We fill the creche after all...

Whew. I never thought I'd be writing this post sitting here with a baby, but here we are. Little Philip Joseph decided to come early...after a bout of gastrointestinal flu that held up the gravy train just long enough to convince the little guy to give up on me, I guess.

Mary says that can happen sometimes. And 37 1/2 weeks was just long enough for her to feel comfortable with having the birth at home. Last week when I had a touch of early labor, she said we'd have to go to the hospital if it didn't stop. She said I should have bed rest for 2 days, but whaddayaknow? My husband got the stuff next, and it laid him up so bad (along with the kids), that I had to be up and about caring for everyone.

So when I started getting more contractions yesterday I just lay still and told Dean I couldn't get up. He tottered around and did his best taking care of the kids while I lay in bed staring at the clock. This went on from early morning until about 2. Finally, the contractions were intense enough so I had to brace myself on the nightstand and breathe through them (although they weren't coming along as regularly as I expected). I picked up the phone and called Mary.

"I'm going to have to get on the toilet," I explained. "I'm starting to have to moan through these contractions."

"How far apart are they?" she asked.

"It's still irregular," I said. "They'll be ten, seven, four, then ten minutes apart. They'll be weak one time and then really strong the next."

"OK, I'll be there in 30-40 minutes."

Funnily, the contractions were a lot slower if I sat on the toilet. As soon as I realized Mary was coming, I thought of a few things I had to bring out and organize, so I got up and started to move. Then--wham--I would have to brace myself every two minutes as wave over wave started to come over me. I looked around. No birth tub. We hadn't had time to get it yet, what with everyone being so sick. Where was I going to give birth to this baby? Laying in bed was not a good position, Mary had said. And there was no way I was going to use that medieval birthing stool again!

I prayed. I told Jesus that He would have to do this birth through me, because I really didn't feel up to it. I told Him I had confidence in His will. His timing was perfect. And He had put everything together for this birth to give me exactly what I needed, so I pushed fear aside. This wasn't a one-time thing, mind you. We are all weak, and I was afraid of the pain without the tub. I had to push the fear aside again and again. And as it turned out, that is the key to the whole process.

With every contraction I would feel the fear rise, and then I would push it away, push it down, down, down. Compression of breath. Sensation. I squeezed my rosary in my hand (trying to relax everything else), because the points of the crucifix digging into my palm distracted me from the relentless pressure going on around my cervix.

You do get tired. I think natural birth without a birthing tub is the most tiring thing there is, because you have to squeeze something or brace yourself or hang onto something to feel anchored enough to get through the contractions as they get stronger. With the tub you can float and moan, float and moan. Then you can hang onto the side and stretch out and the water supports you. Without it, gravity mostly works against you. And my midwife was fond of the squat position, because it opens up the pelvis. I was terrified of the squat position--how many times had I had to squat through that 36-hour labor with my first son? Too many times to count.

But I was stuck. No tub. Mary showed up, and my friend Rachel with the needed birth supplies and groceries. Dean perked up, I heard a lot of talking. Mary hauled all her cases upstairs. She dresses for a birth as if she were going to the theatre. She had on a pretty ruched burgundy top and gauchos and high-heeled boots. That was one of the things that had made Mary stand out, of the midwives I interviewed. She was the only one who didn't have a sort of "tired" aspect to her. She seemed to have some juice left. She had pert opinions, a perky haircut, and jazzy clothes. And 25 years of experience.

"Well..." she said with a little laugh. "I guess I'd better check you." Ugh. I hate this part. Even though she checks as little as possible, I always dread it. So I got up on the bed and opened my legs. "Four centimeters," she pronounced. "You're in active labor." Whew. At least this whole party wasn't for nothing. "Now there's no need to try and slow things down. You've got a healthy baby there, and you just need to get in your zone, your birth zone."

