"Take Me to a Hospital!"
by Jock Doubleday
(a response to Susan Gerhard's August 4,
1999 article,
"Take Me to a Hospital!"
http://www.salon.com/mwt/feature/1999/08/04/homebirth/index.html)
August 5, 1999
Editor
Salon Magazine
To the Editor:
Husbandless city girl Susan Gerhard chronologs her botched home
birth in "Take me to a hospital!" (Salon, August 4, 1999).
Desiring a "supportive" birth, Susan for some reason
hires a midwife whose manner she dislikes and whose advice she distrusts. And she hangs onto a boyfriend too busy
to help her shop for receiving blankets, a special rehydration drink, and
"myriad herbs."
A big girl in a big city, Susan schleps whining through the
streets, detailing her every lonely labored shopping step.
Annoyed that her midwife constantly offers her tea and frets over
her due date, Susan brightens when a false alarm sends her prematurely to the
hospital. Here she meets "a
calm, nonchalant staff" who give her tests, a tour of the facility and
"warmly" invite her back.
Back home, baby on the way, the annoying midwife breaks her water.
Susan pushes too soon and swells her cervix shut. The midwife is not allowed (or has no competence--we don't
know which) to push the baby's head back so the swelling can go down.
So Susan goes to the warm and friendly hospital! . . . where she
cascades through the usual interventions: IVs with Pitocin and glucose and
water, an intrauterine pressure device, catheter, antibiotics, monitoring
devices screwed onto her baby's head, and two epidurals.
Like taking a cat-trespassing to the police, Susan surrenders her
bruised cervix to the awesome powers of the birth machine. Her miraculous escape from that great
revenue-enhancer, the cesarean section, is testament, perhaps, to surgeons gone
golfing.
Had she read Joseph Chilton Pearce's 1993 book Evolution's End instead of spending her time cataloging
her miseries, she might have discovered that hospital childbirth has been found
to be the first and foremost cause of the epidemic increase of violence in
America, and six times more likely than home birth to lead to infant death.
Had she not pooh-poohed "fresh-baked" Mothering magazine but actually read it, she might
have benefited from Nancy Griffin's article "The Epidural Express,"
which lists some common side-effects of epidural anesthesia: paralysis of lower extremities,
headache, severe backache, septic meningitis, prolonged first- and second-stage
labor, malpositioning of the baby at the end of second-stage labor, cranial
nerve palsies, respiratory depression, nausea, vomiting, and seizures. Local anesthetics, she might have
found, also rapidly cross the placenta, resulting in lowered infant
neurobehavioral scores, infant respiratory depression, and fetal heart rate
variability -- a C-section lover's dream.
Stuck between an incompetent midwife and a cold, hard place, Susan
seems to be a victim. But she should
have done research (she's a journalist) to find a truly competent midwife, one
engendering trust and one worthy of trust. She should have read books and articles to know what to
expect. She should have talked to
women who had given birth--her mother, for example, or her sister, or her
friends--all of whom are missing from the life portrait she offers us.
Susan's ditzy "just cut me" style makes for an easy read
but an uneasy feeling. She
condescends to what Suzanne Arms calls her "ancient female lineage"
and dismisses traditional cultures' birthing practices in a single swipe: "how many women would enjoy the
method [that] the Guarani of northern Bolivia use to get the placenta out:
making the mother gag on a chicken feather?"
What is missing from Susan's life is community, respect for
nature, a sense of history or connectedness to things, and an ability to
surrender, not to masked technicians ready for gain, but to human being.
Her unfathomable crowning glory, "Why do homebirth teachers
like to refer to birth as 'sacred'?" invites us to recommend to her a
3-month vacation from her nonhusband, her work associates, and city life.
Dear editor, will you grant it?
Signed,
Jock Doubleday
Director
Natural Woman, Natural Man, Inc.
A California 501(c)3 Nonprofit Corporation
http://www.SpontaneousCreation.org
director@SpontaneousCreation.org
[The below from http://www.salon.com/mwt/feature/1999/08/04/homebirth/index.html]
Take me to a hospital!
What possessed me to think there was something appealing about
cleaning up after the birth of my own child?
