I'm glad I didn't have an epidural

I gave birth to my first son in 1992. A lot has changed in those years, but a lot hasn't, too. Now, 17 years is a long time to hold on to a birth story, and I didn't keep a journal of experiences in those days so much as I kept a journal of emotions, so I know that during my pregnancy I was incredibly depressed. I was 21, for most of it, and had married that February and gotten pregnant on the honeymoon--the same honeymoon that we had to cut short because we found out my then-husband was losing his job. I spent the entire pregnancy on WIC, food stamps, and Medicaid. Thank you, taxpayers of Virginia.

I remember more about the birth itself the closer I get to my due date, now. I had been flirting with toxemia; my blood pressure and weight gain were the biggest concerns but I was starting to show protein in the urine. But I was already showing signs of effacement and dilation, so the doctor made a decision to go ahead and induce me the following Tuesday with an amniotomy.

I remember coming in on what felt to be the coldest day of the year. It was blustery as my then-husband dropped me off at the door; he parked, we went up together. I don't recall checking in, but I do remember getting set up in the bed to be induced. The nurses started an IV. Ten minutes later, the doctor walked in, and asked why they had started an IV. They were visibly startled; I was just impressed. "I want to see how she does after we break her water. I have a feeling she won't need Pit."

I honestly can't recall how insistent I was at that time for a low-intervention birth, but I must have made myself clear at some point. The amniotomy itself didn't bother me; it struck me as a physical intervention rather than a chemical one. But what surprised me was what the doctor said upon examining me. "She's already 3 centimeters. She's having this baby today anyway." I had been in labor all morning and not felt a thing--something that is common to my mother and my grandmother. He performed the amniotomy; I didn't feel that either. By 10 a.m., labor was well established. "No need for Pit," the doctor said again.

I called my mom. "You'll have this baby by 1:30," she said. We all had a laugh, but it turned out she'd be right--I was ready to start pushing around the time that everyone else was finishing up lunch. Suddenly, the entire world turned round: my eyes, my mouth, my soul was all formed into a perfect "O" shape--and everything I could see *felt* round. (I'm prone to synesthesia, so in hindsight that makes better sense than it did at the time.) The head was out, and the nurses were pleading with me to pant, because one of my son's shoulders was hung up on my pelvic bone, a condition known clinically as shoulder dystocia. The doctor deftly worked him up, then down, then up, then down, rocking him past the barrier--and then my son came into the world, all 9 1/2 pounds of him.

One of the nurses who was helping me breastfeed made an offhand comment to me that has stayed with me ever since. "It's a good thing you didn't have an epidural," she said. "Oh?" I replied, asking her to explain. I was 6 weeks past my 22nd birthday at the time, and didn't have any more of an understanding of labor other than what I'd gotten from "What to Expect," my childbirth education class, and my mother's tales of carrying me and my brother. But I suppose I was influenced by my mother's explanation of the difference between her birth with me, done under twilight, and with my brother, done completely natural. I showed up in five hours; my brother in 3. (We're wondering, actually, whether I will have time to even get to the hospital at all, if I don't know I'm in labor until I get to 5 cm and I roll through dilation half as quickly as I did with Elder Son.)

The nurse explained that she'd seen cases where an epidural actually caused a labor to drag on and on. "Your baby was so big, that it was a good thing you and all your muscles were fully present to work with your baby and your body to get him out. I think, if you'd had an epidural, you'd have wound up having a section."

This made me curious, even then, about whether we should always trust in medication. Sometimes I think we're taught to be afraid of the pain, so afraid that the epidural looks like an attractive option. So many women in my childbirthing ed class this time around have the attitude of "pass me an epidural as quick as you can!" And while I'm a huge advocate for allowing women to make their own choices about pain management in labor, there are times when I wish this aspect was made more clear to women. Interventions have a funny way of cascading. I feel like I'm lucky that my doctor was Pitocin-averse, at least in my case--because I've heard so many stories about how Pitocin creates unnaturally strong contractions that leaves a woman begging for epidural relief. Then, sometimes the epidural creates a difficult environment for pushing; other times, the pitocin makes it such that the oxytocin rush that I think I felt in that O-moment of birth never happens. Either way, it can lead to that nebulous diagnosis that scares me so much: failure to progress.

As if women didn't have enough "fail" pressure in their lives, right?

So anyways, the point is: in 1992, I was told--after the fact--that having an epidural would have made my life more difficult. I'm glad I turned it down. And will do so again with this pregnancy, even though I'm 17 years older.

Pregnancy Is Not a Pathology

Reading Pushed at the recommendation of my midwife last week has really made me regret my fickleness in 1995 that led me away from nursing school, which had been my intent until my first marriage fell apart. My goal back then was to pursue nursing through to the graduate level and become a certified nurse midwife, but as we fell apart and I immersed myself more and more into creative writing (and I failed organic chemistry), I second guessed myself. Then things between us really disintegrated between 1996 and 97, and I lost all interest in school.

