I’m a big fan of modern medicine. I have found it to be efficacious in everything from the treatment of allergies to the management of depression. I have generally had doctors that I like and trust—people who have seemed to regard me as an intelligent individual capable of making sound choices—and I have, for the most part, felt like an active participant in my healthcare.
While I do tend to prefer free-range eggs, organic produce, and dairy products that have not been enhanced with antibiotics and rBGH, my faith in the “natural” is neither pure nor total. There are a lot of reasons for this, some of them better than others. The first is conceptual, and it’s the reason for my use of quotation marks above: I went to a progressive, liberal arts college in the early 90s; postmodernism and deconstruction were much in vogue at the time; and I have difficulty believing in concepts like “natural”. Indeed, I tend to distrust any claims that rely upon an essential, unchanging, non-contingent understanding of “nature”.
I also find any suggestion that the natural—I’m dropping the scare quotes now, but they should be regarded as implied henceforth—is unambiguously and fundamentally good. Malaria, tuberculosis, typhoid fever: These are natural phenomena. One might also argue that high infant mortality rates and death in childbirth are also natural, given their prevalence in historical periods and geographical locations without modern obstetrics. I think it’s ridiculous to rant against the perceived failures of allopathic medicine without acknowledging its successes.
Finally, I have no tolerance for sanctimony. Thus, I often have a gut-level aversion to much natural-childbirth advocacy. And it’s not just the judgmental tone that bugs me: I have often felt that the natural-childbirth cohorts have clung to a combative, outsider status that no longer makes much sense. For example, when I was consulting my copy of Our Bodies, Ourselves—not the latest edition, but the 1998 edition—I discovered that the first-person anecdotes of obstetric malfeasance were the same as those in the edition of Our Bodies, Ourselves I used to read at the Stow Public Library when I was a kid, an edition from the 70s. I feel that it is disingenuous, at the very least, to submit stories that are 30 years old as representative of contemporary medical practice, and I have often felt, when I have encountered other natural-childbirth arguments, that the patriarchal medical establishment decried in these sources is a straw man, a ghost of medicines past. It has seemed to me that many women’s health advocates would rather identify as embattled revolutionaries than take justified credit for changing the attitudes and practices of doctors, nurses, and expectant mothers.
This is not to say that I have utterly rejected the notion of natural childbirth. Throughout my pregnancy, I consulted books by Henci Goer and Sheila Kitzinger and websites like Birthing Naturally. I used the information I found in these resources as a complement to the information I got from my doctor. For the most part, I think I achieved a good balance between doing what was least invasive and doing what was best for me and my baby. My birth plan, such as it was, was flexible: I wanted to try laboring without pain medication, but I was prepared to get an epidural if I felt overwhelmed. I wanted to deliver my baby vaginally, but I was prepared to have a c-section. I chose not to induce early just because I had a big baby, but I decided to try induction when it was 9 days past my baby’s due date and I still hadn’t given birth.
While my decisions were informed by experts like Kitzinger and Goer, most of them were made in concert with a doctor who I liked and trusted, a doctor who always presented me and my husband with the pros and cons—often accompanied by statistics and data gleaned from recent studies—of any procedure he offered and who never pressured us to do anything. I always felt like my health and the health of my baby were my doctor’s highest priority; certainly, I never felt like his primary goal was making his job easier. This relationship with my doctor, combined with my understanding of the way his hospital conducts childbirth, was instrumental in convincing me that many advocates of natural childbirth are fighting battles they’ve already won.
Unfortunately, my doctor was on vacation when my baby was born, and I spent the last week of my pregnancy in the care of one of his colleagues. It’s an understatement to say that my husband and I did not have the same rapport with this new doctor, and my experience with him has changed my attitude towards the continuing need for childbirth activism.
I do not believe that this doctor was a bad doctor—he did, after all, successfully deliver my sound, healthy, beautiful baby girl. I don’t feel that he’s callous or irresponsible, but my husband and I both had a very hard time communicating with him. Rather than present us with choices, he tended to tell us what he was planning to do. He would answer questions, and he was open to alternative suggestions, but Ted and I had to work hard to understand our options and express our wishes. For example, when we were several days past the baby’s due date and I was ready to try cervidil, this doctor just assumed that we would follow the cervidil with pitocin and, if necessary, amniotomy. It was only after Ted asked about it that the doctor said, sure, if we wanted to give cervidil a few days to work and try a couple of doses we could, rather than going straight for the pitocin. If Ted and I hadn’t done our homework, we wouldn’t have known to ask.
