No, I’ve no aspirations to become a real published author.  I’ll leave those aspirations to those with far more mettle than I.  But, when an organization to which you belong spouts as one of its philosophies something that you simply don’t believe in, well, submitting an article for publication in their quarterly magazine is just something you have to do.  Test them, if you will, to see if they’ll listen to the other side of the story, or gasp! actually publish it for the rest of the membership to read.

And publish it, they did.

In this month’s issue of International Doula magazine, these fine words (if I do say so myself) appear.  Many thanks to Rebecca, who pushed me to dig a little deeper, and to Jennifer, who helped me uncover something under all that dirt.

——————————————-

Calling It Like It Is

Words are, without a doubt, powerful.  We use them to express our needs, our desires, our fears, our hopes and our dreams.  Indeed, all of our emotions — if we’re lucky — can be put in to words.  The ability to consciously and carefully choose our words is our fundamental right — and a source of great power. To take our words lightly, then, is to foolishly dismiss that source of power, and to allow others to put words into our mouths is to foolishly allow that power to be used against us.

The first time I heard the phrase cesarean birth, I was taken aback.  The words came from a childbirth instructor advocating for the use of the term instead of the more clinical, cold, and passive cesarean section. Soon, I began to hear it more and more; doulas, childbirth instructors and others in the birth community saying cesarean birth, trying to effect a change with their words.

Certainly, the sentiment behind the selection of the word is pure; the only agenda in the choice of the phrase is to take away the disempowering connotation of the term section and give back to mothers the power and beauty and ownership so inherent in the word birth. This motivation may be pure, but I would argue that the effect of its implementation – particularly when it is used to provide the opportunity for a woman to shape her vision of her own cesarean experience – is far more disempowering than the original term itself. “But it’s still a birth,” a doula offers supportively to a mother adjusting to the news she is about to have a cesarean. “It’s still a birth.”

Is a cesarean really a birth? What a provocative question.

For some women, the answer to that question is undoubtedly and emphatically yes.  So much so, in fact, that to posit that it isn’t would be an affront to their feelings.  Upon hearing the question, Jennifer, mom of three, reacted strongly.  “[I felt] that I’d been knocked in the stomach, actually.  It has never occurred to me that what took place in those operating rooms were anything less than births.  My children were born those days…I associate birth with my children’s entrance into the world.  No matter how it happened, they were born.  I don’t know that I actually delivered that day, but I do know that I gave birth.” For Jennifer, her cesareans are lovingly remembered birthdays.  They are also triumphs over a cancer that required cervical surgery in her early 20s.  Kristen, a mom who underwent a cesarean under general anesthesia for an abrupted placenta, feels similarly. “My body decided it needed to do this.  I had to have outside help – help for me to give birth.”  But, she continues, “without me, without my body, there could be no birth.”  There’s an emotional component to her choice of words, too, stemming from the particulars of her cesarean under general anesthesia:  “[S]aying that I ‘gave birth,’ includes me in on something I so badly wanted to be included in…[I]f I don’t see it as me giving birth, then I have nothing from [the] experience. No memories, no sounds, no smells.”  When these moms speak of their experiences, using the term cesarean birth is an empowering choice, one that reflects their most heartfelt feelings about their birth experiences.

But as surely as there are women who view their cesareans as births, there are others who find the concept decidedly offensive.  A woman who feels this way might think of her cesarean as a loss, a betrayal, an affront, or any other number of things, but not a birth.  Upon reading an announcement sent out on her behalf stating that she’d given birth, Dana reacted bitterly.  “Like hell I gave birth.  I just laid there,” she says.  Bonnie puts it another way, very matter-of-factly.  “She was ?born. I was the vessel. But I didn’t give birth to her, any more than her father did. I, did, however [have] the surgery.”  Perhaps, for these women, it’s an issue of semantics, but, if it is an issue of semantics, it is one wrought with emotion.  They’re not being pedantic as much as they are being true to their emotions.  As Krista explains: “I don’t argue that a baby born by cesarean was [not] born, or that it was [not] the day of his birth.  But for me, the phrase ‘giving birth’ implies active physical participation, and I know that it wasn’t true of my experience. I couldn’t have been less a part of my son’s surgical removal.”  There’s a sense of loss echoed by all of these women.  They would never consciously choose to refer to their experiences as cesarean births, and to be encouraged to do so by a doula, a therapist, or a childbirth educator would be encouraging them to normalize something that, for them, was not at all normal.  These women have the right to choose how they feel and they should also have the right to choose what words they want to use to name their experience.

