on natural childbirth

This has nothing to do with homeschooling, but this is something I just did, and I am passionate about, so if this is not your thing, feel free to skip reading.

I gave birth to my fourth this past Friday. It's a boy! He was born on Friday morning in a very natural-birth friendly hospital. This birth experience was the closest to what I wanted ever since I got into natural childbirth. In fact, I think, this was pretty much it. I wanted a hospital setting, just in case anything goes wrong, but I also wanted a hands-off approach. I wanted to be supported during labor, but not have anyone speak for me. I wanted freedom to move around and to choose the positions which were most comfortable. I wanted to wear my own clothes. I wanted to be surrounded by people who have seen birth without interventions, and who believed that it was possible.

I am so happy that I got all of those. I am also grateful that this is my fourth baby, and by now I had no fear of giving birth. I trusted that my body could gestate this baby and that giving birth to him would not be traumatic to either one of us. I knew that I could do it, but it would be hard work. I did not think that giving birth is the most painful experience of my life, just one of the hardest.

A few things I did to prepare myself.

Read, read, read. With my first, I read "What to Expect When You are Expecting", and ended up with all the interventions which are so casually mentioned there. I recommend all Ina May books, starting with "Ina May's Guide to Childbirth". Watch The Business of Being Born to get a feel for the alternatives. Trace the development of current childbirth practices through Pushed and Birth Day. Find out what midwives really do in Baby Catcher. See the natural childbirth through a frum perspective in Labor of Love. I got most of these through my library, so if it's not your thing, you can always return it.

Take in positive birth stories. Read about them, listen to them, seek them out. My grandmother lost one of her babies in childbirth (carbon monoxide poisoning from a wood-burning stove) and she proceeded to tell me the story in great detail when I was just a few months' pregnant with my first. She was still shaking and crying, fifty years later. My mother did not have such a good birth story either, especially since it emphasized me choosing to get born prematurely, and me shooting out of her and tearing her up. That hang-up came out in this labor: when it came time to push, I lost it. I kept going through my mind, telling myself that I have to get this baby out, and then feeling that I am pulling back instead of pushing. I kept searching myself for what is preventing me to embrace what I have to do here. I felt that nobody is catching the baby, that the baby will "shoot out" (this is after three kids who definitely did not "shoot out" and neither did this one!). Afterwards, my husband was saying how interesting it was that this was my concern, but now I realize that some part of my brain got branded with this horrible possibility that a baby can "shoot out" and rip his mother. So I tried exposing myself to positive stories as much as possible, people relishing the experience, women trusting their bodies, having fun with their pregnancies, feeling empowered by childbirth rather than defeated.

Do psychological cleansing. For that I recommend "Birthing From Within". Yes, some of the ideas might be kooky, but the principle that psychology profoundly affects how one perceives childbirth is worth exploring. It also allows to zero in on what the hang-ups one might be having about childbirth, what one assumes it will be like, and what can be done to work through them. I liked the idea of birth art. In fact, this time around about a week before I gave birth I got this image into my head. I am not an artist, in fact, I paint so infrequently that when I finally sat down to execute the picture, I discovered that a bunch of my acrylics have dried out. Nevertheless, the picture was gestating in me, so to speak, and one I completed it, I went into labor the next day. I used it during labor and it helped me focus.

Create affirmations. I had a few for myself (wow, this was a good contraction, it is helping me open up; I can ride this one; my body is meant to do this) and a few as a pep talk to the baby ( c'mon baby, come on out; I want to to meet you). When I was pregnant with my second, I created a set of cue cards in Powerpoint, and I browsed through them in labor to see which ones spoke to me. Again, there was a lot of psychological prep beforehand.

Research what's safe. This is where it is important to separate fact from fiction and to realize where one's wishes might contradict reality. For example, during the last two pregnancies, I had low platelet count towards the end. It was not too low, but I was notified that if I wanted an epidural, it might be an issue. Thankfully, I did not want an epidural, so that was not a concern. I ate and drank during labor (water, tea, juice, crackers, toffee which I made as my labor was getting started and we brought it to the hospital to nurses' desk). I went to the bathroom often so that my full bladder would not get in the way. I skipped an IV and even a Hep Loc (IV access) this time.

