Giving Birth in America

by Ashley Weeks Cart

The U.S. is the only developed nation in the world whose maternal mortality rate has been on the rise since 1990. This is B-A-N-A-N-A-S. And truly unacceptable (slash unnecessary).

Semi-tangential – bear with me: Addison’s first Thanksgiving, while we were still living in Los Angeles, we spent the day after the holiday making turkey BLTs with James’ extended family who all live in the LA area. It was during this post-Thanksgiving fete that I met James’ cousin who works for Every Mother Counts, a non-profit whose mission it is to make pregnancy and childbirth safe to every mother, everywhere. She had just finished filming the documentary, No Woman, No Cry, addressing global maternal health and the shocking reality that nearly 1,000 women die each day from complications related to pregnancy and childbirth, nearly all of which are preventable.

While acknowledging that maternity in many developing nations needs more medical support and training to help prevent these maternal complications, I relayed my concern that we were “overdoing it” here in the US and over-medicalizing and controlling a process for which only 15% of women really needed that extra intervention and medicalization. I began discussing my own birth experience just four months prior at a fancy pants hospital in Beverly Hills, and my frustrations and concerns with how I was treated by the nurses and medical staff during the experience. Clancy nodded along knowingly. We talked about the wonder and significance of doulas to help cut down on this over-intervention (you can revisit my dear friend’s very data-driven analysis in support of doula support for more information on that front) and how outrageous it was that doulas were not covered by insurance. Every woman should have access to a doula for her birth experience. Pregnancy and childbirth should be treated as a normal biological process by health care providers. For instance, the mission of the midwives with whom I’ve consulted for my subsequent pregnancies is, “We honor the normalcy of women’s lifecycle events.  We believe in watchful waiting and non-intervention in normal processes. We will utilize appropriate interventions and technology for current or potential health problems.” Yes, yes, yes.

Why is maternal mortality on the rise in the U.S.? Because instead of taking a woman-centered, normalcy-based approach to pregnancy and childbirth, we face medical-legal, hospital and insurance barriers that are out of sync with women’s needs, like lack of support for vaginal births after C-sections (or VBACs) and mandatory C-sections for conditions that can often be managed safely by vaginal birth. It’s also important to acknowledge the racial, cultural and systemic impediments that leave women of color and low-income women with lower quality care or no care at all in this country.

I write all this to encourage you to watch a new film series created by Every Mother Counts titled Giving Birth in America. The series follows four pregnant women and their healthcare providers in Florida, Montana and New York in the days leading up to delivery. Together, they navigate the challenges of race, poverty, chronic illness, overuse of medical interventions and other inequalities.

I also encourage you to sign this Change.org petition to cover midwife and doula services for all women in America. I have benefitted from the care and support of doulas and midwives and know that they made a tangible, significant impact on the positive outcomes of my birth experiences. All women deserve access to that level of care and support.

This morning, I revisited Addison’s birth story as thinking about #GivingBirthInAmerica, I can’t help but reflect on my own personal experiences.

I’m re-sharing the full story below. As I think about confronting another birth experience in less than three months (HELLO THIRD TRIMESTER!), I’m finding my voice and my strength and revisiting my past experiences to help remind me of the awesome responsibility and process it is to bring life into this world. I am grateful that I have a team of care-providers who I know will support and trust me throughout, and will have my (and my baby’s) best interests and health at the fore of their thoughts as they participate in that process with us. I wish that for all pregnant women.

meetingaddison_2009

The day that I awoke to my abdomen constricting in the rhythmic, consistent way that all expecting women anticipate began with such eagerness and excitement.

I remember sinking into the tub, belly floating above the water like a bleached watermelon, relaxing into what I presumed would be the final moment to myself in quite some time.