I wanted to laugh. I imagined birth happening as it might in an Olympic event, with all the athletes scattering before the starting shot in order to repeat their mantras, or visualize their success. I had successes to visualize. But I couldn't foresee how this birth was going to go. Where was I going to have this baby? "You might try squatting through some contractions," suggested Mary. "Your cervix is still posterior. It needs to come forward. I want you to visualize that cervix coming forward and opening up, just like a beautiful flower."

I got some pillows and kneeled beside the tub. By hugging the side of the tub and kneeling with my legs far apart, I got through some contractions. Here I had what I felt had to be a God-given insight. As I was squeezing my rosary and visualizing those huge, blooming roses they have over in Portland, I heard a thought: "The contractions are going to reach a peak...and they won't get any worse. The only thing that will happen is that the baby will move down. Nothing's going to happen to you. Just relax through it and let the baby move down." I squatted and visualized through more contractions. Soon, it seemed, a tingling sensation was gripping the side of my legs with each contraction and I could feel a slight burning sensation inside me, my cervix probably. I told Mary about it. "Good, good!" she cheered. "That's what we want to hear."

By then, all the midwives had shown up. Mary's assistant was her daughter, Emily, who had three children of her own. There was also a Japanese midwife, who had been hoping to observe a waterbirth. I was dimly aware of a constant flow of conversation in the background. "Oh, I never leave a multip who's at four centimeters. This one time..." "Do you think we should try and call her?" "I hope she gets here in time..." "Is this how they do it in Japan?" The house seemed full of people, but I was deaf to everything but my own struggle to stay on top of these contractions.

"I want you to try and not breathe so deeply," said Mary at one point. "You're hyperventilating." It was true. I was lightheaded, and felt tired. The last thing I needed was to pass out while trying to have this baby. There was a quick search around the house for a paper bag. I breathed into the bag between contractions, but still gulped air during the contraction. "Try to have more normal breaths during the contraction," Mary said. "I don't know..." I said, confusedly. "I don't know any other way to do this." I had always gotten through by gulping air and moaning for all I was worth. The compression of breath does wonders for pain.

But I was resolved to obey everything Mary said. It was like it was a condition. A deal between me and Jesus. I had been having a real struggle with obedience lately, even if I felt I had my reasons. But this was the deal, I felt. I would trust her and do everything she said. If she told me to breathe normally during the contractions, then there must be a way to do it. So I tried it. The contraction intensified, reached up as if it were going to engulf me, then I drew the breath out in a weird, moaning laugh: "huh-huh-huh-huh-huh-huh-huh" After a bit, it worked. I broke out in a sweat, but felt more alert.

But I was also feeling more intense pressure. I had to find a new position. My arms were getting tired--and without the tub I knew I was wasting energy just by holding myself up. I needed to focus on getting through the contractions while letting my lower body open up and relax. I asked for a certain mattress we had that folded up into the shape of a chair. The chair was almost worthless as something to sit on--but I draped myself over it and hugged the back, and it gave support to my belly and legs. By now the contractions were at their peak intensity. The tingling in my legs and hips was wild--my cervix, a ring of fire. But that mantra kept occupying my head: "It's not going to get any worse...let the baby move down." I could actually feel the baby's head doming and stretching and moving through the cervix.

Suddenly there was a knock at the door, and more voices. Mary came back up. "I need to check you again," she said. "The birth tub is here and it'll take 20 minutes to set up. We need to know where you are." I had no concept of time. Had I been doing this for 30 minutes? Or 3 hours? "Don't check me," I gasped. No fingers. No more pressure. Don't ask me to change position. "We have to know if we have time to set up the birth tub," she said. Her next few words faded out as I felt a sudden shift within me and an uncontrollable urge to push. "Too late," I gulped. "I'm pushing!" "OK then," she said. "Too late!" I heard her yell down the stairs. Later I learned that Elisa from Waterbirth International had volunteered to try and drive the tub up to us in time for my birth.

