Friday, October 9, 2020

Choose Your Own (Birthing) Adventure

A week before Valentine’s Day, my husband and I bundled up and headed out in the frosty morning for a tour of the bougie hospital where Dr. Baby-Maker’s patients delivered.

The tour group was huge; over a dozen couples. Most looked like they were further along than me (or just had more prominent bellies) and much younger than me, like in their 20s.

The set-up at the bougie hospital was a little bit different than the other hospitals where I’d given birth. For my previous deliveries, I was admitted, given a room, and stayed put. At the bougie hospital, however, patients started in the maternal assessment area, a grim, dark, and windowless space where nurses used fetal monitoring and internal exams to determine if you really were in labor (or, if you were scheduled for a C-section, to get prepped).

Once labor was confirmed, patients were moved to a birthing room (or the operating room if scheduled for a C-section). The birthing rooms were newly renovated, spacious, and featured lots of natural light. Some even had huge soaking tubs. Two hours after birth, patients were moved yet again to the postpartum floor, which featured small, no-frills style private rooms.

Some hospital procedures had changed since I last gave birth. Most notably, the hospital now emphasized “the golden hour” as a sacred time. It’s the first hour after a baby is born, which moms and babies are encouraged to spend together skin-to-skin to help the baby transition from the womb into the world. Nurses didn’t even clean the babies off anymore before handing them to the mothers. This sounded like a welcome change to what my previous deliveries had been like – newborns immediately whisked away for cleaning, weighing, and Apgar testing followed by mass intrusion of well-intentioned but overbearing family members. 

While the bougie hospital offered comfort tools like birthing balls, birthing stools, and those luxurious tubs, the nurses were upfront about what a hospital birth meant – drugs. “Our focus is on pain management,” the nurse leading the tour told us. She rattled off some of the available options, including narcotics, epidurals, and nitrous oxide.

I now believe that all births are natural, whether they are medicated or unmedicated, vaginal or C-section, but at the time, I was really hoping for an unmedicated birth and considered them superior to any other kind of birth. I admired women like Ina May Gaskin, perhaps the most famous midwife in the world and author of the unmedicated birth bible Spiritual Midwifery, as well as Rikki Lake, who advocated for home births in the documentary The Business of Being Born.

While the hospital setting scared me a little, the what-ifs scared me more. I’d seen a lot of news stories about pregnant women who had strokes or other health emergencies during labor. I also remembered that I had been in incredible pain during both of my daughters’ births. What if this birth was longer or more painful than my previous deliveries? Though my goal was an unmedicated birth, I liked the idea of having drugs at hand if I needed them.

At my 24-week prenatal appointment, Dr. Baby-Maker asked about the deliveries of my daughters. The first, at 39 weeks, was long and tortuous – around 21 hours – and involved a totally useless shot of Nubain, which I would never ask for again because it did nothing to ease the pain and made me so dizzy I couldn't stand up. The second delivery, at 38 weeks, was so fast I barely made it to the hospital. I begged for painkillers but I was fully dilated and effaced, so the only way to find relief was to push. I did, three times, and my second daughter was born.

“I’m hoping for another quick birth like that one,” I told Dr. Baby-Maker.

“It’s been a while since you last delivered,” she said. “It might take your body some time to remember how to do it.”

That was not what I wanted to hear.

“But we offer induction at 39 weeks if you want to avoid a home birth or a car birth," Dr. Baby-Maker said. “Something to think about.”

I did think about it and I had two thoughts: 1) "I won't get to 39 weeks!" (In my mind’s math, if I’d had my first baby at 39 weeks and my second at 38 weeks, shouldn’t my third come around 37 weeks?) And 2) "An induction is exactly what I'm hoping to avoid."

I had heard so many induction stories – on message boards, in documentaries, in books – and none of them were positive. Many of them included horrific levels of pain, long labors that stalled, and emergency C-sections. “Uterine rupture” was a terrifying term that was sometimes associated with induction drugs.

So why was Dr. Baby-Maker offering induction so casually, without a medical reason, like it was no big deal? Women have died from being induced. Why would I electively do that? (Oh, just you wait…)

Similar to when I was at the maternal-fetal medicine clinic, I started wondering if the medical model was best for me, my delivery, and my baby. Or was it a lot of unnecessary interventions? Could I advocate for myself in a hospital setting?

It was time to call on reinforcements, namely, a former boss of mine who had become a doula. She gave me the spiel about her services over the phone.

While I appreciated her passion for empowering women to have the kind of births they wanted, I wasn’t sure if I really wanted another person in the delivery room; on the other hand, I’d never given birth with my husband, and I wasn’t sure how helpful he was going to be during the delivery or if he would just end up irritating me.

Some of the services included in the doula’s package sounded a little woo-hoo to me, too. I really didn’t want a helper at my home postpartum, nor did I need guidance on processing or composing my birth story. But she did get me to think twice about the bougie hospital, where she said the likelihood of an unmedicated birth was low. She was also vehemently opposed to me being induced at 39 weeks – and even said that at my age, some doctors would refuse to induce me.

“Have you thought about a birth center?” she asked.

“I have, but I want to keep all my options open,” I said. “If I change my mind about pain medication or something goes wrong, I’d rather be at a hospital.”

At the very least, she recommended I switch to a midwifery practice that delivered at the hospital. I didn’t know there was such a thing.

Our conversation was helpful, but it didn't alleviate all my anxiety. Everyone has an idea of what the “best” way to give birth is, but the reality is that birth is not an event you can control, plan, or predict. While I'd scribbled down a birth plan just for myself (yes to movement, massage, hydrotherapy; maybe to nitrous oxide; no to induction, internal monitoring, epidural, episiotomy, vacuum extraction, forceps, or C-section), I knew that in an emergency, I would submit to whatever the doctor recommended.

After the conversation with the doula, I spent the afternoon Googling the bougie hospital. There wasn’t much online – almost as if the internet had been scrubbed of dirt – but there were a few message boards where women chimed in about their birth experiences there. They seemed to be equally split between bad (one woman said a nurse laughed when she stated her desire for an unmedicated birth) and good (surprisingly, by women who’d had C-sections).

Part of me wanted to just stick with Dr. Baby-Maker and the plan to birth at the bougie hospital. But another part of me wanted to give the unmedicated approach the best chance I could. The medical model made sense in the beginning of the pregnancy, given all the infertility hurdles and the subchorionic hemorrhage, but now that the pregnancy was progressing normally, maybe I didn’t need so much intervention.

While I decided against having a doula because of the cost and the nagging feeling that three would be a crowd, I did take the doula’s suggestion and transferred care to an OB practice that had a few midwives on staff who delivered at the bougie hospital.

Things seemed to be falling into place. The due date would be here before I knew it. Now it was time to bask in the beauty of the third trimester – by decorating the nursery, getting maternity photos taken, and arranging the baby’s baptism…

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