Ultimately, the cervidil had very little effect and I did start pitocin, in part because I was beginning to be worried about the baby’s safety—I was mostly concerned that my placenta would give out—and in part because waiting was wearing me out emotionally and physically. I have to admit that I was disappointed to be resorting to pitocin, and that it was, indeed, dispiriting to be anchored to an IV drip and a monitor. Still, I didn’t quite feel like a victim of the “medicalization” of childbirth. I felt like I had made the best choice I could.
Labor did not progress quickly—I had contractions, but not especially powerful ones, and my cervix proved very reluctant to dilate—but, eventually, my water broke. This, I felt, was a positive development, a sign that my body did, in fact, know what it was doing. The doctor, however, was less impressed, and he said that he might, at some future time, give my amniotic sack another poke in the hopes of expediting my labor, since the initial flow was pretty light.
I was not at all enthusiastic about this idea, but I was losing the will to fight. I should have talked to Ted about this. He knew that I was wearing down and he had already told me that he would talk to the doctor if I lacked the wherewithal to do it. But I didn’t. I decided to simply ignore the doctor’s suggestion in the hope that he would, I don’t know, forget about it.
The doctor was conducting a vaginal exam, checking my cervix, when he performed the amniotomy. I didn’t even know he was doing it—he didn’t tell me he was going to do it; he just did it—until I felt the rush of warm water. It was a terrible, terrible feeling. It just felt wrong, and at that point I felt like I had ceased to be an active participant in the birth of my child. It was one of the worst moments of my life, but not nearly as bad was the time that followed.
A few minutes after the amniotomy, the baby’s heart rate fell dramatically. The nurse called the doctor, and, within seconds, the room was filled with people. It appeared that there was no longer enough amniotic fluid in my uterus for the baby to float, and that she was compressing the umbilical cord. At this point, my participation in my child’s birth basically consisted of doing as I was told. I laid down on my left side. I laid down on my right side. I got on all fours. Ted held my hand when he could and touched my shoulder when he couldn’t and told me I was doing a good job and that everything would be all right. I have never been so scared.
After a few minutes that seemed like days, the doctor explained that they were trying to get fluid back into my uterus, and, if that didn’t work, they would perform a c-section. I’m not a doctor, and nowhere in my pregnancy research did I encounter this scenario (my research into amniotomy was not especially thorough), but this was, truly, the stupidest fucking thing I had ever heard. There was no way, at this point, that I was going to have a beautiful, natural, earth-goddessy childbirth experience. What was the point of prolonging labor, of using artificial and, it seemed to me, precarious means to preserve a vaginal delivery that wasn’t going all that well to begin with?
I got my voice back. I asked if we could just go straight to the c-section immediately. That’s what we did.
I struggle not to blame the emergency c-section on the amniotomy, nor on the doctor who performed it. It’s not because I have any particular interest in defending the practice or the physician; it’s just that I’m trying to be fair and rational. There was no control group against which to compare my experience, and there’s no telling how my labor might have progressed without the doctor giving my bag of waters a jab. Certainly, the experience has not turned me off medicine. Given the size of my baby and her apparent reluctance to be born, it was always likely that I was going to have a c-section—it’s quite possible that a c-section was the only way for my baby to be born safely, and there’s no more “medicalized” birth than a cesarean.
My experience did force me to reconsider my view of natural-childbirth advocacy, though. Even at this late date, it’s possible to have an obstetrician whose manner—if not his methods—is not qualitatively different from that of doctors practicing 10 or 20 or even 30 years ago. I still believe that it’s counterproductive to demonize medicine in general (especially since my encounters with midwifery during my first pregnancy were almost as bad as my recent experience with the not-so-great doctor, but that’s a whole other story), but, clearly, there’s still a place for activism and consciousness-raising. The best thing anyone can do for expectant mothers, I believe, is to remind them that their feelings and opinions matter, and that they need to work with a practitioner who believes that, too, and the best thing an expectant mother can do for herself and her baby is to find a practitioner she trusts and respects.
My experience also reinforced my belief—one I maintained throughout my pregnancy—that childbirth wasn’t about me. It wasn’t about my politics or my principles. It wasn’t about fulfilling my vision of a beautiful birth. It wasn’t about providing me with a positive experience. Childbirth was about safely delivering a healthy baby. Focusing on this healthy baby is what made it possible for me to continue functioning when my baby’s heart rate plummeted. It got me through the c-section, which, although it was clearly the best and safest option at the time, was disorienting and alienating. It kept me from losing it during the purgatory of recovery, when I was separated from my baby and my husband and parked in a curtained alcove with two thirds of my body paralyzed and my whole body shuddering with cold. And, holding my healthy baby now, I know that it was all worth it, even if I wish that things had gone a little differently.