Then there was a whir of activity--pads laid on the floor, pans and cloths brought out, gloves being pulled on--and Mary said, "Where do you want to have this baby?" I looked around frantically. "You could go on your hands and knees," Mary suggested. I looked, dubiously, the next contraction imminent. No way I could hold myself up. "You could squat at the end of the bed," she said next. The bed. We had acquired a stately, humongous cannon-ball type wooden bedstead from my dad, which had a footboard with an enormous turned wooden bar across the end of it. "I could hang onto this," I said tentatively, not sure how. "Why don't you squat in front of it," she said. Ugh. Squatting. But the contraction was coming. Hurriedly I whipped off my bathrobe, squatted down in front of the footboard and hung my arms over that bar. Reaching down, I just felt my fingers lock in some grooves that were carved into the footboard when the contraction hit.

Then we were off to the races! Pushing is nothing like the more passive process of trying to relax and wait out the contraction. It's active, and immediate. You can finally do something. It took me a couple of contractions to remember which muscles to use, however. You only use these muscles when you're giving birth. It's like trying on the ice skates in the back of your closet. "You should stand up and rest between each contraction," came Mary's voice, seeming far away and irrelevant compared to the tsunami building up inside me. But she was right. Dean was there, now. He helped me up. Then down again, plunged into the roar of the waves, my moans rising to screams as I felt the roundness of the baby's head just inside the opening.

The screaming is primal. Its source isn't simply pain--it's partly the unstoppable impulse of nature (asking a woman to stop pushing at this stage is like spitting into a hurricane), partly the panic of realizing there's a baby in your vagina and the physics seem impossible, and partly the fact that all your muscles are rock-hard...and your throat is just along for the ride. "Pushing" is really an abysmal descriptor for what's going on.

Still, I pushed. Each time I pushed with all my strength, because I felt I was at the end of my strength--suspended on that bar between heaven and hell. Finally I felt fingers, Mary's gloved hand reaching in, feeling around for a moment, then pulling. Plish! There went the water sac. My water never seems to break until Mary breaks it right before the head crowns. But it meant we were almost done! Wearily, I stood up. Then down, gathering everything for the last two pushes, the head straining, almost out...will it go? Screams rising into shrieks as the head stretches, stretches, gloved fingers pulling at me one moment, pushing on me with a warm washcloth the next--then out! No time! The next thing, an impossibly large, bony pressure, a huge contraction, more shrieking (was that me?), more fingers pulling, another huge thing popping, then sliding bbblblllllllblldldddddthumpwhoosh...

And then crying! Little gray limbs flushed with pink, a red mouth, wiggling arms and legs. My baby.

"It's Philip Joseph!" someone (my husband) cried.

Immediately, I was calm. "Oh my baby," I said in a husky voice, sinking to the floor. I don't know what Mary did in the few seconds between when he came out and when she handed him to me, made sure he was breathing OK, I suppose--but as soon as he was in my arms, heaven began. [Oh, but there was blood everywhere! Just like with my first birth. Messy messy. With the birth pool, it was so clean, everything just washed off into the water.] I was helped up and into bed, the warm blanket and the tea were brought, my baby snuggled in my arms as I was able to finally lay down and relax my whole body, the terrible pressure gone.

After that, a kind of party atmosphere prevailed. I looked at the clock: ten minutes to six. "How long?" I asked. "From the time I got here and first checked you, it's been 2 hours nine minutes," said Mary. Emily and Akiko bustled about, gathering up the pads, pulling out towels, packing up unused supplies and unneeded equipment (Mary always came equipped with oxygen, Pitocin, IV, stitching-up supplies--"I never use it," she told me once). Pictures were taken, the kids came and went, the placenta came out, food was brought. Dean lay down with me and checked the baby out, but couldn't get too close for fear he was still sick. Then the poor guy went back to babysitting duty. I got to cut the cord this time, and settled Philip down to nurse. He latched on immediately, and everyone left me alone for a while.

