"You will be a better mom because you are a theologian, and a better theologian because you are a mom."

Is it true? In this blog, I explore the interplay and intersection of motherhood and theologianhood.

Tuesday, December 23, 2008

10 Days Later...

Well, little Eva's umbilical cord fell off yesterday, and I've had ten days now to reflect on this last birthing experience. It hasn't been any sort of a conscious meditation, but the kind of thing that pops up as (what I refer to as) a "screensaver for the brain" - you know, what you think about when you're not consciously thinking of anything in particular.

As I've mentioned before, my sister is a midwife (a CNM), and I think it's fair to say that when it comes to pregnancy, labor, and delivery, I know a tad bit more than the average woman on account of this extreme advantage of having a sister in midwifery. As with my first birth, I had certain expectations and hopes for this delivery. And, as with the Maia's delivery, I've learned once more that - even for those who know a tad bit more than the average woman - one simply cannot have complete control over the things that happen in labor and delivery. Of course, this shouldn't come as a big surprise... it's just one instance of the workings of everyday life. We like to think we're in charge of everything, but (as Hauerwas says) when we look back at our life we find that a lot of things just happened TO us, rather than by our own agency.

When it comes to labor and delivery, the United States seems to lead the world in medicalization of birthing and the professionalization of delivery. Along with this, women generally have (or at least feel they have) very few options/choices when it comes to labor and delivery. This is especially true for the average hospital delivery. For more on this, I'd recommend the Ricki Lake/Abby Epstein documentary The Business of Being Born. Jeff and I watched it about a month before Eva was born, and it was good birthing prep.

With my first pregnancy, I specifically sought out a practice of midwives (CNMs). At the time, there was only one option covered by our insurance. So we ended up having to drive about 25 minutes to their office for each visit, and we had a 30 minute drive to the hospital when I was in labor. All in all, I would say we were pretty well satisfied with the midwives in this practice. They had a homey office and alotted 30 minutes per visit. There was never a wait once we arrived, and overall they had a laid-back and empowering approach to pregnancy, labor, and delivery.

On the other hand, the OB director at the hopsital was a first-rate jerk. From research done after the fact on this doc, I'd even probably class him as evil. I won't go into that, however, so as not to turn this into a purely personal attack. I'm a swimmer, and as someone who spends a lot of time in the water, I had planned on a waterbirth. I signed the release form early on in the pregnancy, and I was pretty excited that the midwives had done water births before. So one month before the delivery, the OB director decided (without any convincing medical research) that waterbirths are dangerous. So he locked up all the tubs (which were portable) in a room and took the key. After Maia was born (on land, as it were), he failed to pay the midwives' malpractice insurance and effectively shut down their practice despite the assurances that their office would not close for six months. These issues didn't make the news, of course... the closing of this practice was formally all chalked up to finances.

For this pregnancy, it turned out that there were midwives on our insurance much closer to where we live. I made the appointment for my annual with them before I was pregnant and, by the time of the appointment, I was three weeks pregnant (that's five weeks pregnant in medical terms). In general, this practice had much to recommend itself, not the least of which was convenience in terms of distance. On the other hand, the practice also had one major disadvantage, namely, it is a practice of both midwives and doctors (originally two and two respectively, now three and two). While I have nothing against the OBs as such (both are very nice and provide excellent care), I found it a little discouraging that I sought out (female) midwives only to find myself under the care of (male) doctors. Moreover, unlike my first midwifery experience, their office schedule was routinely running late, so much so that one time the husband, toddler, and I waited an entire hour to get in for an appointment. And, mind you, this was not a 30 minute appointment but a 10 minute (if that) in-and-out wherein we barely had time to ask questions.

Anyway, the most exciting aspect of Eva's delivery was that it was to take place in a birthing center. The hospital where I'd be delivering has both a normal L&D and the birthing center. Jeff and I attended the orientation and toured the center, which has great rooms that include a huge bathroom with a good-sized waterbirth tub. The birthing center has a non-interventional approach that was also appealing to us.

