blanket so only her ashen face was showing. She felt so light in my arms, like a tiny bundle of feathers. The nurse said, "she has your hair."

Though there was no religious obligation to have a funeral or sit shiva, our supportive rabbi helped to arrange a burial in a Jewish cemetery. Though there were family members who discouraged it, I insisted on attending. The day after I was discharged from the hospital, we drove to north London and watched as Leah Naomi was buried in an unmarked grave, full of babies, secrets, and loss.

I noticed that most people in my life didn't want to talk about the baby that had failed to live. Some people never ever mentioned it to me. It was like I had never been pregnant. For whatever reason, it was hard to talk about.

It's hard to write about, too. There was so much guilt, so much second-guessing, as I wondered what I must have done wrong; I felt like I had failed grandiosely as a mother. But that caring neonatologist in the hospital said one other comforting thing I'll never forget: she said that considering the innumerable things that can go awry in the process of growing a baby, the miracle is that they ever come out of the process well and fully-formed.

Dr. Dworetz's piece starts with Jackie Kennedy's loss, which I have thought about a lot: how publicly she was pregnant, and how publicly she was forced to mourn. Pregnancy, for most women, is a time of celebration and joy. What I didn't know, until after, is that loss is an ever-present part of the fragile life-giving process. I had entered the secret society in which women--some friends who had never before mentioned a word--shared stories of their own or their relatives' losses. I attended a support group, where I found out that babies die; not just mine.

As explored in another New York Times piece from this past weekend, trauma is an ever-present part of everyone's life, and our traumas are bound to us. They do not simply evaporate. This one will be with me, always.

When There's Such a Thing as Too Much Medicine

This past weekend's New York Times magazine cover story, "Our Feel-Good War on Breast Cancer," explains how a very well-meaning campaign to save women's lives has terrified women and resulted in unnecessary medical interventions, without actually saving lives.

It was impossible to read the story without feeling strong emotions. We all know someone who is a breast cancer survivor, and we are of course grateful that those friends or family members (or ourselves) are well. But what does it mean to be a survivor of a disease that may not have needed treatment all all? What if the treatment is permanently damaging, but does not change the overall outcome? The idea of watching and waiting doesn't sit comfortably with many of us patients. We want doctors to heal, and to act. But what if, sometimes, there's nothing at all to be done? What if the research supports watching and waiting?

Yet who among them would dare do things differently? Which of them would have skipped that fateful mammogram? As Robert Aronowitz, the medical historian, told me: “When you’ve oversold both the fear of cancer and the effectiveness of our prevention and treatment, even people harmed by the system will uphold it, saying, ‘It’s the only ritual we have, the only thing we can do to prevent ourselves from getting cancer.’ ” (Peggy Orenstein in New York Times Magazine, 4/28/13)

All this made me think about the over-medicalization of birth. Replace the words cancer with "birth" and "prevention and treatment" with "caesarean", and you have yet another area where women's bodies and selves are often being harmed under the guise of being saved.

There are many reasons why 1 in 3 births in the US are by cesarean, but an important one is that women are oversold the fear of birth. Because birth most often takes place in the hospital, where people usually go to have pain-free operations under sedation, people (both men and women) often believe that women should be passive and calm when they give birth. When if fact, birth is not designed to be a passive experience. To give birth, women need first and foremost to be empowered. They need to be reminded that their bodies are designed to give birth, and be given the freedom to follow the signs that there own bodies are giving them in labor--to move around, to stay upright,  to have privacy, to vocalize, and/or to do whatever they need or want to do (with whomever they need or want present to help them).

But instead, women are sold fear. When I was pregnant with my first daughter, I told one doctor that I wanted to have a normal (intervention-free) birth, and she responded by saying, "Don't set yourself up for disappointment." Not one word of encouragement. Birth is not easy, but it's a lot harder when everyone around you tells you you can't do it. (This is why I hired a doula: I needed to have someone in the room who knew what normal birth looked like, and who believed in me.)

Many women who have unnecessary caesarean births are told by their doctors that the surgery was life-saving. But what they aren't told is that it is the cascade of interventions that have become standard in hospitals that often leads to the moment of distress: making women lie on their backs in bed attached to an IV, preventing them from eating and drinking, attaching them to continuous fetal monitors, giving them medicines that prevent them from moving around and actively using their own bodies to move the baby down through the pelvis--all of these interventions work against a woman's ability to give birth normally. These interventions often cause labor to stall, or make a woman's efforts at pushing less effective, or cause the baby's heartbeat to drop, all of which can lead to the fearful all-too-common moment when the doctor announces that this just can't go on any longer--the baby must be taken out now.

Just like women are "oversold both the fear of cancer and the effectiveness of our prevention and treatment", women are also oversold the fear of birth and the effectiveness of the cascade of medical interventions that supposedly make birth safer. But surgical birth is not safer, and it is not without consequences, both physical and psychological. 

One thing I know, as a health care consumer who has given birth three times in this country, is that trying to have a normal birth in a hospital is an uphill battle. (The exception was my second birth, which was midwife-attended in an in-hospital birthing center.) I also know that birth can be beautiful, empowering, fear-free and peaceful.

