Midwifery Is Not a Luxury
by Lydia Bertrand

[Editor's note: This article first appeared in Midwifery Today Issue 90, Summer 2009.]
Photo provided by the author

Midwifery Is Not a LuxuryI had a nice, ordinary homebirth with my first baby in southern Mississippi. A little over a year later I was pregnant again, and without a second thought I began planning for another homebirth. In the middle of the pregnancy my husband, Mike, was offered a better job in central Louisiana, and we were very excited to move. When we got to Louisiana my husband and I were disappointed to learn that not a single homebirth midwife practiced in our area.

If we couldn’t have a homebirth our options were limited. We could have the baby in the hospital or we could have an unassisted birth at home. Reluctantly, I sought out as progressive an obstetrician/gynecologist as I could find and started preparing for a hospital birth. I was scared of the hospitals near where I lived because of their shocking induction and cesarean rates. Louisiana has one of the highest cesarean rates in the nation, at over 35%.

I toured both hospitals near my home and was told that natural births are rare in both of them. One of the hospitals in my city still has a nursery where normal healthy newborns are taken immediately after birth and kept away from their mothers for at least four hours. If a mother wishes to breastfeed her baby during the first four hours after birth, a nurse at the hospital told me, she may be allowed to go to the nursery and breastfeed it there—if they aren’t too busy in the nursery. With hospital policies like this one, it’s not surprising that Louisiana has one of the lowest breastfeeding rates in the country.

I didn’t have an exact due date, but I knew I was due around the middle of July. On July 8 I started periodically having strange pains that felt like pressure down behind my pubic bone, near my cervix. The next afternoon I noticed that these pressure feelings had started to become more intense and were coming regularly every 10–11 minutes. I thought that this could be early labor, but it was very different than how I had perceived contractions felt during my first labor. I went to bed at about 10 pm and the contractions stopped, so I slept. By 6 am I knew my son would be getting up soon, so I got out of bed. The labor became serious as soon as I got up.

I got in the bathtub and tried to relax through the contractions. The pressure feelings down low were intense and close together. Relaxing and breathing with the contractions was hard and didn’t seem to help much. I couldn’t decide whether the reason I was having difficulty handling the contractions was because I was being a real wimp this time or because things were progressing rapidly. I threw on my nightgown and grabbed a quick snack while Mike started loading the car. The seven-mile car ride was very unpleasant. I moaned during contractions. Our son was in the back seat imitating the sounds I was making. It made me laugh.

When we got to the L&D unit at around 8:30 am, Mike had to leave me with our doula to take our son to the babysitter. After getting into a hospital gown I had my doula get my birth plan to give to the nurses. They wanted to get me on electronic fetal monitoring (EFM) first thing, but I told them that my obstetrician said it was okay to do intermittent fetal monitoring. The nurse said that we had to get a 20-minute test strip first, but after that nobody made any moves to actually put me on the EFM for a test strip. She just used a Doppler to listen to the baby occasionally.

When the nurse checked me I was 8 cm. This reassured me that I wasn’t just being a wimp! She called the nurse’s station for help and several other nurses came in to help get me admitted quickly. One of the nurses said to me, “This will be the first unmedicated birth I’ve seen!” I wasn’t encouraged by her comment. I was afraid to ask her how long she’d been working there, but I got the impression that she wasn’t new—natural births are just very uncommon in that hospital. About half an hour later my husband got back to the hospital, and I was very relieved to see him.

All the nurses left the room, so it was just me, Mike and our doula. I was feeling a lot of pressure and thought that maybe I had to pee, so I got up to use the bathroom. I tried to pee, but nothing happened. I was afraid to sit down on the toilet so I sort of stood/squatted over the toilet and hung onto my husband during a few contractions. Then I thought I’d better get back to the bed. The bed wasn’t far from the bathroom, but a contraction started before I could get there and I had to get down on my hands and knees. Halfway through this contraction I felt my body begin to push, and the sound I was making changed. We better get off this dirty hospital floor, I thought. I got into the bed and had another contraction on my hands and knees. During this contraction my water broke with a gush. The nurse came in and checked me again and said, “The baby is right there.” Then she left the room.

Before I knew what was happening my body was really pushing, and then I felt the ring of fire. I was so surprised that I reached down with my hand and felt the baby’s head go from crowning to halfway out. I wasn’t expecting the baby to be born right then, so I was sprawled in a lopsided semi-sitting position in the middle of the bed, with my body twisted to the right side where I was clinging to Mike’s waist and arm. The baby’s head was born almost completely involuntarily. The doula ran to the door and yelled “She’s crowning!” but none of the nurses in the hallway responded. Then a nurse who didn’t hear the doula’s yell came in to check on me and appeared quite surprised by what she saw. The baby’s head was already out and I was working on delivering the shoulders when a bunch of nurses raced into the room. Someone told me to stop pushing. I ignored them. I knew that the baby would just come out onto the bed. As the baby was being born someone grabbed my left arm and leg roughly and yanked my body into a straighter position. The baby went from not crowning yet to completely born in one contraction. The official birth time was listed as 9:30 am.

As soon as the baby was out, it started yelling. A nurse said, “It’s a girl,” and I was so excited I kept saying, “It’s a girl? It’s a girl?”

They clamped the cord and cut it right away, then handed her up to me. A few minutes later my obstetrician/gynecologist came in to find me naked and holding my baby girl. The nurses laughed when he came into the room, and he said that he wasn’t surprised that this had happened.

The nurses broke down the bed and the doctor pulled out my placenta. Because the baby had been born so fast with nobody prepared to help me slow down the delivery, I ended up with a second degree tear that needed some stitches. Getting stitches was scary to me because I hadn’t torn or needed stitches when my son was born, even though he had been several ounces larger.

The pediatric nurse was really anxious to get her hands on the baby, even though I was clear that I wanted at least an hour uninterrupted with her. Another woman across the hall was about to deliver, and the nurse wanted to finish what she needed to do with my baby so she would be available when the other baby was born. We put her off for about 45 minutes or so, but then I gave in and let her take my baby.

My daughter’s birth was nothing like a homebirth. The moment of birth was a whirlwind of chaotic activity, bright lights and noise. She was poked and prodded more than I wanted or thought was necessary. Many of the items on my brief birth plan were ignored, even though I had been assured during pregnancy that everything on my birth plan would be accommodated. And the hospital staff left me alone during transition even though I was a multip with a history of a short first labor. Even taking all of this into consideration, I’m thankful that my daughter and I are both healthy and that I escaped an unnecessary cesarean. I am also proud that I birthed my baby in a way that I felt preserved my dignity in a minimally supportive hospital environment.

Obstetrician/gynecologists are not experts in normal pregnancy and normal birth—midwives are. Midwifery should not be a luxury for middle and upper class women, for white women, for women who live in the North and on the west coast, and for women who live in urban centers. Every woman deserves access to quality maternity care, and that means access to midwives.

Lydia Bertrand lives in central Louisiana with her husband and their two children. She is a registered nurse and plans to become a midwife someday.


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