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By Susan Gerhard
August 4, 1999
Homebirth. The word sounds so warm, so inviting, so fresh-baked,
so Mothering magazine. Do it yourself in a soft-sculpture kind of way. Think
"hospital," and soon enough, you're conjuring up bureaucracy and
blood draws, brutal parking and antisocial bacteria. Place, however, might not
be the most important factor in a "good birth outcome," as the jargon
goes.
The safest place to have a baby, I remember reading once, was the
back seat of a car. My doctor told me I was crazy when I said I was planning a
homebirth. "Sure, if everything goes right you could have your baby on a
beach," he said cryptically. In retrospect, perhaps that's exactly where I
should have gone. I might have chosen to do what the other animals do and crawl
away to a secret corner of the woods to have a good scream for three days if
the option were available; barring that, I thought I'd do my grunting at home.
I was part of the 1 percent of birthing women in the United States
confident enough in my own body, or scared enough at what hospitals would do
with it, to make the choice of having my baby in the bedroom. I'd expected my
homebirth to give me a more personalized, more supportive, calmer, less
interventionist, simpler, happier experience than what I would get in a
hospital. You hear all the talk of water babies delivered by naked papas;
homebirth, I assumed, could be customized like a new car. Midwives, I supposed,
would have fewer rules -- and could bend what rules they had to fit the
circumstances. The final moment of ecstasy, I figured, would happen under the
loving gaze of friends and family, and the newborn boy would spring into the
arms of my partner, who would embrace the goo as he placed the child on my
breast.
What I didn't know is that midwifery has come a long way since the
early '70s, when Ina May Gaskin, the matriarch of the contemporary homebirth
movement, rambled across the country in a spiritual Partridge Family bus,
delivering babies in parking lots. I'd read a story from a tattered 1973 issue
of "The Realist" by Raven Lang, another founder of the homebirth
movement, describing mythic flower-power births in which fresh fruit juices and
hash helped the laboring mother along.
I wasn't really hoping to sneak in a bong hit during my labor, but
I did want to avoid the dangerous "prophylactic" measures --
antibiotics, IVs, episiotomies -- that hospitals dump on patients to fend off
lawsuits. I had definitely been turned off by my first tour of the HMO
hospital: a peach path through suburban anxieties. The kindly nurse who led us
through the Level III facility kept bragging about the many layers of security
that were going to prevent us from having our baby stolen. Then there were the
mishap stories one always hears: an anesthesiologist who put in an epidural and
was somehow an hour's drive away when the anesthesia wore off; a baby whom a
hospital pediatrician mistakenly diagnosed as having his stomach "on the
wrong side," engendering a battery of unnecessary X-rays. I had started
out with a conventional OB-GYN, but had grown increasingly frustrated with
five-minute physician visits and ongoing rounds of blood work-ups for conditions
no one in my entire family history had ever known.
What I got instead from the world of homebirth were herbal teas
and hour-and-a-half conversations along with the ongoing rounds of blood
work-ups for conditions no one in my entire family history had ever known. These
days ultrasounds have replaced bongs, and the wide-eyed and untrained have
moved on to the "unassisted childbirth" movement.
And yes, I know they call it "homebirth," but to tell
you the truth, it was never really my home we were gathering in. Every couple
of weeks my boyfriend and I ambled down to a cozy suburban cottage with a
quaint backyard and built-in family. Appointments with my midwife had a
reassuring routine. "Tea?" she'd ask. "Yes, thanks," we'd
respond. There might be a slice of pie. Then, as the bleeps of a boy playing
video games punctuated the background and a husband popped in or out, we'd talk
emotions, get a fetal heartbeat and eventually be on the road.
Unless, of course, my health actually came up. Then the
appointments involved a different routine -- one epitomized by the rainy
Monday, 41 weeks into my pregnancy, when I left the tea bags and chitchat
because I was instructed to head directly to the hospital for some tests, with
the caution that I might have to get induced that day. We quickly and
dejectedly packed our bags and headed for a very unplanned C-section. But when
we got to the dreaded hospital, instead of being greeted by officious health
professionals ready to straitjacket the wayward homebirth couple, it was a
calm, nonchalant staff who gave me tests, a tour of the facility, and warmly
invited me to come back -- even as they sent me home with the unexpected label
"normal."