As doulas, it would be contradictory to our purpose of support to subtly encourage, by our simple choice of words, a perception that runs entirely counter to a mother’s thoughts or experience.  Whether we’re talking to a mom about her previous cesarean experience, or to a mom facing the prospect of a cesarean, offering the term cesarean birth as a salve can inadvertently sting worse than the cut itself.  Doing so doesn’t necessarily provide her an opportunity to reshape her own experience; it can, in fact, show extreme disrespect for her experience and her very legitimate, normal feelings about her cesarean.

What to do, then?  The term section is disempowering.  Reverting to its usage is a step backward to the days of deliveries, a word so egocentrically focused on the care provider that the mother is left out of the experience entirely.  But substituting the term birth clearly has its drawbacks as well.  The solution, in my mind, is to simply leave the choice up to each woman individually. We never know how a woman feels about her experience, unless she tells us.  So let her.  Cesarean. When we use the term without a modifier, mom gets to make a conscious choice without having any words put into her mouth for her.  Talk about empowering.

Writing this article has been a bit of a transformative experience for me.  I will admit that prior to beginning this article, the term cesarean birth was a little more than unpalatable to me on both a personal and professional level.  Hearing doulas and childbirth educators advocate for the language change was an affront to my understanding of our mutual passion.  When we choose to use the term cesarean birth in general conversation, in our writing and in our publications, I believe we’re propagating the myth of cesarean normalcy.  As the cesarean rate continues to unjustifiably rise in the U.S. and other industrialized nations, I’ve always felt that we in the birth community must take a stand – in ways both big and small — to ensure that cesareans are not viewed as “just another way to give birth.”  To do otherwise would be to materially participate in a phenomenon we are working so hard to counter.  This, I still believe.

But as I spoke to women regarding their personal cesarean experiences, I found within me a place where I understand that sometimes the term cesarean birth does make sense.  Initially, I wanted simply to advocate for those, like me, who cannot describe their cesarean experience as a birth.  I still want to give voice to that opinion.  But, I now understand that those who feel the opposite feel so just as passionately.  In the end, I believe this understanding strengthens the argument for choice even more.  We don’t want to inadvertently hurt a woman by implying that her cesarean was a birth any more than we would want to hurt a woman by implying that it wasn’t a birth.  That is a distinction each woman should have the power to make for herself.

I’ve never understood the adage sticks and stones may break my bones, but words will never hurt me. Words can hurt. As doulas, we must take care not to use words that can have this effect.  But words can also move mountains.  It is part of our job — and our passion — to empower women.  Perhaps the most important support we can give to the women we touch is the mountain-moving power of their own words, consciously chosen, to reflect their own experiences.  Let their voices be heard.

I can remember, clearly, one day when I was a teenager and was sitting in my father’s office. A man walked in. Immediately, I felt uncomfortable. Cold. Severe. And Evil. These were my immediate reactions to this man. My intuition was screaming viscerally, and I could not ignore it. Something, I knew, was not good about this man. I had never been so sure about something in my life as I was sure that this man could not be trusted.

Later, while speaking with my father about it — the incident had chilled me that much — my father confirmed my intuition. As it turns out, this man was well-known to be untrustworthy, with legendary acts of dishonesty and unscrupulousness under his belt. “Wouldn’t trust him any more than I could throw him,” he’d said.

Through the subsequent years, I’ve heard my intuition speaking to me many times. Usually, she’s speaking kindly, letting me know I’ve found a friend and a kindred spirit. Other times, she gently tunes me in to things of which I should be aware. Rarely, though, does she scream and yell and kick and holler like she did so long ago. But when she does, I listen.

She screamed like hell the other day.

The man walking in to the room, to whom my intuition was reacting so strongly, was my client’s obstetrician. Uncomfortable. Cold. And Evil. There was no mistaking it. This man could not be trusted. And over the course of the next few hours, my intuition was proved entirely correct.