The result of all this, for both birthing women and for women considering mammography and/or cancer treatment, is a confounding quagmire wherein doctors are trying to treat and satisfy patients while protecting themselves from those same patients--who have the right to pursue justice in the courts if they don't like the outcome of their birth/ illness. One thing patients forget (encouraged by a litigious environment) is that life is not without inherent risks; doctors may do their best, and a certain percentage of the time, things will not go right. In court, a doctor can defend herself better if she did something, than if she did nothing. Even if nothing would most likely in most cases, based on research evidence, be better and safer. 

I do believe that doctors want to do right by their patients--that they want to protect women and give them what they want. But I also think that the system sometimes acts against what is actually in women's best interests. Doctors too often worry about worst-case scenarios, so they treat every patient as a potential disaster. This attitude may protect a small percentage of women, but it has the potential to harm many more. 

Move Over, Birth Trauma. It's Time for Joy

This post is for a friend who is in the final days of pregnancy with her third child. She is tired, 'over it', and ready to meet the kid already, both emotionally and literally, as she is nesting up a storm. She's trying to be patient (compared to how I was at this stage--ready to stand on my head if it would get that baby out). She's worrying about names, about childcare, about having space and time for all of her kids. All of that is to be expected. 

What concerns me is that she's scared about the birth.

Unlike first-time moms, she's not frightened of the unknown. She not worried about her friend's horrible labors, or a birth she saw on TV, or a co-worker's fright-filled tales. She's scared because of her own first two births. She's scared because she doesn't want another broken tailbone and dozens of stitches like she had with her first baby. She's scared because she doesn't want an emergency Caesarian birth with prolonged pain and difficulty breastfeeding, like she had with her second baby.

Birth is many things: emotionally wrenching, painful, joyful, ecstatic. But it shouldn't have to be traumatic. I could sing this from the rooftops. There's too much birth trauma out there, and too much denying of women's emotional and physical pain from their births, as women are told they should be happy they have a baby. Period. Women are constantly told that the experience of birth doesn't or shouldn't matter. 

But the experience does matter. Growing and delivering a baby is an overwhelming, life-altering experience, second only, perhaps, to raising one. 

Here's my message to my friend:

You are a beautiful, wonderful, capable mother to two terrific kids. You will soon be all that and more to your third. You have the power to birth your baby. I believe in you. You are strong, and you are brave. Surround yourself, in these final days of growing your wonder baby, with people who will remind you of all of these things. When you are in labor, remember that you only need to get through one contraction. When that one is over, you'll have a break. Just focus on one at a time. When it's time to deliver, stand or squat or lean. Protect yourself and your tailbone by getting into a good position for that baby to emerge, no matter the size. I pray that you will both be healthy, and safe and happy. I pray that this will be the birth you've been waiting for. 

And as I said to you, on learning that you were expecting this child: the first is a biological necessity, the second is fulfillment of a plan, and the third is pure joy.

Welcome Sunshine, Part Two

Part One recap: 41 weeks pregnant, in hospital. Finally, labor starts picking up. While the details are hazy for me, my lovely doula Jill Fransen wrote an account. Thank you, Jill, both for writing the story and for agreeing to let me share parts of it, here.

When I arrived around 4:00, your dad was there, and your mom arrived in a little while with food for Josh. Your contractions were tolerable as you sat in the rocker. That rocker would be your friend for many hours that night. 

After your folks left we got down to the real business of labor. Your contractions were really quite close and strong. It seems that your labor was a series of rhythms. The rocker was very effective...you would "OM" through the contraction...going inward and being very focused. Then we decided to walk, stopping every few feet as you bent over holding onto the rail. You were determined to just continue to let your body and baby work together. You got in the shower; we listened to Sting, Stevie and some jazz. 

You labored--your contractions were mounting. You were getting very tired...your energy was being drained, and still your dilation was very slow. Things were getting intolerable: from the birth ball, to the shower, back to the chair, slow dancing with Josh, back rubs, foot rubs, hand massages...it all helped, but you were about to hit a wall. What you needed most was rest. Around 10:30 the nurse removed the rest of the Cervidil to give you a break from the piggybacking contractions. Finally around 1:30 in the morning, you got in bed, had a half dose of Demerol, and were able to get some rest. 

Here's what I remember about this part: I remember that the nurse saw me working hard and said something to the effect of, "I don't think you can go on like this much longer." She wanted me to have pain relief, but an epidural was not an option because I wasn't dilated enough (not that I wanted one anyway). I consented to the Demerol because I believed that I was still at the beginning of labor--that it could potentially be another day or two before the baby would be born, and I just didn't see how I could go on for that long. Josh was also exhausted because we'd been up for past several nights with false-alarms.

Josh opened up the couch, I positioned myself by your side, your small hand in mine. We turned off the lights and you got the rest you needed. I have rarely seem Demerol work so perfectly. You were aware of the contraction, only at the peak...you moved around, moaned, then were able to fall back into a restful peace. I did not leave your side as I held your hand and talked you through the peak of each contraction.

