I'm 42 years old, and starting fatherhood anew with a glad heart. My 4th daughter, Emrys Hadley Allerding, was born this Sunday, September 15, 2013, at 9:30pm, weighing 8 lbs, 4 oz, 21" long. As an archetypal Sunday's child, she is bonnie and blithe, and good and gay. "Blithe" is a trait that I share with my wife and our children, and which is typically not meant as a complement. However, I think of being blithe about things that don't matter to be healthy and enlightened... it's just that the Clan Autery list of what doesn't matter is much more extensive than is typical. Emrys hasn't actually shown any blithe behavior yet, because, well, she's a baby. But it's coming, and we welcome it.
Like we did with our daughter Adelaide, who will be 2 next month, we attempted to have a home birth with a local midwifery group. In both cases, we rushed to the nearest hospital shortly after pushing began because the baby's heart rate dropped low enough to make everyone nervous, myself included. Also in both cases, minutes after arriving at the hospital, Liberty delivered vaginally without any fuss, and before doctors had time to lobby for a c-section or other interventions. I find this state of affairs pretty inexplicable.
I have strong opinions about the travesty that is the standard American hospital birth path: Ultrasounds, Lamaze, "Mommy and Me", social workers, breastfeeding counselors, stirrups, epidurals, pitocin, heart rate sensors drilled into babies' skulls, the mom being denied food, cesarean sections being hard-sold (especially around lunchtime), putting baby under heat lamps instead of being warmed by skin to skin contact with mom, clear plastic buckets on wheeled carts where baby is meant to sleep, numbered bracelets, RFID tags clipped to the umbilical cord, brightly-lit nurseries staffed by people acclimated and indifferent to babies' cries, blood tests, plastic urine catchers taped to skin, earphones and electric sensors taped to heads, and a scolding, belittling attitude greeting any resistance to Empire. What a nightmare for the expectant mother and her baby.
What's my beef with ultrasound? There is an oft-repeated report of babies being able to hear ultrasound waves in the womb which is, at best, dubious. The pitch of the sound waves is supposedly well outside the normal hearing range, and the report itself had some methodology problems, most notably not being peer-reviewed before publication. Babies being able to hear ultrasounds isn't my complaint. The NIH acknowledges, however, that ultrasound raises the temperature of amniotic fluid, which can lead to damaging the fetus or slowing its growth, and the current recommendation is to run them for as short a time as is necessary to get whatever reading is being sought. In other studies, ultrasound has been linked to an increase in miscarriage and pre-term labor, even highly skilled operators give false diagnoses greater than the actual rate of the condition being checked for - in the case of growth retardation, the false diagnosis rate exceeds 2:1 - and causes profound and unnecessary anxiety in the parents. The studies showing all this are listed on this Midwifery Today article. I recommend at least skimming the article over... before telling your ultrasound tech to kiss your ass.
Lamaze? Breastfeeding counselors? "Mommy and Me"? What kind of animal do I have to be to hate "Mommy and Me"? I don't. I hate the fact that they're necessary. Most of the items on my list above show how dehumanizing the process of bringing new life into the world has become, but these three show how much traditional knowledge has been lost. Before hospital birth became the norm in America in the 1950s, a community's women would come together to share what birthing knowledge was passed down to them, or what they experienced personally. Now we have an instructor working for the hospital reading a script. We need the script now, and women benefit from it, and some of their fears are quelled, their confidence boosted, and the early life of their baby is improved... however, all of those things were true 4-fold in the past, before birth was institutionalized.
Enter the modern midwife, stuck between two worlds, sometimes (like Ohio) in a very grey area legally, and trying with all their might to bring back some dignity and some community to birth. An enlightened primer on what birth has become, what it's supposed to be, and the women trying to improve it, is Ricki Lake's The Business of Being Born, which at the time of this writing is still available to stream on Netflix... you do have Netflix, right?
One of the women interviewed in the film is Ina May Gaskin, a midwife at The Farm, and advocate for midwifery and home birth. In 1977, she published a book called Spiritual Midwifery, which has a collection of birth stories from women on the commune she lives on and the midwives that attended them. My wife has a couple copies of the book (including the '77 edition, which is basically falling apart from use). Here's a recent interview with Ina May on the podcast "The Story", which is a good primer on what she's all about.
"Spiritual Midwifery" speaks from a point of view that Western suburban types such as myself are wholly unfamiliar with, and was the trigger to me taking a step back from what I thought I knew about medicine and asking myself "Wait, what's necessary, and what's just a boat payment?" My opinion now is that very little of what goes on in a labor & delivery ward is necessary.
It would be unkind to the doctors working in good faith to bring healthy babies into the world to leave the "boat payment" barb out there; I don't think that's what's going on. I think instead that some of the problem is an out of control bureaucracy, compensating controls for new parents who lack community and experience to guide them, and a good bit of cover-your-ass in a litigious world. Mostly, though, it's an unenlightened view of womanhood, and just the simple fact that it's a hospital. Hospitals are where sick people go to get cut into, and that concept finds it way in the L&D world, where it doesn't belong.