First, there were the sly comments from the nurses. “He’s in business alone for a reason,” one of them said. “I’m going to have a hard time convincing a nurse to take you on at the shift change. No one likes to work with your doctor,” said another. These comments, on the surface nothing short of unprofessional, were strong signs my intuition was right. These nurses felt an obligation to warn their charge, even at the risk of being unprofessional.

There were other things, too. There was the hand extended in a simple gesture of polite greeting that he refused to take, offering only the flimsiest of explanations for his rudeness. There was the gruff — not joking — remark about his patient’s labor’s inconvenient timing, coming on the heels of a sleepless night with sick kids. There was the open rudeness with which he treated all of the nurses, belittling them into an annoyed submission. And then there was the episiotomy, cut after only a few minutes of pushing, with no regard for mom’s wishes, and with a deeply disturbing sly smile on his face. All of this, evidence that my intuition was right. The term misogynist crossed my mind more than once.

But the final blow? The final sign that brought the gavel down with a resounding crack? It was an action so subtle that many in the room missed it. The baby born, he held her close — not to perform any medical tasks — but to be the first to rock her and coo at her and be next to her. He taunted the parents, if only for a minute, holding in his hands, their child. I’m holding your child and I’m not giving her to you — yet. One of the most intimate moments that can belong to a mother and father, stolen from them. Stolen, not by circumstance, but by calculated, cold, and heartless arrogance. Power. There is no doubt in my mind this doctor knew what he was doing. It was a clear, conscious action. And unconscionable.

My reactions to this birth and to this series of events were intense. Shock. Horror. Disgust. A sense of being violated, just from being witness. And a deep, soulful mistrust — even hatred — for the man responsible. Its taken me a while to process the strength of my emotions. Was I reacting to my own sensitivities? True, I am sensitive to the importance of those first newborn moments, and to the importance of respectful care. I really had to question myself. I needed to understand how much of this was about me, and how much of this wasn’t. I believe my intuition speaks to me for a reason; in this case, I believe she was warning me — trying to protect me. That I reacted as intensely as I did gives merit to the fact that I needed that protection. The intensity of the reaction is about me.

I have been asked, more than once, how the parents felt about this series of events. It is an important question, one no doubt aimed at redirecting my place of concern, turning my focus away from me. Interestingly, the answer to this question has revealed the other half of my own query; that is, how much of this is about me, and how much of it isn’t?

You see, I argue whether the parents noticed or cared is really not of consequence. Certainly, if they do care, it makes these actions all the worse. But if they don’t care, or if they didn’t notice, it does not excuse this physician’s actions. A midwife once described the moment of catching a baby as “like heaven into my hands.” She wasn’t being arrogant about being the one to receive a child into this world as much as she was being respectful of the enormity of the moment. So enormous is the moment that to take away Mom and Dad’s first touches, first coos — without reason or purpose — is nothing short of reprehensible, nothing short of cruel.

I’ve heard “integrity” defined as doing the right thing, even when no one would notice you doing the wrong thing. Regardless of whether Mom or Dad or anyone else in that room cared or noticed that that sweet baby girl belonged in the arms of her parents at that moment, it would have been the right thing to do. At the very least, then, this physician’s actions lacked integrity. Of course, my intuition told me as much — and more — the minute he walked in the door.

There’s a fine line you walk as a doula. Actually, there are a dozen or more fine lines to walk: balancing childcare on a moment’s notice without wearing out your welcome with friends and neighbors, squeezing in prenatal and postpartum appointments in the evenings without taking away too much family time, and tending to the needs of a laboring woman while keeping your own health and stamina up. All of it, trying. All of it, an art as much as a skill.

But the finest line to walk, the thinnest and most difficult, is that line between respecting and supporting your clients’ decisions and respecting and supporting your own values and passions. Most of the time, if you’re lucky, there’s little difference between the two tasks, and there’s no line upon which to teeter. But, sometimes, these two things do oppose each other. And, when they do, I find balancing those two equally important goals to be among the most difficult tasks of my job. Because, teetering between falling into a chasm of hypocrisy and tumbling into a pit of judgment is not a comfortable place in which to be.

