What the hell happened?
Not exactly the question one might expect from a postpartum nurse, it echoed in my mind incessantly after birth. Induction, intervention, ultimately cesarean were nothing new to me…until I was the one atop an operating room table birthing my firstborn through an incision in my uterus.
Over three decades (1920-1940) and in rural working-class America, my grandmother birthed ten of her eleven children at home with the attending of lay midwives—knowledgeable, nurturing, “wise women” of the community—who respected my grandmother’s right to choose how she would experience birth, even though she may not have had a choice in where she birthed.
My mother, the last of those eleven, was the first to be born in a hospital only because my grandparents came into health insurance during that time. A time when hospital birth was phasing out home birth. A time when home birth was uninsurable across-the-board.
With the exception of my mother’s birth and although it may not have seemed so, given inadequate access to health care with neither insurance nor the means to afford it, I cannot help but think that my grandmother had more rights in birth nearly a hundred years ago than we do in the 21st century.
When, in 2013, it was my knee-jerk reaction to have a midwife-assisted birth—be it at home, a birthing center or a hospital—my health insurance did not honor that right. The only supported/covered birth available to me via my primary insurance was hospital birth in the hospital system in which I worked. Basically, the hospital was my insurance company. A hospital that had yet to integrate midwifery.
When I verbalized my intent, telling my ob-gyn “I’d like to try and birth naturally,” her response was “Yeah. Sure. We can give it a try. Just know, there’s no need to be a hero.” Another basic right went unacknowledged, dismissed.
When, at 39-weeks and a day, my water trickled in the absence of active labor and my ob-gyn immediately pushed for induction, I again verbalized my desire to stay home and see how things progressed. By all accounts, I was healthy, low-risk, even tested negative for group B strep.
I had, however, succumbed to weekly cervical checks from 36-weeks on with neither knowledge nor explanation that evidence suggests they are of no benefit and can actually increase the risk of PROM. In fact, it wasn’t quite an hour after a duplicate 39-week cervical check—a cervical check that notably hurt when others had not—that PROM ensued.
Active labor may not have been imminent, but something was happening. I was experiencing intermittent low back squeezes that wrapped around my lower abdomen—uterus. I lost my mucus plug in the wee hours of that morning—the rationale for the duplicate 39-week cervical check. Labor was slowly initiating. I wanted to rest while I could, give my body and natural labor a chance. It was my right to do so, wasn’t it?
After another earnest call from my ob-gyn’s office with looming fear of “risk of infection” due to PROM, I ambivalently gave up that right and conceded to admitting myself into the L&D wing of the hospital where I could be monitored and ultimately induced.
When, after 12 hours, Cervidil was not effective, Pitocin followed. Cue the epidural, having been up all night, the intensity of intervened contractions too much to bear without proper preparation or resources. Not even a birthing tub, which I desperately wanted, was provided or allowed to be brought in. On the clock and a sum of thirty-six hours later, amid the ubiquitous diagnosis of “failure to progress,” the cascade of interventions culminated with a cesarean birth. A MEDICALLY UNNECESSARY CESAREAN, in my case.
I consented to it all without realizing I was consenting away my rights to a natural birth I was naturally entitled to. Against instinct—intuition—each and every time I thought and/or said “this isn’t necessary,” I eventually consented to procedure.
I did it out of FEAR. Fear that, if I did not consent, then I was not making the best/safest choice for my unborn child. And I did it as an RN who on several occasions had advocated for patients who were uncomfortable speaking up for themselves. After all, I had once learned and believed that the most important thing we can do as health care providers is LISTEN.
Multiple unnecessary postpartum complications—surgically-induced hematoma, incision dehiscence, tunneling wound, secondary infections due to overprescribed antibiotics—one miscarriage, oodles of birth preparation books and shared and divergent birth stories, and three years later…I listened.
I recognized and honored my instinct. I recognized and honored my birthing body. I recognized and honored my right to birth our second born at home and in the bed he was made.
A midwife listened, too. The same midwife who previously and safely saw me through miscarriage. When I verbalized my intent, telling my midwife “I’d like to proceed through this miscarriage naturally,” her response was “Your body knows how to do this.” A midwife essentially acknowledged, empowered, and assisted my rights in loss and in birth.
Fear was present, sure. Can I do this? Will my baby be okay? If I or—God forbid—my child requires true emergency medical attention, will the closest hospital at five minutes away be close enough? I took solace in the fact that there is no such thing as “risk-free” birth in any setting.
I took solace in a favorite Nelson Mandela quote:
“May your choices reflect your hopes, not your fears.”
This birth was not shepherded by fear. I was not pushed into it; I did not consent out of it. My birth attitude and ideology—underpinned by evidence not by procedure, and respected by my caregiver—fostered this birth.
Anchored in trust and surrender in my birthing body, I assumed whatever risk there was to be had. I assumed my right to do so.
Those choices, desires, visions, basic rights provided me with a pregnancy, birth, and postpartum experience beyond anything I could have ever imagined. Easy? Effortless? The journey was neither. However, fundamentally prepared for and labored for, it was transformative, unforgettable, the truest adventure of a lifetime.
Safely and sagaciously assisted by a competent LM/CPM, my HBAC was unequivocally healthier and more efficacious than my hospital birth.
It was not a medical event. Much like the community, the culture in which my grandmother experienced her births, it was another of life’s natural physiological processes…a rite of passage.
A rite that connects me to her. A rite that restored to our lineage—after 70 years, the time between her last home birth and my first home birth—the privilege to birth at home.
Do not mistake my passion for judgment. My home birth is no more superior than another’s hospital birth. We all want nothing more than for each and every woman to birth safely in her own vision, be that with or without pain-relieving medication, vaginally, cesarean, in a hospital, in a birthing center, at home, unassisted, in a tub, on a bed, or on the moon!
Coming off the heels of Cesarean Awareness Month (April), and in this month of May that celebrates International Day of the Midwife (May 5th) and Mother’s Day (May 12th), it simply seems paramount to reflect on women’s rights—human rights—in birth.
Without awareness of, reflection upon, a conscious mulling over of these rights, birth became something that happened to me. It wasn’t until I approached birth as a right that it became a rite, an experience, more than a medical event.
Even if medical care is part of a birth experience, birth is a profound rite of passage and should be treated as such.
How different our birth experiences would be if they were not herded by insurance, liability, money, the clock, and the systematic approach, but by practices that safely nurture the human right to choose the circumstances of birth.
It is too easy to forget that we do not labor for them; we labor together.
One of the most heart-stopping statements I came across in my journey of assuming my rights in pregnancy and birth came from medical and cultural anthropologist Robbie Davis-Floyd’s book Birth as an American Rite of Passage:
“I have long believed and have stated many times in my oral presentations that the most important determinants of the outcome of a woman’s birth are the attitudes and ideology of her primary caregiver(s).”
Does your caregiver genuinely listen to, honor, and empower your birth attitudes and ideology? Does your caregiver safely nurture your right to choose the circumstances of your birth? The question is not are you right for your caregiver: Is your caregiver right for you?
by Brooklyn James, author of the birth memoir
Born in the Bed You Were Made: One Family’s Journey from Cesarean to Home Birth