Going back in time a bit, in 2011 I was substantially more flush with cash than I am now, so when Liberty was pregnant with our first shared child, Adelaide, we were able to become clients of The Farm, and took a trip down to Tennessee to get acquainted with them. (We actually saw Ina May driving down the road at one point). I had planned to take a month off of work and rent a cabin there during the final month of her pregnancy. We ended up not being able to do that, unfortunately, because Liberty had a stomach ailment through most of the pregnancy, affecting Adelaide's size in the second trimester, which was hard to diagnose and treat from out of state. They ended up dropping us as clients (they're hippies, not idiots), and we went with a local midwife group in Columbus, CHOICE, and to a gastroenterologist to try to address the stomach problem.
Of the two, the midwives were the better choice. The stomach doctor diagnosed H. Pylori just from symptom descriptions and not a blood or breath test, and prescribed Prevpac, a pregnancy class C drug which has been shown to cause fetal development problems in animals. She didn't take the Prevpac, naturally, and a little over a year later we found the true cause of her persistent stomach pain: a gluten allergy. Little Adelaide, who as I write this is quietly watching Ruby Gloom on my iPhone beside me, could easily have been miscarried or deformed had we gone with the advice of the gastroenterologist, which wouldn't have corrected the stomach pain. Although that is a single anecdote, my experiences with doctors, be they specialists or general practitioners, seems similar to Liberty's: I'm rushed out of the office, and frequently misdiagnosed. For a man, that's irritating. For a woman who may be pregnant, it's a lot worse for both mother and child.
Liberty's labor with Adelaide was an anxious affair, and she was in constant pain, one contraction leading immediately to the next one for a few hours. When it came time to push, baby's heart rate dropped too low (midwives use a doppler microphone to check fetal heartbeat, rather than drilling into the baby's skull with a sensor, as is typical in a hospital delivery), and they asked Liberty to stop pushing, gave her oxygen, and we rushed to the hospital. If the assessment was that the baby wasn't in duress, we would have stayed home and delivered, but there appeared to be a real problem needing a real medical intervention. Except there really wasn't. We rushed to the hospital, got Liberty up on the delivery table, and she delivered naturally about 5 minutes later. That we could have done at home, but it would have required ignoring evidence of danger to the baby, which no one was willing to do. Again, they're hippies, not idiots.
With Emrys, after we figured out gluten was the problem, Liberty's pregnancy was much better. We planned another home birth, expecting Liberty's better health to translate into a better delivery. Except it wasn't. It was worse. After many abnormally painful contractions, trouble getting the baby's head past her tailbone, and, again, the pulse inexplicably dropping too low during pushing, we made another emergency trip to the hospital. And again, she delivered a few minutes after being on the delivery table. I have no explanation. Psychological block? Maybe laying on her back, feet raised to stirrup height was the one position we never tried?
Either way, with both babies, our main goal of staying out of the hospital entirely was a big failure, however the prenatal care given by midwives was by far and away more personal and supportive than we would have received at an OB/Gyn. They were emotionally supportive, were able to take the same size, position, and heart rate measurements an ultrasound would have with non-invasive tools (tape measure, Leopold's maneuvers, and a stethoscope), and they didn't push an obedience agenda involving scare tactics (hemorrhage! placenta previa! hearing loss! retardation! get those percentages up! up up up!!!)
With Adelaide, we hit the jackpot in timing, arriving at the hospital at 4:15am on a Friday: Shift change at the start of the weekend. No one wanted to take ownership of our case, and we were discharged 4 hours later after pinky-swearing that we would get follow-up care with our family doctor. No midwife, doctor or nurse we have spoken to since has ever heard of such a thing.
With Emrys, we arrived near 8:25pm on Sunday, and while we didn't hit the timing jackpot, we scored big on the doctor on duty. If I understand correctly, he did his residency in Africa, and was comfortable with low-tech, emergency procedures where he was effectively an outsider - sort of the situation he was in with us. Liberty arrived with two midwives, already at the pushing stage, and a husband with 20 inch hair, and was unfazed by the spectacle. He calmly walked up while his staff ran around like chickens with their heads cut off setting up IVs, tool trays, and the machine that goes "Bing!", and said "alright, let's see what we have... yeah, looks like you're ready... give us a push... ok, there's the head, one more... yah, here we go..."
And here Liberty gave a good final push, and doc helped inch Emrys out with his fingers, took her in his hands and immediately placed her on Liberty's chest with a mighty yawp of "aaand TAKE HER!" No ambiguity there. Liberty, moments ago still a pain-wracked mess, was immediately Mom, the proper noun, at peace, love flowing over the baby in her arms, smiling as she pinked up. And that's another benefit of a doctor trained in the third world: He wasn't in a hurry to cut the umbilical.