This is where I find myself, right now, as I attempt to write the birth story for a client. I’ve always offered to do these stories for my clients, and, up until now, it’s been a pleasure. No, I don’t always say everything that’s on my mind when I sum up my experiences with them in a story, but, most of the time, I’m able to write a fair approximation capturing my true reflections from their birth that’s at the same time “presentable” to my client.

Not so, in this particular case. I’ve struggled for days to write something, and I just can’t.

I just can’t write a reflective piece about a couple that lost patience. About a father that said, in an almost bullying manner to his wife, “No, we’re not waiting any more. I’m ready for our baby, and we’re not leaving here without her.” I can’t write a reflective piece about a mom who clicked on the computer, closed business deals, and tidy-ed up last minute details during labor. I can’t write a reflective piece about a dad who watched an offensive movie, whittling away the hours of boredom while he simply waited for that which he’d demanded hours before. I can’t write a reflective piece about a birth when the parents couldn’t be reflective about it in the first place. It was just an ordinary day to them. So why should I try to make it out to be any more than that? I can’t, and I won’t.

I’ve had some conversations recently about the uncomfortable entwinement of passion and judgment. It’s hard to hold strong beliefs without at the same time appearing to judge others who don’t hold those same beliefs. Appearing, I say. Because, is it judgment? Or is it a fundamental disagreement? You see, a funny thing happened on the way to writing this entry. I visited this particular Mom and Dad. And we had a nice conversation. It was warm and funny and enjoyable. They were warm and funny and enjoyable. And that’s my point. I disagree — heartily — with their choices. But that disagreement doesn’t change who they are to me, for good, bad, or indifferent.  The difference is slight, but it’s significant.

I still am very uncomfortable about that day’s events and my participation in those events. Very. Uncomfortable. Not recognizing and honoring that discomfort, and instead glossing it over with a nod toward the supportive role to which I’m committed, would be falling into that chasm of hypocrisy I fear. I just can’t do that. So I won’t.

Uncensored? You betcha.  Balancing a fine line?  I sure as hell hope so.

Eh. I’m trying to strike a balance. I’m also failing in that regard. But, for what it’s worth, here’s another birth bitch:

I rarely, if ever, participate in banter on my blog — even back in the day when I was posting nearly every day. But Lucky Candice left a comment on my last post that struck a chord, so much so that I felt I couldn’t just respond to her comment in-line. Thus, this post. Her comment was offered respectfully, and I took it as such. Likewise, my response, in the form of this post, is also offered respectfully. Her comment:

I love your blog - so I hope you don’t mind a bit of devil’s advocate here. Many hospitals offer walking epidurals. You can have walking monitors on or take them off. You just tell the nurses you don’t need or want them. If you write in your birth plan that you want the birth to be more natural, most nurses are really really cool about it. Supportive even. Granted, at the hospital you have to stand up for yourself! You have to be in charge and be firm about your wants. I’ve had all three of my kids in the hospital. My doctors (both of them that I’ve had) have been adamant about the fact that they never do episiotomies. You CAN eat, you just tell the nurses you’re going to and they don’t fight it. I guess what I’m saying is this: if you’re going to have your baby at the hospital and want a natural experience - bring a doula or be in complete charge and make it go the way you want it to. Even with pitocin you can walk around, have a room with a birthing tub, request a birthing ball make sure you get the squatting bar. Hospitals have this stuff. People just don’t use it and don’t “shop around” when it comes to the hospital they’re going to use.

Anyway, that’s my two cents.

I’ve heard her sentiments offered often — heck, even I have echoed them at some point in my life. It all sounds nice and good: advocate for yourself, and you’ll get what you want. Except, it doesn’t work all the time, or even most of the time.

Sadly, it has been my work as a doula that has brought me to this conclusion.