It wasn't the first midwife-inspired birth scare of the pregnancy
followed by comforts of medicine's more conventional wing; it wouldn't be the
last. Would my baby be born at 13 pounds with the shoulders of a linebacker, as
my midwife once worried? Would my increasingly variable blood pressure send me
into a state of shock? Was my one-week-overdue infant wrinkling and shriveling
with the last teaspoons of amniotic fluid? Tests generally confirmed
"no" -- and the tea bags would once again be offered. But that's the
schizophrenic world of midwifery as I experienced it -- dictums to relax while drawing
up detailed maps, in triplicate, of worst-case scenarios and how to transport
ourselves to the hospital. Was it any wonder my blood pressure only seemed to
be rising when my midwife was measuring it?
I could only laugh at the question that came up over and over
again from well-meaning relatives and slightly concerned friends -- "Is
homebirth safe?" To that I could only answer: "Perilously so."
Like Boy Scouts, it seems, midwives have a motto: "Be
prepared." My friends never really asked whether or not homebirth was
complicated. If only I had known. Never mind the medical work-ups, just making
the house ready for homebirth was no small matter. There was shopping for the
special juice I was supposed to drink to rehydrate myself as labor wore on (if
only I had been able to keep food down). There was the ordering and buying of
the homebirth "kit," a collection of laboratory sundries from some
place with a name like "Moonflower." There were the 10 receiving
blankets to be put in a bag and placed in the oven to warm the child after he
left the womb. There were the myriad herbs and tinctures I searched the city to
secure -- alfalfa, hops, cottonroot bark, black cohosh, nettles, you name it;
herbs to lower blood pressure and ease swelling, plants to make the uterus stronger,
teas to bring my iron up, tinctures to ease pain and/or bring on contractions.
There was the misguided attempt to have a "hot tub" delivered to my
living room, should the need arise. And there was the waterproofing of
surfaces, to make sure the water-bag/mucus plug/gooey baby/afterbirth would not
mark up any upholstery, via a product called Chux incontinence pads. Need some?
I have approximately an unused case I could sell you. But I think it was the
frozen maxi-pads that finally drove home the point that home-spinning homebirth
is not so simple at all. A molten mass of wetted plastic layered with wax paper
was left to defrost on the kitchen counter for a few days. The frosty pads had
been scheduled to be my "ice packs" after the birth was over, but ended
up a moist mound of uselessness, one final, difficult-to-dispose-of reminder of
the painstaking prep work that was going to save me from the
"complications" of hospital birth.
Surely all that prep was worth avoiding all the interventions of a
hospital birth? Well, no. Before the birth, even though my midwife and I had a
legitimate disagreement about what my actual due date should have been, she
encouraged me to move forward with an herbal induction when I reached the
dreaded 42nd week (only the 41st week or less by my calculation). When labor
was finally under way at a rate I thought I could live with, she broke another
of what I thought were cardinal rules of homebirth, and told me that my labor
was not "progressing" fast enough. She then performed that most
pleasant of interventions, an enema, and with a few seconds of "informed
consent" that I remember as something along the lines of "this won't
hurt a bit," offered a homeopathic dose of blue cohosh to supposedly get
the labor going again -- and broke the bag of waters.
Without water as a cushion, my baby's head plunged onto my cervix,
which of course led to an early desire to push that swelled my cervix closed
again and led me to the hospital, where I necessarily cascaded through the rest
of the usual interventions: IVs with Pitocin and glucose and water, an
intrauterine pressure device, catheter, antibiotics, monitoring devices screwed
onto the baby's head and an epidural -- well, two epidurals. The first one
wandered off my spine and gave me a sweet high until we all realized something
was very wrong and the epidural had to be rebooted. It was 12 hours after my
drive to the hospital, desperately panting all the way, that I finally got to
turn off the pain medications and do what I'd been waiting a half-day for: push
the baby out on my own.
More surprising than the fact that the baby was born perky, pink
and Apgar-ready was that the hospital bore little resemblance to the halls of
horror I'd been reading about. I didn't get my ceremonial staph infection; I
didn't feel the place was a sterile, inhuman baby factory conceived to control
women's destinies. What I got was 24-hour breast-feeding assistance; night
nurses, each with a new helpful nipple squeeze; someone to make my meal, albeit
an unsettling one, and take that meal away (thank God). Yes, my insurance
company was paying thousands a day for the services, but those services did
come in handy: I had one kindly nurse who offered extra measures to help me
through the frightening first defecation. Would my midwives have come over at 4
a.m., after my three days of labor and fourth day without sleep, and taken the
baby for a few hours so I could get some of the most necessary rest of my life?
