who's the ECL?

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Portland, Oregon, United States
I'm not BAD evil, more like devil's food cake evil.

Sunday, October 28, 2007

Deeper Down The Rabbit Hole

Last Wednesday I posted about birth, and all these questions I have about the couples I've worked with. And to my surprise, I got three very honest, insightful and wonderful comments from three lovely ladies. The surprise came from what was said. Each of them brought up so many points, concepts, and personal stories that I didn't know how to comment, or where to even begin. I still don't, really.

But I think, right now, I just want to clarify a few things about my post. The questions I asked were directed mainly at a certain population of women and couples that I have had the pleasure of working with in the last 3 years or so.

I’m not talking about the couples who choose a homebirth. I’m not even talking about the couples who know they are getting an epidural. Those guys know what they want; I’m not concerned about them.

I’m talking about the couples who choose to give birth at a hospital, yet do not like the hospital and are very afraid of the possibility of their birth being "taken over" by the medical staff. They don't want any interventions, they want to give birth without pain meds, and they want to be free to move around, eat, and yell as they feel fit.

I’m talking about the couples who choose to try to fight the hospital's standard care giving procedures by trying for a homebirth at a hospital. There’s a certain contradiction between what they say they want and what they believe they'll get or need that is my issue here. They want a happy, cozy, unmanaged, candles and birth tubs type of homebirth in a sterile, fluorescent lights, IV needle, managed birth setting.

Essentially, all those things they told me they wanted? They would get them, almost guaranteed, at a home birth or at a free standing birth center. (PROVIDED they were deemed low risk and a good candidate for an out of hospital birth by their caregivers, PROVIDED there were no complications during labor--which the MAJORITY of ALL births are.)

Why would they choose a setting in which it is almost guaranteed they WON'T get what they want?

Two reasons, as I can see: the allure of the epidural, and the fear of death.

Calgon, Take Me Away
As much as they want to believe they can do it without meds, they want the meds nearby just in case.

That’s the contradiction at the heart of my questioning. They already assume they will fail to get what they want. They already assume they do not have what it takes to cope with the pain without drugs. They already assume they cannot do it.

That’s what I’m talking about here, people. Why do they want something so bad that deep down, they don’t believe they can have?

Let me be clear here. I have seen the wise and compassionate use of epidurals. I do not think they are evil, or bad. If a couple I worked with told me that they wanted to go straight to the hospital so that they can get their epidural as soon as possible, that's fine. I’m glad they know what they want. That’s not the issue. This post is about the couples who don't really know what they want, or don’t believe in what they want.

Death Becomes Her
The fear of maternal/infant death is very terrible, very scary, and completely terrifying. I have yet to support a couple in labor who ends up losing their child, and I am terrified of that day. I am terrified that if I have children I will loose one—but I am no more afraid of losing my child in childbirth than I am afraid of him getting hit by a car on the way to school. No one can guarantee that either scenario won’t happen. Does that make sense?

I guess it comes down to this: I believe in birth. I believe in midwives that are properly trained and experienced. I believe that more often than not, birth is not an emergency. I believe that more often than not, birth is not a medical event. And when birth becomes a medical emergency, I believe in the ability of my care providers to act quickly and accordingly. I believe in the awesome power of modern medicine to save the lives that nature tried to claim for her own.

Yes, I am na├»ve. No, I haven’t given birth. No, I don’t have my own children. So this story may change, as I get older or pregnant or more experienced.

But I have seen women overcome all the odds to bring healthy babies into this world. I have seen a woman, whom her caregivers had given up on vaginally birthing her baby and had ordered the cesarean, get up and keep trying to push her baby out—and succeeding to the surprise of the hospital staff. I have seen women cope with the unbearable pain of contractions without medication, even after hours and days of slowly progressing labor. I have seen women beaten down by the pressure of the hospital staff to comply with their procedures give up and give in to tubes and needles and medicines and disassociation. I have seen emergency cesareans where in seconds flat, the birthing mother is wheeled away by the entire nursing staff, nurse-midwives and OB, leaving the father and myself standing stunned and alone in the room that once held their hopes and dreams. I have seen high-risk births where nothing went wrong and everyone was happy and healthy at the end of the day. I have spoken with mothers who tried for a homebirth but were transported by ambulance to the hospital. I have worked with couples who had a beautiful birth and a newborn with seizures who spent her first three months on the planet in the NICU. I have worked with a mom who was trying to make sense of the loss of her infant, who died as he was being pushed out into the world.

Birth is wild; it is achingly heartbreaking, awesomely powerful, deeply terrifying. It is unpredictable, and uncontrollable. There is nothing like it in the world. I have only seen and experienced it from the outside, but I think that has given me great perspective. I have a sense of the enormous range of possibilities any one birth could be. I also have a sense of the enormous range of possibilities that a normal birth could be. I know people hire me because of my knowledge of these two things. I know that is what I bring to each couple I work with—this belief and perception of what birth can be. But why is it that some couples carry that belief themselves and so many others only wish to?

For Further Reading
For all those interested in learning more about birth in our culture.
Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Mardsen Wagner
The Thinking Woman's Guide to a Better Birth by Henci Goer.
Obstetric Myths versus Research Realities by Henci Goer.
Ina May's Guide to Childbirth by Ian May Gaskin
Spiritual Midwifery by Ina May Gaskin
Birthing From Within by Pam England
Primal Health: Understanding the the Critical Period Between Conception and the First Birthday by Michel Odent
The Scientification of Love by Michel Odent
The Farmer and the Obstetrician by Michel Odent

That's a start.