Get support. I hired a doula, who was essential this whole experience  She walked with me, squeezed my hips during contractions  talked me through transition, kept me focused, suggested breathing patterns when the going got tough, fetched pillows, water, washcloths etc. She was the calming presence that I craved. I am usually a do-it-alone kind of gal, but for labor, she was the steady support that I needed.

Expect the unexpected. I have a birth plan. I created it with my second, tweaked it with my third, and... forgot it at home with my fourth! I was just ready to go with the flow, let happen whatever happens, and not expect things to go one way or another.  In order to give birth, one has to let loose, let go, and for me, the meticulous planner, this was the ultimate letting go. Thankfully, the hospital was so laid-back, that it did not matter that we had no birth plan; they have seen it all, and just let me be.

some things are meant to be hidden

This morning we trekked to maternal-fetal medicine specialist. The reason: according to my midwife, the baby measured small, and was not lying head down and she did not like that I do not have a specialist managing my pregnancy-induced hypothyrodism. So I found myself sitting in a high-risk office and trying to figure out how did I get there.

In all my other pregnancies, I could clearly tell that the baby is head down and the feet kicking my intestines. This time around, it did not feel the same way. I kept feeling two bumps, lying across my belly. The midwife I am using agreed. Moreover, because of the way this baby is lying, it kept measuring small, even though my weight gain was fine, and there was nothing else to worry about.

So here we were, waiting for a detailed ultrasound to measure to baby and check that it is head down. The technician came in and did a very detailed scan. Thank G-d, the baby measured just where it is supposed to be, and it is head down. Everything else looked good, too, except for a possible duplication or splitting of one of the kidneys. The high-risk doctor reassured me that they are not even positive if it is doubled, but we might want to follow up after birth with additional ultrasound and maybe contrast injection, just to make sure that everything is fine.

While the good news were good, this whole experience left me thinking. The gemara says that we do not know the way of the baby in the womb, it is hidden from us. Today it might sound downright silly: we have technology! Doppler! Ultrasound! Genetic testing! Amniocentesis! Surely there are many ways to poke and prod and extract information. There seems very little that is hidden. Moreover, there seems even less reason to keep things hidden, especially since they can be known so easily.

I remember my first pregnancy, when I proudly announced to my grandmother over the phone that I am expecting. She, being in her late eighties, and never dealing with pregnancy tests, could not understand how I can be so sure so early on. I kept trying to tell her about the hormones, but she was not buying it. Well, a few babies later; a few spottings later, and a few miscarriage stories later, I think she was right. You can have a positive pregnancy test, but it might be more prudent not to rely on it too much. Historically women waited till they felt fetal movement to be sure that this is a viable pregnancy. The information gained by a pregnancy test is minuscule compared to the possibility of things not working out.

Same for the rest of the technology. With one of my kids, the ultrasound did not show a four-chambered heart, so I had to go back (everything was fine, except for a few weeks of anxiety). You can have a genetic screen and still miss a mutation.

With the other kids, we found out the genders. I was more ambivalent. My husband really wanted to know, so we found out. Both boys were due on Pesach, so it made sense to know whether to make a bris or not. This time around, I put my foot down and firmly decided to wait. Apparently, this not knowing is driving everyone crazy. The kids were jumping up and down, trying to figure out the gender today. All my reassurances that we will know within a month were falling on dead ears. How will this bit of information change anything? We have clothes for both genders, and they babies are impartial which color to spit up on...

Now we have a new piece of information to fret and worry about. Most likely this kidney thing is nothing. Most likely, it would have been fine being "hidden", and I would not have to subject the baby to yet another invasive test.

With my other kids, one had a funny heart murmur, and another hiatal hernia. With hiatal hernia, he was awful as a baby, constantly spitting up, not sleeping, not gaining weight, etc. I really wanted to know what was going on. My husband said: " Watch, we will get a name for this thing, but they will not do anything!" He was right: the hernia is supposed to resolve on its own and they do not follow up on it. Was the endoscopy on a few months' old baby worth getting the diagnosis which is just a fancy name for the misery?