I doubt it.
(My midwife, as it had turned out, had to leave her advocacy perch
at my bedside to attend to her other client in labor just five minutes before
the pushing phase of my own labor began. The phalanx of residents and nurses
who had swarmed around my bed during parts of the night somehow evaporated.
Which left a room with only me, my partner and my best friend, holding a mirror
for what seemed like entire minutes as the baby's head began to crown. When he
arrived, it was, as they say, the best moment of my life.)
I had plenty of time to relive the glory as I reclined for three
days on freshly laundered hospital sheets with TV and phone at the ready. Why
had I chosen homebirth in the first place? It wasn't the "home" part
of it -- I rent a city apartment, and it's not exactly the height of comfort and
ease; it's more like a repository of unfinished business and moldy corners. Was
it an act of protest? If so, I'd come to the wrong march. I found out the hard
way that my midwife's reasons for giving me a homebirth appeared to be far
different from my reasons for wanting one. If I wanted nature to take its
course, and was willing to take the necessary risks to let that happen, she
wanted nature to take her course -- a paved road through the woods.
Though I may have been dropping out of one system, I was also
tumbling head-first into a new one, with its own ready-made worldview and
marketing tie-ins. Cloth diapers? Check. Circumcision? Negatory. But do I have
to claim I'm in sync with the entire history of man as I make these consumer
choices? Along with the fluffy organic cotton can come a fuzzy thought process:
The late 20th century midwifery movement is based on a logic that isn't always
practiced in its literature. You get rampant speculation when some of its
greatest voices call up history and anthropology to bolster their views.
Suzanne Arms, the author of "Immaculate Deception," writes that the
"birthing woman has lost touch with her ancient female lineage,"
which is why she fears the pain of birth. Was she there to hear my ancient
female lineage complain? As for the birthing practices of traditional cultures,
which always come in handy when criticizing Western medicine, how many women
would enjoy the method that Midwifery Today reports the Guarani of northern
Bolivia use to get the placenta out: making the mother gag on a chicken
feather?
I'll take the hospital, and not because anyone threatened me with
a chicken feather. Like many unwieldy institutions, it's big enough to host
dissenters and crazies, the tenured as well as the young -- who at least bring
humor along with their lack of experience. The homebirth world seemed
surprisingly staid and monolithic by contrast, with midwives stuck in the same
era that spawned their medical ethos. The culture clash became most apparent to
me during labor, when I informed my midwife over the phone what kind of
entertainment I was using to get me through contractions -- some campy musicals
from my childhood that still had some ironic value. To which she responded with
an earnest tip from the PBS circuit: "You know what's a good musical you
should see? 'Riverdance.'"
It made me suspicious. I mean, why are so many self-help birth
books pink? And why do homebirth teachers like to refer to birth as
"sacred"? Can "getting in touch with the rhythms of nature"
with a good walk on the beach really initiate labor? I logged miles and miles
in fruitless pursuit. Homebirthers themselves appear to be an amazingly
intelligent group of people from the small sample I know -- skeptics who are
often health professionals taking a break from irritating hospital routines.
Why are they bathed in a culture of euphemism? Homebirth books love to point
out the dangers of hospitals while minimizing the "failure" rate of
homebirth. I had a hard time finding homebirthers willing to share the gritty
details of their hospital transfers; there's a kind of "homebirth
macho" that equates hospitalization with capitulation.
Yet that "capitulation" is practiced all the time.
Caution is the keyword for midwives, many of whom are uninsurable. Though they
claim the problem with doctors is that they rely too heavily on technology that
was devised for emergencies, in retrospect, I think that technology may be
doctors' primary strength. Unlike midwives in a homebirth situation, doctors
can be calm even up to the last minute. With fetal monitor safely screwed into
my son's skull, everyone in the room could finally believe he was alive and
well and would eventually make his way out. Signs that had my midwife worried
were not causing panic among the residents treating me. Midwives have to be
trained to think at least hours, if not weeks and months, in advance. They say
they have to believe the best, but clearly they also must envision the worst.