***

A little later Mary came back to examine the baby. He was found to be hale and whole, all 19 1/2 inches of him. She checks the spine and the palate, the hips and testes, traces the fontanelles and pushes gently on his tummy. Emily took down notes as Mary dictated them. He was 7 lbs 4 oz, the same weight as his brother Carl was. "Well, he's not a preemie," she pronounced.

***

Later that night, lying next to Philip, I kept re-living the birth again and again. It's such a mind-blowing thing. You wonder how you ever did it. I looked over at the crucifix on the wall, and I thought No, I didn't do it. You did it, just like I asked. Then I realized that for women, the inevitability of childbirth had always been the corollary to the cross. It is how we share in Christ's suffering. And I know we share in his suffering in all kinds of ways (every suffering can be connected and offered with the sufferings of Christ)--but there's something about birth, the nature of it, and the risks women have always taken. For those moments when we are in labor--when we are pushing for our lives, so to speak--we hang between heaven and hell...between death and life. We hang onto our cross, and find ourselves with Christ.

I'm saying all this because I realize natural birth isn't an easy sell. These days when women cry for their epidurals as soon as they hit the hospital bed and the doctor stands by with his scalpel at the ready, why do birth the old-fashioned way? I've talked up the benefits of giving birth in a birthing tub, but can there possibly be any benefit in the trials I've described here? I leave that to your own judgment, dear reader. Granted, there are cost savings. There are certain benefits to health (fewer interventions=less risk of surgery, quicker recovery). But these mean nothing to a woman when the fear and uncertainty surrounding birth looms large in her mind.

Media depictions of birth don't help. Even a "natural" childbirth, when it happens in hospital, seems frightening--a last resort, when there's nothing they could "do." Birth is seen as scary, painful, uncertain, and dangerous. Women fear it. Men try to control it. People take drugs to prevent it. People kill their babies to prevent it.

It's just not true. Birth is difficult, yes. But it is also wonderful, transcendant, triumphant, and empowering by the realization of a few facts.

1. We are designed for this.

2. God is in control.

3. Babies are good.

I've written about this birth in such detail in order to show that it is a process, one that need not be fearful or unduly painful. It can be understood, it can be breathed through, talked through, and thought through. It can be experienced instead of avoided. It is something special about being a woman that, in all the furor over equal rights, has been misjudged and sold short for too long.

"It builds character," pronounced Mary, when I mentioned this blog article to her. "How are you ever going to get through anything difficult in life, any hardships, if all you've known is comfort? And labor pains...they only last one minute. You can do anything for one minute." She described how an epidural-free birth is better for the baby, helps the initial nursing/bonding period along and speeds recovery for the mom. We talked about the hormones that go cascading through the woman's body during labor and birth, amounting to natural pain relief.

I would also add, as a final note (whew!) that great joy only comes with some suffering. We can spend our lives grasping for pleasure and avoiding pain, like the animals...or we can appreciate the facts of our unique nature as human beings and as women. The ability to carry life and to give birth are great gifts...and should be treated as such. In the Catholic Church, women are far from being treated as second-class citizens, as some believe. The Church has always recognized woman's unique role as life-giver and nurturer. Humankind cannot survive without it. This role, moreover, appropriately mirrors the role of the Church. Souls are given new life through baptism, are nurtured and sustained by the sacraments, are "grafted in" to the Body of Christ and given an entirely new life. This is why the Church is often referred to as "the Bride of Christ." What an honor to be able to live this reality in our bodies!

"You don't need to fill the creche, honey"

Just a quick note to let anybody know that blogging will be thin for the next month. I mean, if I get an energy spurt and a piece of note paper I might go on a real tear (my next target is the banking industry), but the fact is I've got a sizeable wriggling watermelon in my abdomen that pretty much dictates what I get to do with my day. Basically, when the kids are down, I sit. I sit and knit, or sit and talk on the phone and knit, or sit in front of the Internet (if only I could knit).