What I remember is that the contractions at this point were incredibly strong and hard, and that I couldn't "OM" anymore because I was loopy from the drugs. So I was literally moaning in pain at the peak of the contractions. While the narcotic undoubtedly allowed me to rest in bed (I couldn't have laid down otherwise), it actually took away my ability to concentrate and deal with the pain. I was very, very grateful to have Jill's hand to squeeze during that time.

Then, an amazing thing happened. As you roused during a big contraction, you said something popped--"my water broke." While you weren't particularly happy at that point, it sure put a smile on my face. Within a half hour the nurse checked you and you were 6 cm dilated! Josh woke up; the lights went back up a little...we were on baby alert. You went to the bathroom and sat there for a while. I believe that is where transition took place, because you experienced powerful urges to push. By the time you returned to bed, at about 2:30am,  you were 9 cm. dilated. This now was exactly the opposite of the old axiom: Hurry up and wait! This was, rather: Wait and hurry up! Dr. S. had to be called--you were going to have a baby! 

Now you were experiencing real bearing down urges...almost uncontrollable urges. This was when Josh just shone. He had you concentrate on his face, on his finger, guiding you through those extreme urges to push as we waited for the doctor to arrive.

To explain: the nurse was in a bit of a panic, as the doctor was not there. She told Josh to hold his finger in front of my face and instructed me to blow out the candle...instead of pushing. So, essentially I was holding the baby in due to absence of the doctor. Good times!

You were just amazing as you blew on the birthday candle that was Josh's finger. The urge at that time is greater than any other bodily function; watching you two at that moment I knew you were quite a team. I think the nurse thought she would have to deliver this little bundle...the first time we looked we could see about one eighth of her little head peeking out. So we were very grateful when Dr. S. walked in, sleepy and so beautifully pregnant herself.

Because you had done so much work before; because you had done so much breathing down and letting your baby just descend, you only had to push two or three times, and there she was...in all her glory of girl and red hair.

When Bella was placed on my chest I cried, and Josh cried, and I kept saying, "Beautiful! Beautiful!" because she was.

Isabel Renee

January 30, 2003

3:45 AM

8 pounds, 9 ounces

Bella's Birth Story, Part One

In honor of Bella's birthday: her birth story. It only took me ten years...

About a week before my due date I moved back into my parents' house, where I slept in my childhood bedroom. This was because my Ob-Gyn, Dr. S., was my father's partner, and also the same doctor I'd been seeing since I was eighteen. No one wanted me to have to travel to Long Island from the city whilst in labor. It wasn't half bad having my parents watching over me and feeding me, like I was a child again. But there wasn't much to do other than wait, and being away from home really put a big black exclamation mark over that magical and elusive due date.

When that date came, January 22nd, 2003, I started work on my labor project, an idea I took from the inspirational book, Birthing From Within. I made a birthday cake for my little Sunshine, the name we called her throughout my pregnancy, not knowing that she was a she. If only I had actually been in labor... (We stuck the cake in the freezer and brought it to the hospital after Bella was born, where we shared it with the nursing staff. No awards for me in the cake-decorating dept., I know.)

A few days later, I started having daily non-stress tests (a half hour or so strapped to the fetal monitor) at the doctor's office. At each test, Dr. S. said, "The baby sounds great. We can induce you now, you know." 

Josh and I took a lot of walks, as I was determined to move the baby down and get labor going. It was freezing out, one of those bitter winter weeks, so we found a place to walk inside: up and down every aisle of Target and Best Buy and Home Depot. I thought maybe Sunshine was staying put because it was simply too cold out for babies (or because she was afraid of big box stores).

On day five or six, the doctor's message changed slightly: "Soon it will be time to get that baby out." She stripped my membranes (ow!) and said, "You're really not dilated at all. Maybe a one." What I heard was: Nothing's happening. Your body is not doing what it needs to. That baby is never coming out without our help. 

On day seven, at the prospect of Josh having to leave to go back to work in the city, I gave up. I didn't want to be induced. I knew that inductions with first babies have a higher rate of resulting in Caesarean births. But I was beyond ready to be done with the waiting and to meet my baby. 

When I arrived in the hospital (straight from the doctor's office) for my induction on January 29th, I was already having patterned contractions, which had been happening on and off for days. I hadn't slept well the past two nights, and I was already tired. The doctor inserted a Cervidil suppository, and I had to stay in bed with a large uncomfortable plastic belt around my middle. (Whoosh, whoosh, thump, thump..the sound of that monitor never ending; Josh staring at the printouts because there was little else to do.) "In the morning, we'll start you on pitocin," Dr. S. said. Then, pregnant herself, she went home to sleep.

When the contractions soon became strong, I was very thankful to have my wonderful doula, Jill Fransen, at my side. She encouraged me to ask for permission to walk around, and reminded me to practice techniques to get through each contraction. I had prepared for this. I believed then, as I do now, in the mind-body connection that allows a woman to give birth. I tried to gain strength from my (hokey) piece of birth art (another Birthing From Within inspiration), and reminded myself what I had to do.

I don't have a good sense of the timing or details of what happened next, but lucky for me, Jill wrote a detailed description of the birth. 

Tomorrow: Part Two, Jill's account of Bella's birth.