I remember the sand between my toes and the way the ocean breeze rushed through my hair as I paused every few minutes to breath through the beginnings of a pain that I had no basis for comparison. Thinking it wasn’t so bad. Thinking I could do this. No problem. Having no understanding how much more my body would endure before I’d be able to breath a sigh of relief and completion. Realizing now, that nothing could have prepared me for what I was to confront only hours later.

I remember filling that round, full belly with my father’s carbonara, carbo-loading for the intensity ahead. Sitting around the table with my sister and husband, with my dog at my feet. My favorite beings all around me, as we prepared to welcome a new one to those ranks.

I remember the anxiety creeping in as the hours passed, and the pain increased, and yet the time between the pain remained constant.

I remember the earth shaking under my feet as I sat perched on the toilet, willing my body to get going, to do what it was supposed to do. My propensity for instant gratification trumped by biology.

I remember rocking on all fours atop our bed as Kimmy shuttled hot water bottles between the microwave and our room to try to ease the increasing pain in my back. The panic taking hold as I realized I had no real preparation for the road ahead.

Despite all my reading. All my knowledge. Nothing could have prepared me. There is no comparison for the pain and intensity of childbirth. I did my best to recall the words of my doula, the images of other mothers in labor from the videos we’d watched together, and yet none of it eased the growing uncertainty I felt toward my own body. About my own ability to do what billions of women had done before me.

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If I knew then what I know now I would never have left for the hospital in the middle of the night, hugging my furry beast, my “first born,” to my chest as I headed out the door, knowing that our relationship would never be the same after this day. I would never have driven to that fancy hospital all those miles away. Had insurance allowed, I would have stayed exactly where I was, at home, surrounded by the familiarity and comfort that that word implies. And if insurance had not allowed a home birth, I would have stayed where I was, for as long as possible, before going around the corner from our home to a tiny, modest hospital. There, I may have been the only laboring woman in the hospital. There, I may have gotten the attention, respect, and patience that all laboring women deserve. There, my experience may have been different. I still would have had the same outcome, and yet my feelings about my first born’s birth, about the medical care-providers, about labor and delivery, may have been 180 degrees different. I am grateful everyday for the experience I had with my second born. She redeemed something that I feared might be irredeemable on that day three and a half years ago.

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I remember the devastating disappointment and frustration I felt when I learned upon checking in to the hospital that I was only 2 cm dilated. And the confusion I felt when my doctor and the nurses all strongly urged me to start pitocin to move things along.

Everything I had read had told me to trust my body to do what it was supposed to do. And yet here was the medical industry telling me otherwise. I remember nervous phone calls to my doula, my parents, my doctor, and around again in an attempt to decide the best course of action. I ultimately caved under the weight of my doctor’s opinion. I rarely talk about that moment. I’ve blocked that moment of weakness from the story I tell when I talk about Addison’s birth. And yet, there I was, hooked up to an IV of pitocin, angry, confused, disappointed and uncertain, in a room the size of a closet, at the start of my birthing experience.

Not a very great place to begin.

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Fortunately, quite quickly, the pitocin did indeed dilate me to 4, the magic number needed to admit me to a proper birthing suite, a gorgeous, sunlit room overlooking Beverly Hills. I demanded the pitocin be stopped as soon as I arrived to the room where I was to meet my daughter. The nurse refused, concerned that labor would stop or slow if she removed the drip. I angrily called my doctor and she spoke to the nurse, instructing her to do as I’d asked. The pitocin was removed, my doula, sister and birth photographer arrived (now that there was room for their presence), and I began laboring as I’d envisioned: Slow dancing with James, rocking on the birthing ball, showering.

The nurse was negative and confrontational throughout the experience. She didn’t want me in the shower. She wanted to monitor every contraction, despite my request to be monitored as minimally as possible. She continually mumbled, “It doesn’t have to be this hard,” and “Most women don’t do it this way.” She routinely suggested an epidural despite my clearly stated disinterest.