Take for example the case of eating and drinking during labor. Honestly, most of the time I don’t see this restriction placed on moms. But sometimes — most recently included — it happens. And mom says, “I know this is bullshit. I should be able to eat.” And I say, “You know, what happens behind closed doors isn’t anyone else’s business.” Yet, still, mom doesn’t eat. She’s been told — multiple times and quite clearly by the nurses and the doctor: nothing by mouth. The unspoken implication being that she’s putting herself — and her baby — at risk. Does this make her a “weak” individual, unable to advocate for herself? Should the blame be placed upon mom? I don’t think so. The blame — and the shame — is on the care provider: for not practicing evidence-based medicine, for unduly using his influence to force someone into submission, and for putting his own self-interests above that of his client’s. The restriction should have never been imposed in the first place.

Now, about those episiotomies. In the area I practice, I too, can say that most doctors don’t perform them any more. “Oh, please don’t be the one to make me do an episiotomy,” they’ll joke, “I haven’t had to do one in two years and I don’t want to sully my record.” Despite the underlying theme of self-interest echoed by these statements, this is a good thing. It gives me hope, in fact, because even as little as five years ago episiotomies were standard practice. If this protocol can change so quickly, maybe, I hope, others can change as well.

But that doesn’t mean that they don’t happen. “You’re going to tear. I can’t tell you how badly, but you will tear. Or I can cut you cleanly and we can have this baby on the next push.” These are the words mom’s hearing. Over and over again, actually. She’s also hearing from me, quietly, “With each push you’re stretching beautifully. A little at a time, just like nature intended it.” But the words from her care provider hold more weight. They do. Is mom to blame? Or is it the care provider? Shame on the care provider, I say: for lacking patience, for not practicing evidenced-based care, and, most of all, for not listening to mom — who’d clearly told him her preference to tear — and, instead, badgering her repeatedly until she finally submits…to his way.

Monitors — just try taking them off, and watch the fireworks fly.  Walking Epidurals — only one of the five hospitals in my area (yes, five) even provide such an option, and you tell me how you’ll be walking the halls with a fine catheter in your back attached to a pump attached to a wall.  A really, really nice nurse — one you’ve gotten by the luck of the draw — just might detach it to let you go to the bathroom, but, otherwise…these walking epidurals are a sad misnomer.  Birth Balls — you’ll get the only one available if someone else isn’t using it.  Squatting Bars — push all you want while squatting, but when doctor shows up to catch, plan on being manipulated into a lying position on your back.   Wireless monitors?  Again, if you happen to be at the one hospital out of five that even offers such an option, you might get lucky — if the two sets available for sixteen birthing rooms are not already in use.  (And, incidentally, the hospital with the wireless monitors is not the hospital that offers “walking” epidurals).  And care providers — for every one in a given practice that you show me who will respect your choices, I’ll show you another one in that same practice who operates on an entirely different playing field.  Which one shows up on the day you go into labor is anyone’s guess, and that’s an uncomfortable gamble, at best.

So, yes, you can make choices.  You can do the research and choose the hospital that has the most permissive monitoring policy, or the hospital with the “walking” epidural, or the hospital with the wireless monitors, or the care provider who you most “love.” You can make all of these choices, carefully and purposefully.  But, in this environment, you can’t guarantee they’ll be respected.  And, that, in the end, is the problem.  You shouldn’t have to fight to be respected during labor.  You just shouldn’t.

Let’s have this baby today! You’re here. You’re a bit past your due date. Why not?

Why not, indeed?

And so, Mom was hooked up to Pitocin. Monitors strapped on. Encouraged to lie still. Oh, don’t move that way, I can’t read the baby! Just stay still please.

Mom denied food and drink. Nothing by mouth! That’s just the way it has to be.

And soon enough, the epidural was in. Why don’t you get your epidural now? It could possibly be hours before the anesthesiologist can get back here.

Then the blood pressure cuff, and the catheter. Wires and tubes and beeps and blips filled the room. And all the while, mom laid there, flat on her back, and hungry. You can’t move now! You’ll pull the epidural out! Sorry, not even broth. We’ll get you something when it’s all over. I promise.

In the end a little girl was born. Covered in vernix, she was a wee little thing — “overcooked” indeed. Mom, exhausted and famished, having eaten her last bite well over 24 hours earlier, wouldn’t — couldn’t — hold her baby for an hour or so. She simply didn’t have the interest. No interest at all in her newborn daughter. Only after she was given the food and nourishment promised to her hours and hours before was she able to provide love and nourishment to her child. Maslow’s hierarchy of needs, illustrated.