Unfortunately, he didn't let the placenta deliver on its own, but after a few minutes pulled it out. From that point until we left the hospital the following evening, it was medical SOP, with us as the dangerous hippies not wanting to comply with L&D business as usual. We were coached on the dangers of not letting them take the baby from us and perform a battery of tests. Apparently little Emrys was as good as dead in our hands. The dire warning that sticks out most to me is "brain bleeds".
We said no, with as much calm as we could muster. On more than one occasion I gave a nervous nurse the "we're not trying to be combative, but we have post-birth care already planned with our midwives and family doctor" speech. For some reason, Liberty consented to a hearing test, despite no one in either of our families having bad hearing. I followed the nurse to the nursery, and waited while she taped little baby earphones onto Emrys, and some sort of sensor to her temple, and ran her test. Baby got fussy after a minute (as I understand, the hearing test isn't loud, and the temple sensor is measuring brainwave reactions to the sound, or something like that, and Emrys looked to just be upset at not being held), and the nurse, to my surprise, stopped the test, picked her up and rocked her, and sang to her. I stopped seeing them as monsters after that.
When that still didn't calm her down, the nurse called me into the nursery to assist. I stroked her head, let her suck on a knuckle, and the test finished up pretty quickly after that. She wrote down her numbers in her little chart, and then I rolled baby back to our room on their ridiculous cart. She's much safer in my arms, gets jostled less, doesn't have bright lights shining in her face, and feels more loved and connected to me. Anyway, I decided then that Emrys wasn't leaving the room again until we were all leaving the hospital, and I would err on the assumption that Liberty was getting too tired to put up a fight.
We gave a flat refusal to the next attempted intervention, the PKU test, which we explicitly said earlier would be done at our house by Audra, one of our midwives, which resulted in our biggest conflict with the hospital. They badgered us into a half-consent (well, she's already in the room with the stuff, I guess it doesn't matter who administers the test), which was met by "ok, I can do this, but we can't test for everything until 24 hours after birth. We'll also need to do another one later."
This was followed by a bizarre chain of escalation. "No," I said, "you won't be doing the test at all, then." Then she pulled out a form, saying "well, the only reason you're allowed to refuse is for religious reasons... now, I don't have to put down what your religion is, but you need to sign your refusal of..."
"We're not refusing the test, we plan on getting it done at home in the next couple days, which we told you already."
"We can't let you leave the hospital without doing the test."
"Go ahead and mark us down as leaving again medical advice. We've cooperated with this as much as we're going to now."
The next visitor was a social worker who wanted to get a read on us. She saw Liberty nursing the baby, all smiles, and me caring for Adelaide and Scout, who I had gone home to retrieve a few hours earlier (it was 9am on Monday morning by this point.) Seeing no reason for an emergency custody order, she let us be. Having children's services called to investigate when you have a home birth (or almost a home birth, in our case), is a genuine concern, but with Emrys and Adelaide both, we didn't come off as lunatics, and despite being at odds with standard hospital procedure, we didn't alarm anyone, or make them fear for baby's health. Home birth not being recommended by the medical community is bad enough for getting families in trouble with the state, but to make matters worse, there are people like this idiot whose ranting insanity about "dangerous injections" and "unlike most Amuricans, I know muh rights!!" make him sound like he's stocking up his arsenal to defend against the FBI.
I assure you, government official reading this, most of us think this guy is a nutter, and he does not, by any stretch of imagination, represent the rest of us, who just want a happy birth experience without medical intervention, at home, with people who love and support us. We'll go to the doctor for vaccines and checkups. Honest.
Last on the list of visitors, a lactation consultant came in with literature, saw Emrys clamped onto Liberty like a little barracuda, with our growing mound of diapers (I guess most newborns pee once in the first 24 hours; we were up to three at that point), and left us with good wishes, saying she didn't think we needed to schedule any followup.
After that we got Liberty's parents to come to the hospital, both to meet the new baby, and to run interference in case more people with forms and gadgets started showing up, and we made preparations to leave.
So that was just one day in the vortex of standard medicine. It could have been 40 weeks of anxiety, and needless (and in some cases harmful) tests, and, as Midwifery Today puts it, after each test... "women waiting for the results of tests try not to love the baby in case they have to part with it."
In the end, we left with a healthy baby, and no overt concerns from the hospital that we were anything but pains in the ass. Here's a few shots of Emrys, at home and in the hospital, with various family members cooing over her:
A final illustration of the differing viewpoints between natural parenting advocates and the medical community is this: At one point during the all-night defensive struggle to keep hospital staff from whisking the baby away to do God knows what to her, Liberty and I were both getting pretty thirsty. Mom was tired, so I picked up baby Emrys and toted her down to the nurse's station in my arms, to inquire where the snack room with the orange juice was. The nurses looked like they were going to have a heart attack. One of them finally stammered out "in the future, please use the cart to transport the baby; you can't just walk around with her in your arms."
Of course I can. I'm a dad. It's what we do.