Doors

This is a post about birth, but it begins with a bit of travelogue.

We went to Rome in 2000.  I had hoped to get to Rome in 2000 from the minute I first heard about the Jubilee, and I was elated when we actually bought the tickets.  It was not an easy trip: the baby was teething and the 3yo did not -- just imagine! -- appreciate the walking tour of Bernini sculpture.  But it was wonderful regardless. 

When I am an old woman I will remember our day at St. Peter's.  Of course I will remember the Pietà and the great baldacchino.  I will also always remember walking through the holy door, flung wide in celebration.

A door is only a door:  its purpose is merely to get you from one place to another.  And a birth is just a birth; it gets you from pregnancy to motherhood.  But we seem to think, at this time and in this country, that births are meant to be more like the gates to the Emerald City than like Consorti's stunning door to St. Peter's. Absolutely, safety comes first.  If the lintel crashes on your head when you open a door, it doesn't matter that it was a work of art.  But I am saddened by the idea that beauty and welcome and celebration are just frills.  I am saddened that so many women in this country are seeing these doors, and thinking they have no other options.

This post has been brewing in my head since Pete's birth in April. I wanted to write it when I saw the NYT article on midwifery (the one that featured Moxie's midwife). Hospitals are cutting midwifery services, it reported.  They get reimbursed at higher rates when OBs attend births, so they want OBs attending births.  The question of what's best for most women -- a birth attendant whose training emphasizes finding and treating pathology, or a birth attendant who believes that childbirth is a robust process -- is taking a back seat to the question of what's most profitable. 

I wanted to write this post when Katie Allison Granju blogged about the recent study on home birth safety that found, just like every other good study on home birth safety, that planned, attended home birth is no less safe than hospital birth for low-risk women.  I got into an argument in her comments section (and now I can't find that post in her archives) with a woman who told me I should climb a mountain and say "om" if I wanted a sacred and empowering experience.  Her common sense, she said, told her that hospitals had to be safer than homes, the data notwithstanding.  (I didn't tell her that she should sell her car and take the bus if she was that worried about safety, since in the big picture attended childbirth, regardless of location, is safer for both parties than car travel.)

I wanted to write this post when BrooklynGirl posted about policies at the hospital where she will deliver:  no food or drink for laboring women, for instance.  She said, "Going to a high-intervention hospital and expecting low-intervention treatment seems a little like going to a French restaurant and ordering Eggplant Parmigiana."

But there's more at stake when we talk about birth choices than there is when we talk about ratatouille vs. caponata.  I remember hearing Ina May Gaskin and Naomi Wolf discuss their books on WFUV a couple of years ago.  Naomi Wolf was busy haranguing the medical establishment; Ina May Gaskin said, in her calm and matter-of-fact way, "In my community, women believe that their bodies are capable of bearing children.  And mostly, they are right." I do not mean for this post to sound like Naomi Wolf, berating the hospital staff who want birth to be safe.  I am only wishing that more American women could have the confidence that Ina May's neighbors do.  I am wishing for widespread recognition that safety in childbirth need not exclude beauty and tranquility.

This is supposed to be the era of evidence-based medicine, and yet circular thinking abounds.  We don't let women eat during labor because they might need emergency C-sections.  When they need emergency C-sections, we say, "Oh, good thing she was fasting."  It is not rocket science to see that fasting is part of the problem, not part of the solution.  Why isn't there more outrage in the face of a 27% C-section rate?  What if 27% of American women were told they needed surgical assistance to walk, or swallow, or breathe?  Childbirth is different in important ways, of course, and it certainly does have its dangers.  But it is a well-designed process essential to the survival of the species.  It is normal.  A 27% C-section rate simply doesn't make sense.

My frustration with irrational thinking is only one part of why I wanted to finish this post, though.  My home births verged on sacramental -- they were put-out-your-hand-and-touch-the-face-of-God experiences.  I wrote after Pete's birth about being fully engaged -- mind, body, and soul -- in cooperating with a miracle.  It is a fine thing to be alive, I wanted to say after my two home births, a fine thing to have a woman's body.  I wish there were less fear about birth in this country.

Home birth is not for everybody; unmedicated birth is not for everybody (though I want to say loud and clear, in case anyone reading this has suffered through a miserable hospital birth, or has pleaded for an epidural at 4cm after planning to go natural, that my two home births were far, far less painful than my two hospital births). High-tech obstetric care saves lives, and of course I'm grateful that it's there.  What's missing is the recognition that low-tech care for low-risk women, particularly home birth, need not be a choice made on the fringes.  Birth can be both safe and sacred. 

My posts about Pete's birth are absurdly long, but that's because I wanted to hold fast to the details.  It was such a happy day that I didn't want the memories to slip away from me.  Why is it commonplace for women to say, "I couldn't get pregnant again until I had forgotten just how horrific the birth was"?  To my ear that says something telling about mainstream birth practices.

I read a snarky piece on Naomi Wolf's Misconceptions -- a book that does invite some snarking -- in which the reviewer complained that Wolf talked about her births and not her children's births.  I think that complaint speaks volumes about the American view of birth:  we forget, too often, that parturition brings forth a mother as well as a baby.  I will call them my births without apology.  My children will never remember them; I will never forget.

Of course birth isn't just about me:  it is more than anything a call to selflessness.  And yet at the same time it is about me.  One of the hardest things about pregnancy and motherhood is the loss of control, the moments in which you realize you are not in charge.  (I posted about this very thing, hugely pregnant and sobbing, in April.)  In their efforts to improve outcomes, to give better answers to the scary "what if?" questions all pregnant women ask, many hospitals wrest away more of their autonomy [edited to acknowledge that many women willingly cede it].  The irony, the crashing, underappreciated irony, is that for the average low-risk woman such care offers no improvement in safety over lower-tech alternatives.

I believe that for many women home birth can restore a welcome, appropriate feeling of autonomy.  I believe, too, that a joyous birth experience lays an important foundation for new mothers.  With home birth it's your living room, your fridge, your applesauce and your choice to eat it.  It's your labor and you can climb in your own tub when it feels right to you.  It's your pain:  you own it, you ride it. It's your body, doing something astounding; it's your baby, whom you have yearned to meet.  It's your birth -- your very own everyday miracle.