But, hey, in the end, mom was fine. And baby was fine, too. Like they say, all’s well that ends well.

Why not, indeed?

[I never intended this blog to turn into a “birth” blog.  Certainly, I knew I’d have birth stories peppered here and there to reflect that very big part of what I do these days.  But, I certainly intended (and intend) to continue posting the every day minutiae that would continue to make this blog, well, me.  Obviously, that hasn’t happened lately.  One day I’ll get my groove back.  In the meantime, more birthy stuff from me.)

I’m in the middle of reading Pushed: The Painful Truth About Childbirth and Modern Maternity Care, by Jennifer Block.  Published this year, it includes the most up-to-date information on our modern birthing culture.  I picked it up just because it was so new, and I wanted to see what fresh research was out there. (Mind you, I actually keep up on the research; I just wanted to see what was being published about it.) I began reading it the other day.

Thing is, this book just published? It reads much like Born in the USA, by Marsden Wagner, published last year.  In fact, it reads a lot like The Thinking Woman’s Guide to a Better Birth, published in 1999; like Birth as an American Right of Passage, published in 1994; like Open Season, published in 1991; like Silent Knife, published in 1983; and like Immaculate Deception, published in 1977.  1977.

That’s what’s so troublesome.  The critiques of our maternity care system?  Age old.  The data to back up the need for change? Likewise, as old.  Things are broken, and that’s not an opinion.  But things aren’t changing.  They aren’t.  So the problem is bigger than just making note of what the research says and implementing it in day-to-day practices.  The problem is cultural.  It’s doctors being concerned, legitimately, for their practices and financial well-being.  It’s generations of women missing a history of normal birth, missing the wisdom — and confidence — that comes from stories passed down, from births witnessed and shared.  It’s a generation of technology, and know-how, and pictures, and tests, and science — all for our benefit, for our improved well-being, for our civility.  It’s all of this, and more.

I’m not stating anything earth-shattering here.  I’m not.  What’s earth shattering will be the answer to the question, “So, what will it take?”  What will it take for women to once again believe in their ability to give birth to a child?  What will it take for women to understand that they are not broken? What will it take for women to embrace — not fear — the power they have within them?  What will it take for care providers to acknowledge that birth is a natural, normal process that — for the most part — needs little intervention?  What will it take for those same care providers to sit on their hands, watch, and wait?  What will it take?

I don’t know the answer to these questions.  For me, the answer was the research.  It was quite convincing.  For me.  I’m not saying this in a patronizing manner:  I’m educated about the issues.  You’re not.  The information has been out there — for years.  1977.  2007.  Yet, for so many people, the information and the research hasn’t been the answer.  The research and the information aren’t making the change.  So, my question really isn’t patronizing.  It’s honest and open.  I want to understand.  I really do.  What will it take?  What will it take for you?

I’ve always found it to be near-criminal, the presence of a clock in a room with a laboring mom. Too often, we are run by that clock. We time contractions: When did that one start? How long did it last? We time the labor: How long has it been? How much longer will it be? We look to the clock to give us answers, as if it has knowledge deeper than our own. We look to the clock to guide us in times uncertain, seeking the predictable in the orderly minutes and seconds running around and around and around again. All of this reliance on the clock ““ misplaced. The answers aren’t there up on that wall. They never will be. So I try to hide the clock or at least diminish its importance. I ignore it. And I encourage my Moms and Dads to do the same.

But this time, I broke my own rule. “Six o’clock,” I’d said, “She’ll be here by six this morning. That’s my bet.” I found myself cringing as the words escaped my mouth. Too late. I’d broken my own rule.

It was an innocent-enough remark. I wasn’t trying to be arrogant, predicting what can’t be predicted. I wasn’t pointing to an answer up on that wall. I was simply making an observation, extrapolating a logical conclusion based on the pattern of those wee morning hours. And I was reflecting — giving voice to — Mom and Dad’s own thoughts: this was going so fast!

They’d called me at 11. Asked me to come over at Midnight. Arrived at the hospital at 2:00. Six centimeters at 2:30. Eight centimeters at 3:30. Nine centimeters a half-hour later. Each hour, each measure of progress, each rotation of the hands of the clock, was met with the same emotion: surprise. There was no time to reflect. No time to adjust. No time to become acquainted with the idea. It was all happening so fast.