Some things are in G-d's hands alone. Health is definitely one of them.

הַנִּסְתָּרֹת לַיהוָֹה אֱלֹהֵינוּ וְהַנִּגְלֹת לָנוּ וּלְבָנֵינוּ עַד-עוֹלָם לַעֲשׂוֹת אֶת-כָּל-דִּבְרֵי הַתּוֹרָה הַזֹּאת:
The hidden things are for Hashem, and the revealed things are for us and for our children forever, to fulfill the words of this Torah ( Devarim, 29, 28).

mothering the mother

If you have spent some time looking into natural childbirth or alternative birthing, this term will sound familiar. In case you haven't, the concept is simple: during labor, the woman is at her most vulnerable state, physically and emotionally. Chazal recognized this years ago, and recorded it in a famous mishna BaMe madlikin, recited on Friday night: for these three the woman perishes in childbirth: for not observing the separation of challah, lighting Shabbos candles and being careful with the laws of Niddah. In the more recent times, in our secular world we see labor as the time when woman is most likely to lose her resolve, submit to her environment, not be able to make rational decisions about her care, and generally feel stuck.

I used to read about how mothers in labor need mothering and cry about it. Having gone through labor three times already, I had a pretty good idea of what it is, but I also knew what was missing: a person with whom you have a connection, someone who will cheer you on, help you express your wishes, will not freak out and will not impose their will on you, but will support you. This is someone who has gone through a childbirth herself, so she knows what those moments when all hope and resolve seep out are like. In short, I was dreaming of having a doula.

I first read about doulas while being pregnant with my second. I actually tried hiring one, but I had a few thing working against me. My husband was in the middle of ob-gyn residency and thought I was off my rocker with my sudden turn towards natural childbirth ( my first was a classical cascade of interventions: broken water, meconium, continuous monitoring, epidural, punctured veins, a "little" episiotomy, topped off epidural which did not let me sit up and nurse). He was vary of this doula proposition and the first doula I interviewed spent the whole time butting head with him instead of talking to me. It also did not help that she was about my age, so she did not feel like the kind of person who would be mothering. The second person I spoke to was my new downstairs neighbor, trained as a doula. The hang-up was that she just newly married and yet childless, and that I went into labor just as  they were leaving for Pesach. So I birthed without a doula.

The third time around, I read more and more about doulas. I met people who did home birth, and their experiences sounded so much more in tune with what I wanted: familiar environment, supportive relatives, no pressure. However, I was quite depressed ( this was less than I year after my father passed away from a prolonged illness), and was in no shape to be proactive about getting the kind of care that I wanted. By that point, my husband had more experience with natural childbirth and doctors who did not interfere with mothers. The hospital was also much more in tune with my wishes, so I decided to rely on my improved circumstances and go at it alone, again.

This time around, when I started reading my natural childbirth psyching-up material and came to the passages about douals, I decided to be proactive. I knew what I wanted, and I wanted a doula. I wish some of my close friends could be there; I am sure that I could get just that kind of support from them. However, since this is not happening, I am simply hiring a friend.

Am I expecting that everything will be honky-dory just because now I have a doula? No, but I feel that I am maximizing my chances. I am also making my wishes to be heard. It is a big deal, especially when it goes against your upbringing: you are not really feeling that, you cannot possibly feel that, and you will be fine whichever way things are. Well, I will play a hand in how things turn out.
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Stepping back, I need to apply this a bit more to the rest of my life. With kids at home, it is very easy for everyone else's needs to take precedence: first the kids, then my husband when he comes home, then whoever expects their phone calls answered, and then, somewhere at the bottom of the pile, me. I seem to never get to me, or have any energy left. What if I reshuffle things a bit, putting myself first here and there? A very unmotherly concept, I know. I am not so sure how it will work: babysitters? gym membership? quiet time? but I will be thinking about it, because not putting my needs first will just earn me unhappiness and a breakdown.
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So I am looking forward to being mothered, both in childbirth and beyond.

somebody has got to pay

This is a little rant, slightly off-topic, but on a subject that is near and dear to my heart: natural childbirth.