Well, little Eva's due date came and went, much to my delight. I was hoping for a late baby because my sister had off on the 13th, 14th, and 15th and could come down for the delivery. All of the people in the practice that I'd seen (the three midwives and one of the doctors) had said it would be fine if she caught the baby. While Ann was in route to Dayton, my water broke, and this was the beginning of the limiting of my birthing options.

For some reason, shortly after my water broke, my contractions stopped. By about 2:00 a.m., they were pretty insignificant. But by 4:00 a.m. we decided we'd better head to the hospital anyway, since I was GBS positive. GBS positive shouldn't have to be a big deal, but I have to admit, the need for antibiotics put a lot of pressure on me. I never imagined I'd be going to the hospital with such minor contractions, but, already, I didn't feel like I had a choice. We checked into the birthing center and then spent most of the day trying to get my labor going using natural induction methods (including walking, dancing, and a breast pump). It turned out that the person on call from the practice was the one doctor I'd never met. He was willing to be patient for most of the day, but when it got to the point that my water had been broken for 18 hours with no real progress, he very strongly suggested that we do pitocin.

I've spent the last few years nurturing a very strong dislike of pitocin, largely because of my friends' birthing experiences that involved it, but also because it just generally seems to be overused. It's a sort of commonplace intervention that U.S. hospitals assume is necessary and normative. In this case, however, the decision to go on pitocin was made much worse by the fact that it necessitated transferring out of the birthing center and into a normal L&D. So, once more, I was foiled in my expectation of and hope for a waterbirth. And of course, with pitocin also comes monitors - a continuous fetal heart rate monitor and a contraction monitor. So there I was, tied up to an I.V. and two monitors in a normal L&D room without a waterbirth tub. Needless to say, I cried.

I hadn't seen Maia all day (the longest I'd ever been away from her), so once they started the pitocin, my in-laws stopped by with her, and she really cheered me up. Not only that, but their visit was a great distraction from contractions that were definitely growing stronger and more painful. At one point during the visit the nurse came in and looked at the contraction monitor. Then she glanced over at me sitting calmly and talking to Maia. "You have a very high pain tolerance," she said. I attributed this to my being an athlete. She asked what sport, and, before I could respond, Jeff told her boxing and football (the sports of my past!). Anyway, my boxing experience seemed to her a pretty good explanation.

And, after the in-laws and Maia left, I have to say, I did sort of feel like I was in some kind of sparring match. (Someone could make a great Jack Handey quotation about how boxing is a lot like birthing...) The pitocin started at 4:00, the visitors left at 5:30, and the baby was born by 8:08 p.m. After all that time in the hospital, my actual "labor" of painful contractions was only really a few hours. But, although my memory of the pain from Maia's birth (which was also a natural delivery) has somewhat faded, I have to say that this seemed much more painful (supposedly pitocin makes for stronger/more painful contractions) than her delivery. Jeff and Ann thought it went by pretty fast, but I did not share their sentiments.

Some things went exactly according to my plan for this birth: my sister was there with me and my in-laws were in town to watch Maia. On the other hand, as you can see, many things did not go according to my plan: transferring out the birth center, using pitocin, being hooked up to monitors, and not having a waterbirth. One other thing was that the on-call doc didn't really want to let my sister catch: "My name's on the chart," he said, "I've got the head and the anterior shoulder; you can do the rest." Ann still counted it as a delivery (Eva is number 151!), and it was great that she was the one who ultimately caught her and handed her to me. Although he was nice, I never would have chosen to have a male doctor overseeing Eva's birth. And perhaps this is why I was a little antagonistic toward him (we even had a little argument right before Eva was born).

After Eva was born, Maia and the in-laws stopped by (they brought us pizza, which I ate in the delivery room!). Then the hospital staff allowed us to return to the birthing center for recovery. That was great because of the queen-sized bed. Jeff, Eva, and I were able to cosleep on our first night together. Not to mention they had great food in the birthing center.