My midwife says I need to take walks. I try to stifle my incredulous laughter. Even after walking the short distance to the mailbox, this baby feels like it's about to drop out. The due date--Jan 6--approaches. But it feels too far away.

Preparing for a third baby is a lot different than the first one. Where to put the baby is a principal concern. This child will be lodging in our (pretty big) walk-in closet for a time, until I can get the boys to share a room (Tom doesn't always sleep for his nap, while Carl does). I cleared off the changing table, weeded out some ragged diapers, and rounded up enough plastic pants to last me several months (thank you, Rachel!). The dresser had to be cleared off, the birth kit refurbished. I need to stop by medical supply and pick up a few things. Then the birth tub will be paid for and picked up.

This is going to be a home birth.

While this idea has become comfortable for me, it scares a lot of people. So I don't mean to advocate it unconditionally. My experience with Tom in the hospital has given me a lot of faith in conventional medical care, and were I to need their services, I wouldn't get a spike in my blood pressure about it. However, the road less traveled in birth--at least by most Americans--deserves a look. It offers advantages that some women might prefer:

1. You're in control.

2. You can avoid unnecessary medical intervention.

3. You can avoid unnecessary and inflated expenses.

I don't know how it happened, but there's a subtle conditioning at play that says, you're not safe giving birth anywhere except in a hospital bed with a doctor catching the baby and the OR and neonatal unit located just down the hall. When I was about three months from giving birth to my first, somebody asked me whether I'd ever considered home birth, and I was stunned. "You mean, people still do that?" was my reaction. But then I went home and Googled "home birth" and my education began.

Not only do a substantial number of moms give birth at home, but they enjoy lower mortality rates and much lower Cesarean section rates than the rest of the population. Outside the US, where midwives and birth centers (not hospitals) are the norm, outcomes for moms and babies are even better (we're talking industrialized nations here, not the third world).

Not only do home birth moms enjoy better outcomes, they reap incredible savings. While the average vaginal birth in hospital can cost upwards of $8-$10,000 (and you meet parents of toddlers who are still "paying on the birth") a home birth can be as cheap as free. Not that midwives don't request compensation--fees vary considerably--but our first two births were covered completely by insurance.

How's that again?

The typical medical codes and charges submitted by our midwife were reimbursed as if we had given birth in a hospital--which we hadn't--so our midwife's very reasonable fee was fully covered from what they reimbursed us, and she returned to us all that we had paid her on deposit. It doesn't always work out so well. Now we are on a cheap insurance plan with a high deductible. But here again--thank the Lord for home birth! Because the premiums on our current insurance are super-low, we can afford to pay the midwife out-of-pocket and not pay any more than what the premiums under the old plan would have been.

Of course, you must do your homework if you plan to pursue a home birth. I interviewed four midwives with a two-page questionnaire before I found my midwife, the one that seemed more friend than anything and inspired my confidence. I am not suggesting that any mom take risks with her health or her baby. High-risk pregnancies are why we have hospitals. But I do believe that many risks are exaggerated, and pregnancies which would have turned out just fine if left alone are turned into medically-managed "conditions" that scare the crap out of the parents and cost them thousands. Even if I had a so-called "high risk" pregnancy, I think I would consult an experienced midwife before I sought conventional medical help. I've spoken to midwives who've caught 3,000 kids apiece and believe me, they've seen it all.

But how do you get through a labor without pain management? Hmmm. While I am not the be-all, end-all expert on pain (and I hope never to be!), I can offer a few thoughts from my own experience. After having read Dr. Dick-Read's Childbirth Without Fear and a LaMaze manual, I thought I was prepared for the birth of my first. "I've been through boot camp," I thought. "This'll be no sweat." Whoa, was I wrong. Not only was the labor really long (36 hours by my count--Mary's was somewhat less), but the pushing was very hard and I was exhausted by the time the kid came out, bloody wet mess everywhere--about as medieval as you can get. Sounds terrible, right?