As the hours passed, the pain increased, and I tired, my mental and emotional outlook grew dimmer and dimmer. Thank god for my amazing doula, sister, and husband that kept the nurse at bay and kept me going despite my growing fears and doubts. While I am still resentful of how I was treated by that nurse, it only enhances my appreciation and respect for the rest of my birthing team.

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The pain reached its zenith when I stopped being able to move around the room and insisted on lying on my side in bed. I hummed and buzzed my way through each contraction, and decried my ability to survive it during periods of rest. After six hours stuck at 6cm, I was ready to give up. I wanted an epidural. And I wanted my doctor to cut me open and remove the baby from my belly so that this would end. So that this nightmare would be over.

After a screaming fit of “I can’t do this. I hate this. My body is failing. I can’t, I can’t, I can’t. I want it over. I need this to be over!” My doula quietly pulled her face to mine and softly urged me to ask for an IV of fluids to provide some much needed hydration. I hadn’t been drinking water at all, and she reasoned that after such a long period of hard labor, I was severely dehydrated and that that was only adding to the delay. She also suggested that since my membranes had not yet ruptured, I might want to reconsider my request to not have my water broken. Better have a doctor break the bag than have the unwanted epidural, she reasoned.

I listened to this calm, reassuring older woman, a woman who had been down this road personally four times and had held the hands of women in my shoes over 300 times prior. She knew what I wanted from my birth experience, and was there, still fighting for it, adapting to the way the situation was playing out, with my best interests at heart.

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What happened after I was hydrated and the bag was ruptured moved at lightening speed. Suddenly I was at 10cm, my doctor had arrived, as had a team of other nurses, and there was great cheering and urgings and words of encouragement that the end was near, and yet so much was about to begin.

I was taken aback by the pain of pushing. By the physical screaming and burning of my body and the immense, gut-wrenching effort I had to throw behind that pain. Between pushes, when the contractions would relent, I remember laying my head back and the room falling silent, as though in prayer-like repose, awaiting my next move. I felt as though everyone around me was holding their breath in quiet respect, while I attempted to catch my own. Those 30 seconds of rest felt like hours. I fell into a peaceful slumber, convinced that the work was behind me, that I could finally relax and breath. But then biology would surge from the depths of that quiet, throwing me headlong back into the ring of fire.

I am grateful that pushing was short, relatively speaking, and before I knew it, I felt my daughter exit my body, and the pain ceased, and I lay back, eyes closed, taking in that moment of relief before opening my eyes to meet my first born child.

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I distinctly remember my doctor asking me if I’d do an unmedicated birth again before she left the room that day, and I meant it, with every fiber of my being, when I told her that I would never EVER EVER put myself through that kind of pain ever again. I believed those words vehemently. Despite that beautiful, healthy baby on my chest, despite my ability to walk around the room mere minutes after her birth, despite ultimately having accomplished what I’d wanted, I felt completely beaten down and disempowered by so much of the process. I never wanted to feel that kind of disappointment and uncertainty with my body ever again. And so in that moment, I truly believed that I would never go through birth again. I loved that newborn body pressed against my own more than anything I had ever loved in this world, but I absolutely could not suppress the feelings of anxiety, and fear, and doubt that had been so much a part of the process of her arrival.

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Thank goodness that we forget. That while in the throes of labor with my second born I was reminded, but ultimately cannot recall, the exact sensation of what it feels like to be in the process of bringing life into this world. Thank goodness I got the chance to do it again. And in such a way that I felt completely invigorated, and proud, and empowered by the entire process. In such a way that reinforces why it is not just having a child that is life-changing, but that the very act and process of having that child makes all the difference.

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I could not know what I know now. And looking back, I am in awe of that woman that fought through all that incertitude and achieved what she’d dreamed was possible despite less than ideal conditions. I admire that woman I was three and a half years ago and am inspired by a strength she doubted and a body she questioned. I know that I am more sure of myself today having been tested by that birth. And I am more grateful for that experience than any other in my life.