All in all, it wasn't a horrible birthing experience. My recovery has certainly been a lot faster than last time, and I am glad that we got to spend some time in the birthing center, even if I didn't deliver there. But, as if to prove that I'm not ultimately in control of everything, shortly after our 24-hour discharge, the pediatrician called to let us know that Eva's bilirubin level was high. By the next morning, I was back in a hospital for another 24-hour stay, this time with my newborn under blue lights... and with nurses stopping in every hour to ask if my milk had come in...and with residents pressuring me to use formula ("Either give her formula or I'm going to give her an I.V." was one resident's message, passed on by the nurse.)...and, this time 24 hours straight without Maia (the longest time I'd ever been away from her). Moreover, it appears that Eva's jaundice was pathological- ABO incompatibility. I think this means there's a good chance I'll have to go through this with my next kids as well.

So we can't really control what our kids are like; I certainly wouldn't have wanted Eva to be jaundiced. On the other hand, however, Eva is remarkably even-tempered. She sleeps a good amount and hardly ever cries (this is VERY different from Maia's infancy). Maybe this time Jeff and I really did cancel each other out in terms of personality - a calm baby, could it be true?!?!?! It's a nice (and unexpected!) blessing.

In conclusion, ten days later, I can say that next time, I think I'll have a homebirth. It seems to be the only way to have any more agency in the birthing process. In the meantime, I'm going to enjoy celebrating the birth of our savior with my very own newborn.

1 comment:

Clara said...

If I may ask a possibly foolish question (and one coming from the perspective of someone who has never given birth)... why is "agency" in childbearing per se a thing for which we should strive? Or maybe you think of it as only contingently good, perhaps as a corrective to certain mistakes or prejudices of the medical community. (Just as I, for example, don't think of freedom of religious worship as being per se an absolute good, but I do appreciate it insofar as it allows *me* to practice my faith despite being in a religious minority.)

On one level, certainly, it's just common sense to take care of a person in pain or distress, or one engaged in a difficult and/or important task. One part of that might be making the person comfortable by catering to their preferences. I've heard people complain before about how doctors' preferences tend to trump patients' in most hospital settings, and this seems particularly inappropriate in the case of a laboring woman; the doctor's job is important too, but surely the mother is working much harder. To that extent, then, it might make sense to honor the "agency" of the patient.

But obviously you're interested in much more than music choices or lighting schemes. You want patients to have control over medically significant things such as controversial methods of delivery, medications, monitoring equipment and so forth. And while I wouldn't venture an opinion on whether your preferences in these matters are better or worse than those that would prevail within the medical community, I am inclined to think that some choices are surely better than others. And if so, is "agency" really something to be desired so much? Shouldn't we really be looking to instill the healthiest customs and practices? Even if the particular things that you want to do are sensible, surely you can imagine in the abstract that it's often best for doctors to tell their patients, "Yes, you really do need to do this," and "No, that's not such a good idea."

I'm somewhat aware of the general philosophy that one of the best ways to help laboring women is to make them feel empowered; as someone once explained to me, childbirth should be something the woman *does* and not something that *happens to her.* Those sort of people clearly would be in favor of increasing the patient's agency, making it clear to her that she is the one making the important decisions concerning her own and her baby's health.

This strikes me as being very similar to the attitude that so many modern people want to instill with respect to life as a whole -- that we want people to feel empowered, to make their own decisions as much as possible, etc etc. And while I can't really say for sure about childbirth, it certain seems to me in life as whole that this is wrong, or at least only partly right. Feelings of empowerment can be good in some contexts and in moderate amounts... but they can also be illusory and destructive. Like life generally, childbirth is something the woman does, but also in another way something that happens to her, and I don't see why it should be such a good thing to emphasize the one to the exclusion of the other. After all, the paradigm of Christian motherhood and childbearing is the Blessed Virgin... and in her "Fiat mihi secundum verbum tuum" the "mihi" is dative, not nominative.

Anyway, sorry to wax philosophical (or philological, as the case may be) on a subject of more pragmatic import, but there seem to be some assumptions behind your views on childbearing that aren't fully clear to me. And I am really interested, not just in the principles in the abstract, but in how they might apply to this subject.