The worst, as it turned out, was a frequent topic as my pregnancy
wore on. I had just wanted reassurance that I could deliver my baby at home,
even if he was going to be late. The books I'd borrowed from my midwife's
library and read at her insistence had all reasoned, as did I, that "due
dates" were a normalizing fiction. But what I was finding from my
homebirth class and my two midwives as I headed toward the end of my pregnancy
was that "post-dates" pregnancies are considered risky these days,
even though the numbers say that from 40 to 43 weeks the risk of mortality per
1,000 babies increases from 2.3 to only 4. With constant checking of my vital
signs and those of my "post-term" baby, I truly believed I would be
one of the 996 moms whose baby beat the odds. Was I so crazy?
Apparently I was, according to my midwives, experts whose opinions
were just as difficult to question as any other medical authority. When told my
family history (my own mother had eight consecutive late-but-normal
pregnancies; all my siblings have had prolonged pregnancies), my midwife's
assistant told us she'd never seen a pregnancy go post-dates that wasn't a
miscalculation. If you say so.
In the hospital, I made a habit of refusing treatments. With
midwives, it's they who refuse you. Is your baby big, small or breech? When a
midwife tells you her rates of hospital transfer and Caesarean, do you know
what kind of population she's talking about? Mine had a rate of something like
one in 10, though she kept insisting hospital transfers were "rare."
But a one-in-10 transfer or Caesarean rate is not a minimal percent of the
population. And the population she was talking about doesn't drink, smoke, is
generally not overweight and has been eating meticulously for nine months;
otherwise she wouldn't have taken them on. Not to mention that most midwives'
customers, I would hazard a guess, are not first-time mothers.
Hospitals, on the other hand, have to accept the great unwashed.
And hospitals' numbers reflect it: For low-risk pregnancies -- according to a
report from the Institute for Childbirth and Family Research in Berkeley,
Calif. -- hospitals are more dangerous than homes. Other statistics on both
certified nurse midwives and direct-entry midwives (those who work outside
hospitals) back up the idea that homebirths are safe, as are hospital births
with CNMs. But to my mind, it's the overriding concern over safety that has led
midwifery down a frightening path, one where caution replaces common sense.
Defense is an understandable posture, of course, given the years of persecution
direct-entry and certified nurse midwives have faced from the medical
profession. While hospitals have adopted many of the groovy innovations
midwives and birth advocates had been clamoring for, hospitals and doctors have
also done their best to put midwives out of business, in many cases actively
fighting laws that would allow midwives to simply do their work. Midwifery's
response, however, has been a problem all its own. Standardizing its own
practices and adopting its own codes has led to the kind of hard-and-fast rules
midwives of the '70s wanted desperately to avoid. Perhaps midwives have been
obsessed by doctors for so long that they've become the thing they hate.
That's what I was left to ponder after my own homebirth gone awry.
In the weeks following my "post-dates" pregnancy that turned out to
hatch a "pre-term" infant with vernix coating his newborn body -- an
indication that he was not post-mature at all -- I was still entertaining the
quaint notion that bringing health professionals into my home would somehow
neutralize them. But even after the child was born and deemed healthy, my
midwife assistant's visit followed the familiar narrative. First there was
chatter; maybe I offered some tea. She would make some wry comment. Then came
the bad news: and there was always the bad news. This time, the midwife found
my baby was too cold by a few tenths of a degree. She took and re-took his
temperature and I panicked for an hour after she left, until I had the
forward-thinking idea of checking the thermometer on myself. I was an entire
degree lower than my child, and so was my partner.
Yet I have to respect my midwife for overcoming her fears and
attempting to deliver my baby at home, though it did, of course, climax with a
dramatic evening transport to the hospital. The picture of me with my legs
crossed in a hilarious attempt to keep the baby inside me as we drove through
winding San Francisco streets in foggy darkness is my fondest memory of the
whole extravaganza -- the 20 minutes that could qualify as a legitimate
sequence in an action flick. It made me realize that what I wanted from my
birth experience was anything but soft-sculpture. That specter is something few
midwives in the late '90s are willing to let themselves consider. Later, my
midwife was way off the mark when she tried to empathize by saying "I'm
sorry you didn't have the birth you wanted." She couldn't have known I
actually did.
salon.com | August 4, 1999
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About the writer
Susan Gerhard is a journalist and film critic in San Francisco.