So anyway, being pregnant again has totally renewed my energies in that direction. And the more I read, the more I see that things have actually gotten worse for women in the 17 years since I was last pregnant.

My midwife wants to write a book about childbirth, but she's a midwife who wants to be a writer. I am keenly interested in these issues too, and I am a writer who would have wanted to be a midwife.

I'm thinking she and I will be talking more.

Anyhow, you don't have to read the entire book to get an idea of what I'm on about. This L.A. Times article, which was published yesterday, addresses it more concisely:

Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

With that surge has come an explosion in medical bills, an increase in complications -- and a reconsideration of the cesarean as a sometimes unnecessary risk.

It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.

....

The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade.

The problem, experts say, is that the cesarean -- delivery via uterine incision -- exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

Inducing childbirth -- bringing on or hastening labor with the drug oxytocin -- also is on the rise and is another source of growing concern. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own. Induction, studies show, also raises the risk of complications that lead to cesareans.

Despite all this intervention -- and, many believe, because of it -- childbirth in the U.S. doesn't measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight.

And in at least two areas, the U.S. has lost ground after decades of improvement: The maternal death rate began to rise in 2002, and the typical American newborn is delivered at 39 weeks, down from the full 40. Public health experts view the trends with alarm.

I should add that I don't consider myself a radical. I'm not interested in a home birth, not crazy about seeing certain common sense things I did with my first son now being proselytized as "attachment parenting," and I tend to be moderate in most political arenas, mostly because being a journalist causes a person to be more circumspect in examining all sides of an issue. But I do believe that obstetrics is an important field that should support midwifery, not the other way around and not competing with one another.

Momma's got a secret

I'm pretty good at keeping confidences, in general. Except for my own. I'm a compulsive writer, so when there are things on my mind, I have to jot them down. Public or private, online or off, it happens. Twitter has kind of taken the edge off the one-liners, to be sure, but they still happen.

But I don't see how I can get through this weekend without telling my son I'm gestating his second half sibling. It's funny. He's 8 1/2 years older than his brother; and this one is coming along 8 1/2 years after that. Numbers crack me up that way. Just like my favorite aunt, is 17 years older than I am. (Actually, 17 1/2, but you get my point.) Around the house, there are things like prenatal vitamins, and pregnancy books and magazines, and I can hide those well and good enough, but..

I can't hide this from him, not only because I love him so much; but also because he's going to need as much time to get used to the idea as Dean and I do. At Christmas, he told me he wanted to move back in with me, and it would break my heart if he changed his mind because of this. But I'd understand, too.

I went down to my church today, to talk to my priest about all this. And before I could even get started I was already crying, something I think I needed to do since I found out, but I couldn't. It's so overwhelming. And I just sobbed and sobbed and sobbed. All the emotions that have been swirling around, unable to find purchase because I was--and am--so determined to be strong about this.

I got the paperwork today for the ob/gyn I want to go with, and as I was going through it, I noticed a line that said, "This practice does not support the Bradley method of Childbirth. If you plan to use this method, please seek prenatal care elsewhere." Not that I'm a fan of the Bradley method, but I'm wondering about their obstreperous denunciation of it. I chose this practice because I want a holistic, woman-centered practice. I came pretty close to natural, honestly, with my son, though I did have a bit of demerol at about 5 cm. Lamaze worked beautifully for me, honestly, though my nurses did more to keep me focused than my ex did. (In fact, part of me wonders if the objection to Bradley has to do with partner-as-coach thing, because I think some partners make great coaches, others not so much.)

The only thing I've been able to find is that the Bradley method itself is (a) proprietary and (b) steeped in principles that can be seen as inherently anti-feminist, so if you want a holistic, woman-centered birth the Bradley principles are a bit antithetical (and, quite possibly, ironic). And there are some that cling so much to the method that they are downright radical about it, and apparently this turns medical professionals off. When the movement started, it was a reaction against "twilight births," as many women experienced it between the 30s and the early 70s. (I was born while my mom was under that kind of sedation. She doesn't really remember it.) It's weird: the Bradley method is anti-medical, which Dean would probably dig; but before they changed the name to something more politically correct, it was known as "husband-coached childbirth." And Dean, my love, my partner, I do love you, but I can't imagine you taking charge of my labor. :D

The way I see it, if this practice doesn't work out, both of the doctors I had with my son's birth are still practicing up in Winchester. My doctor--I remember this so clearly--got irritated with the nurses when they IV'd me before he told them to, because he felt I could go natural if I wanted to. But anyway, whatever all that works out to being, I have to get there first.

And first things first.