A bit of background: my husband is an OB-GYN. I had one highly interventionist birth and two natural ones. I am not a crunchy granola type, but I read up quite a bit on natural birthing and midwifery. Therefore, I do believe that most babies can be born safely, without medical intervention or assistance and probably not even in a medical setting. Or, as my husband would paraphrase: an OB should have small hands and big behind, so that he could sit on those small hands with his behind and let the birthing commence.

However, there is a subset of women who do require medical assistance, whether in coping with prolonged labor, pushing baby out, or for obvious fetal distress. There are extremely overweight patients, diabetic, with multiple health issues, requesting an epidural and laboring on their back. Needless to say, by the time it comes to pushing, they might not be very active participants at all. They cannot flip on all fours to resolve a shoulder dystocia. There are women who are scared of the pain, so they prefer epidural and whichever drug cocktail during labor. Finally, there are clear indications for c-section. Unlike what a lot of militant midwife literature would lead one to believe, c-section was not invented in the 20th century to streamline doctors' schedule, c-section has always operated as a last resort. Till 20th century, the choice used to be between the life of the mother or the life of the baby. Nowadays, most people expect a happy ending, where everyone goes home safe and sound.

Why am I writing this now? That's because my husband is attending a birth of a woman whose baby has been in distress since 4 am. (It is 9 pm now). This woman chose to labor at home with a midwife for a VBAC. So far, so good, more power to her for trying to swim against the current, making her own choice. The problem is, the midwife did not have a doctor backing her up, so when the baby showed signs of distress, the woman was brought to the nearest hospital and they called the doctor on call, who happened to be my husband. Now, the happy ending would be a section right then and there, but the problem was, this lady wanted an epidural to cope with the pain. Epidural slows labor down. Epidural confines mother to the bed. Epidural does not allow one to walk and use gravity to bring the baby lower into the pelvis. In short, a patient with an epidural is not laboring as effectively as one without. By the time my husband got there, the woman was dilating, but the baby was high up in her pelvis, nowhere near the delivery, and showing those signs of distress for which the midwife brought her in in the first place. The other problem was, this lady was adamant about not getting a repeat c-section.

All of this dragged on the whole day. I understand that woman's perspective: nobody wants a major abdominal surgery. She probably envisioned a very different birth, and a certain amount of control over the situation. She wanted to be given a bit more time, let the things progress on their own.

But I would like all patients like this to understand the situation from our perspective (my husband's and mine):
My husband has been up and at the hospital since 4am, when the nurses called him in. He had another two c-sections scheduled today, together with a gynecological surgery. He has not been home the whole day. I have not seen him the whole day and neither did the kids. This is not a nine-to-five job, with a round of golf and martinins to take your mind off things. So we  adjusted to a very different day from the one we were supposed to have. (Not golf and martinis, but, maybe an outing to Bruster's after dinner and some help in tucking kids into bed). Now, this lady's baby has been in distress for so long, that there is a possibility that something might be wrong with it. There might be some oxygen deprivation, some developmental delays, or some other form of damage. And that's where the lawyers come swooping in. This patient did not have a previous relationship with a doctor, so, instead of thinking about how she might be responsible for any possibly bad outcome, a scapegoat will be found. A scapegoat in the form of an evil doctor, who SHOULD have done something different. By this point, all natural hopes go out the window, and it becomes a malpractice suit, because someone has got to pay.

An average obstetrician gets sued four times during his career. The lawsuits are usually brought by the patients who do not have a relationship with a doctor, the walk-ins. The insurance companies are so worried about losing a case that they often choose to settle, even if the obstetrician did nothing wrong. And it is easier to accuse an obstetrician of wrongdoing when nothing was done, than when medical procedures were performed, such as a c-section.

I am all for natural childbirth, women's education about what our bodies are meant to do and as few interventions in labor as possible. But next time someone goes on a rampage blaming obstetricians for every singe thing that went wrong, please spare me.