My prediction was not far off. Just before the turn of that six o’clock hour that morning, a little girl arrived into the arms of her parents. Again, at least one of the emotions was surprise. Look at her ears! Her fingers! Certainly, these were natural moments of discovery. But I sensed, too, that sense of surprise. As if it had all happened so fast — too fast — for those ears and fingers and sweet, sweet toes to actually be a reality. Surely, there had not been enough time to make this all real.

Only hours before, they had been at dinner. Now they held a little girl in their arms. Had the time in between been enough? Was there enough time to know how to be this little girl’s parents? Was there enough time to know what to do? How to act? How to love? The clock on the wall can’t answer those questions. But I think they know. They’re ready. And then they’re not. They’re prepared. And then they’ll find themselves unprepared. You see, it’s a funny thing, the reality of this parenting. It’s about having all the time in the world, and never enough, all at once. That’s the reality. And there’s no clock in the world that can reflect that kind of  time.

It’s hard to describe a birth that occurs entirely naturally. Certainly, every birth is different. But even though they’re each unique, these births share a kind of intensity, a kind of strength and power that belies any kind of description. There’s no preparing for it. There’s no painting a picture of it. There’s no knowing it, until you actually experience it.

She was so close; we all knew this. All of us, that is, except Mom and Dad. How could they? Mom said she couldn’t do it any more. And Dad tried desperately to help her. We heard them. We really did. But the help they asked for would take time, of which they had precious little remaining. So we helped them, for the moment, in the only way we knew how: with our words.

“What you are about to witness is the most intense, powerful thing you have ever seen. Nothing can describe it.”

“But, is this…is this–,” he said, pointing with heartfelt concern to his wife, “…normal?”

“Absolutely. Normal. And Intense.”

Intense. Is that really a fair description? I’m not sure. Birth is intense. But it’s also overwhelming. Fierce. Formidable. Shocking. And it’s beautiful. Wondrous. Breathtaking. It’s all of this, and more. So, somehow, intense does not capture it all. It falls utterly short. Dad was about to witness just how very short, indeed. A vocabulary lesson, of sorts.

In the meantime, Mom herself had lost the need for thoughtful description. She’d passed the point of needing to know. Doubt, fear, unknowing — all of it, gone. No longer concerned that she couldn’t do it, she was doing it. Quiet and resolute, her words and questions just stopped. Turned entirely inward, withdrawn from the world around her, she found her purpose — in pushing.

Then, a sweet baby boy was born. Placed on to Mom. Caressed by Dad. Welcomed in to the world.

And then she said it. It certainly wasn’t the first thing she said. There were the intimate hellos and sweet coos first, but when the moment came that mom was once again aware that there was a world beyond herself and her newborn son, she looked around and said to those who had been with her, “You guys were amazing!” In her voice, there was gratitude — for our presence, for our support, for our guidance. But there was awe, too. I heard her, surprised — and saddened just a bit — that she felt that way. Her sense of awe? Entirely misdirected. Entirely.

Dad found new meaning in the word intense that day. Forevermore, he’ll understand that word in a different light. So, too, I hope Mom found new meaning in the word amazing, for she was the very definition of it that day. The very definition, indeed.

It’s an indescribable landscape, really. Doulas, midwives, and doctors know it as the place where women go — really, really go — to give birth to a baby. We speak of it as a place, as if it could be located on a map, as if it could be navigated with simple directions including lefts and rights. But there is no map. When you’re there, you’re almost always alone. You can’t see anything in front of you. There is no horizon to speak of, no edge, no end. And although it’s desolate, it’s not at all cold. It’s yours. Your landscape, your walk, your journey. You go there only when you’re safe, only when you’re sure and only when you’re brave. You walk that landscape, your entire world at the time, with the sublime combination of will and acceptance, of strength and faith. You go there as one; you return as two. Labor Land.

Eyes closed, hand held by her husband, her own hand caressing and speaking wordlessly to her soon-to-be-born son, she walked out on to that landscape. Mom was in Labor Land.