But here's the silver lining. Despite the endurance test and mess of that first birth, I may have avoided a host of medical interventions that could have left me with a Cesarean scar and an admonishment about future births. I would have left the hospital with a baby, for sure, but also with a lot of trauma and trepidation about the birth process (not to mention a huge bill). This experience is all-too-common for first time moms, unfortunately. No wonder they swear they'll stop at two.

The funny thing is that after that birth, I felt empowered. I was thrilled with my baby, amazed at my own accomplishment, and (I confess) a bit proud for having done it "my way" (my midwife thinks I was nuts for not using a birth tub). I recovered quickly and was so thrilled about being a mom that we voluntarily got pregnant again nine months later! I just don't think I would have felt the same way about it had the whole thing gone down in a hospital.

But we were talking about pain...I think contractions are more painful when the mom is tense, or afraid. It's not like breaking an arm. There is sensation, pressure...you breathe through it as long as you can. Then you start moaning. Your brain squirms around in your head trying to make sense of everything, and distractions become incredibly irritating. Then you can't think in words at all. Time sort of stops. It's just you and that massive force building up inside you. You moan louder. A weak, downward pushing seems to help. For me, sitting on the toilet seemed to help. Most women feel pain because they tighten up in fear, in fear that the contractions will just get stronger and stronger until they can't handle them anymore. But Dr. Dick-Read was right: they reach a peak of strength and just kind of stay there awhile. But if you can work with them up to that point, slowly, you can manage them (not having nurses running in and out of the room sticking their hands in your vagina is also nice).

Hot water helps.

The second time we used a birthing tub. This is simply a portable hot tub that was set up in the guest room after the labor started. We were caught a bit off guard by Thomas, since I hadn't had a period and we didn't have a sure way to set the due date. But everything came together quickly and the labor was obviously going to be much shorter. Instead of 36 hours this time, the whole thing was done in about 6.

You float in the warm water, and breathe. The midwife shouts into your tin ear, "The baby is moving down! Everything's normal!" You feel the urge to panic a little bit, then someone suggests you change position, grunt a little more. Surprisingly, it works. You can feel that baby moving down. But the contractions are oh-so-powerful. Something else is taking over your body. You have to give in to it. You have to give yourself over to God. This, I think, is the secret to natural childbirth. You gotta have faith in the process, that it is a process that was created by God, and it's natural and normal. Just a few more pushes and--amazingly, incredibly, with a thubbity-bubbity-whoosh--deliverance. Then I brought the baby--still underwater, and whisper-soft--up into my arms, where he immediately drew his first breath, turned pink, and opened his eyes for the first time. Everyone was laughing and crying and we were singing hymns.

As wonderful as my births were, I have to recommend home birth for the aftermath, as well. Instead of a cold tile hospital room with paper sheets, I was wrapped in a warm blanket fresh from the dryer, tucked into my own bed, and brought a cup of strong, sweet tea while the midwife examined the baby and my husband cut the cord. The baby was placed in my arms, where he was urged to nurse immediately. The placenta came out when it was ready, and I was packed into a diaper, on top of a waterproof pad. After I urinated (this part is important to make sure there's no damage to the bladder or urethra), the midwife left for the night with a promise to be back tomorrow. Then...sleep...oh wonderful sleep, that terrible pressure gone, gazing on the face of my new little one, who was allowed to sleep as well (no force-feeding all night).

So there's my apologetic on home birth. Is it for everybody? Probably not. If a mom (or her husband, for that matter) are simply too nervous, then don't bother with it. It's something you have to look into and decide about for yourselves. And I don't advise a woman to go against her husband's feelings on it. Birth is a really touchy-feely thing and everybody needs to be on the same wavelength in order to support the mom. But it can be a true liberation, if learned about and pursued with a proper perspective--in Dr. Dick-Read's words: "a monument of joy."