Thirty-six hours. Forty-two hours. So Long. She never once complained. She never once questioned. She never once doubted. Not once. I watched, amazed as always, stunned by the beauty and power she displayed in those long, long hours. Finally, I was compelled to sit by her side and tell her what I truly felt. Grace. Patience. Acceptance. This is what she was bringing to her labor. This is what she brought to her Labor Land.

“I don’t know why it took so long. It wasn’t what I’d expected,” she’d said as we sat talking that day a few weeks after she gave birth. “It wasn’t what I wanted.” No, not at all. “But, maybe one day I’ll understand why it was that way for me. Maybe one day.”

I’ve often talked about the mystery that is birth. Every birth I attend builds on that mystery as much as it chips away at it. I understand mom’s sense of mystery for her birth. I understand it, deeply. And while, for me, the mystery will continue always, I would like to offer mom an answer — if not a complete one — to her personal mystery.

All that time, all those long, long hours, you never once complained. You never once questioned. You never once doubted. Sincerely amazed, I had told you then what you brought to your labor: Grace. Patience. Acceptance. And now I’ll tell you this: Grace. Patience. Acceptance. This is what you brought to your labor. This is how you painted your Labor Land. And this, I believe, is what you will bring to your role as a mother.

What a beautiful place in which to be raised.

The question came up quite naturally.  There was a logical segue to the query, certainly, and the tone behind it was nothing short of friendly.  We were two dear friends sharing an afternoon of poolside conversation, flowing freely  from children’s eating habits to tattoos and topless sunbathing, with a good dose of protective mother-child exchanges peppered in between.  Nonetheless, the question landed like a bomb in my lap.

“My son was born with thick meconium.  They whisked him away with all sorts of neonatologists scurrying about.  How could that situation have been safe during a home birth?”

Again, my friend wasn’t being particularly doubtful or skeptical.  She wasn’t feigning interest while remaining steadfast in her belief that home birth was nothing short of insanity.  I believe she was truly curious.  Still, I needed to take a deep breath before answering.  This wasn’t some highly doubtful, holier-than-thou anonymous exchange on an Internet chat board.  Those exchanges far too often lead to nothing but further entrenchment of divided camps.  This was my friend.  And perhaps this exchange could lead to something different.

So, I took a deep breath and offered my answer.

“Well, in two ways, probably.  In the case of thick meconium being present in the waters, there would have been a conversation well before the actual birth about the prudence of continuing the birth at home.  Perhaps a transfer to the hospital would have occurred in your case, but certainly not under immediate emergency circumstances.  There would have been time to act prudently.”

Ok, that was the easy part.  Now, the more difficult part.

“Secondly, there are some things that occur in hospitals that make things appear to be incredibly dire and emergent, when, in actuality, they aren’t.  In the case of the presence of meconium in the waters, the science and research doesn’t actually support some of the actions they take in the hospital.”

There, I’d said it.  As gently and tactfully as possible, I’d basically told her I felt her beliefs were wrong.  What would come next?

“Oh,” she replied with a bit of a pause.  “All that hustle and bustle was a bit of a self-important show, then, huh?”

I smiled and just let the conversation end.  She could make what she wanted of it.

Talking about birth is a bit like walking through a land mine field.  Talking about home birth?  Nothing short of stepping on a land mine.  Too often, the conversation goes nowhere, with one party convinced the other is sacrificing the fundamental safety of her child all for an “experience,” and the other party believing the first to be uninformed about and deaf and blind to the harsh realities of the hospital birthing culture.  All of it, judgmental.  Yeah, that’s productive.

So, while I believe passionately about informed birthing practices,  whole-heartedly endorse home birth, and am vocal about both here in this blog, when it comes to face-to-face conversations, I tread particularly lightly.  I’m doing neither myself nor my “cause” any favors by alienating people.  I meet them where they are, and I talk.

Whispers.  Hints.  Respectful dialogue.  And room for thought.  Somewhere in there is a place where women can birth at home and not be seen as being selfish.  Somewhere in there is a place where women can birth in the hospital — and yes, still have an epidural available to them — with deserved respect and evidence-based care.  Somewhere among those conversations, those poolside encounters, somewhere in there, I believe, is change.