“It’s Shannon, and our baby decided today is The Day. I don’t believe this! We’re on our way to the hospital.”
“When did it start?” I asked as I leaped out of bed with a sudden spurt of adrenaline and ripped a clean outfit from the closet.
Usually I have my clothes laid out on a chair in the order I would put them on during the general time of any upcoming births. I’d have my bag by the door with my ID tag on top and a sticky note above the lock on the front door reminding me to bring a snack, my watch, my cell phone, charger cord, and purse. I have arrived at too many middle-of-the-night births missing one of these essentials.
I asked which hospital they were going to. A pencil and notepad live under the phone by my bed to write it down immediately. I don’t trust my brain to register correctly, especially when I’ve had little sleep, and this night was definitely one of those.
Sleep or no sleep, it is always an honor to be invited into a family’s most intimate moments and witness the miracle of birth once again. And this miracle would be happening on Christmas!
This was Shannon’s third baby, so there was no time to waste. I tugged my clothes on with one hand while still holding the phone with the other, the usual litany running through my brain at the same time: coffee, filter, mug, lid, creamer, sweetener, spoon . . .
Shannon, her husband Aaron, Eloise, their toddler, and sometimes her older sister Lilli were always early for our appointments. Shannon even brought her mom along once. I enjoyed our visits and looked forward to their birth. Her two previous births had been plagued by high blood pressure. Combined with that, Shannon was living with Ehlers-Danlos Syndrome, which complicates not only pregnancy but daily life. A side effect is hypermobility, when joints over-extend. People with joint hypermobility syndrome may experience many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue as muscles must work harder to compensate for the excessive weakness in the ligaments that support the joints. Hypermobility syndrome can also lead to chronic pain and disability. As her pregnancy progressed Shannon needed to use crutches just to walk. Her pain continued, growing worse in the final two months. A scrupulous organic diet helped to stave off the worst complications. Shannon had thoroughly researched everything that is known about this disability and the benefits of the right diet and certain supplements.
Shannon was dealing with the contractions quite well when I got to the hospital forty minutes later. She was up and walking around the room with Aaron’s support, but she didn’t feel she could go further, not even down the halls. A birth ball also helped since she could be upright, letting gravity move her baby down. During the next hours, as she steadily dilated, she ate and drank and combined short rests on the bed with time up on the ball or in a chair. While she rested we used a peanut ball, which is like a birth ball but shaped like a giant peanut. When she lay on her side, I would put the peanut ball between her knees. It is large enough that the upper leg that is draped over the top of the peanut can hang up and out over the side of the bed. The lower leg is brought up, bent at the knee as high as is comfortable. This position opens the pelvis as wide as possible in a lying position to facilitate the baby’s continuous descent. Every half hour or so, Shannon would roll over to her other side and we would replace the peanut again. Her blood pressure was creeping up during this time, possibly because of the added pain she was experiencing in her expanding joints, along with the contractions of labor, so her nurses suggested staying in bed if possible to help keep the blood pressure from rising any higher without medications.
Shannon began dilating quickly and by 10:30 a.m. she was able to push. Nora Jane was born after a short second stage with perfect Apgar scores. We didn’t really need those numbers to tell us she was finally, happily, here, though she seemed to register otherwise with her lusty cries. And then, before she was weighed or the cord even cut, she held up one pudgy little hand, thumb up, seemed to contemplate it for just a second, and then popped it in her mouth, sucking contentedly. That was a first for me.
I stayed long enough to celebrate this very special baby (who turned out to weigh nine pounds, eleven ounces) with her parents and made sure she was nursing well. There was no problem there. She had already made up her mind that today she was going to feast.
“Many western doctors hold the belief that we can improve everything, even natural childbirth in a healthy woman. This philosophy is the philosophy of people who think it deplorable that they were not consulted at the creation of Eve, because they would have done a better job.”
~Dr. Kloosterman
Chapter 4: An Amish Birth
On my way home from the hospital, I thought back to another birth I was honored to witness. When we lived in Wisconsin in the early 1980s, I attended several Amish births. The Amish don’t use modern farm equipment, electricity, or indoor plumbing, and also don’t have telephones, much less computers, email, iPods, or other gadgets. So when a baby announces his or her imminent arrival, the mother has to first locate Pa somewhere on the farm, get the children to Grandma and Grandpa’s “doddy haus” (the grandparents’ apartment, usually attached to the farmhouse), find a teenage neighbor to agree to do the morning or evening milking that day, and have Pa go to the nearest friendly “English” (non-Amish) neighbor to use their phone to call the midwife or doctor.
Emma and Joel were expecting their seventh child. She had experienced easy births with the others and remained in good health throughout this pregnancy. She had carried the baby to term, he was growing nicely, she took good care of herself, understood good nutrition, kept her house clean and tidy (one of the things I observe when I consider a family’s suitability for a homebirth) and was excited that they had been blessed with yet another baby, though they didn’t know if it was another little “dishwasher” or “wood chopper” yet—the terms they used when announcing a new baby girl or boy to their Amish family and friends.
I carried a primitive kind of pager back then and had the dads call me as early as possible when things started up. The Amish settlements stretched for over fifty miles in all directions. There were perhaps half a dozen of us covering this area who often assisted at these births.
When Joel’s call came one sunny day about noon, I quickly called my husband David, who helped me pack up our five children so he could drive me to the Lehmann’s farm. When we got there Emma had everything all arranged—the farm and kids were all taken care of, she had washed the dirty dishes, the bed was made up with a plastic sheet under fresh linens, with another full set under that for after the birth, and she was walking around the house in her homemade nightie and slippers, grinning from ear to ear and blowing little puffs of air along with the contractions while Joel was nervously trying to work on a jigsaw puzzle she had assigned to him (to keep him busy and occupied, I suspect).
She walked around for a while, sipping juice and taking short trips to the outhouse every hour or so. The bedroom had a freshly painted commode by the bed so she wouldn’t have to leave the bedroom after the birth for ten days. A nightstand was set up with everything she would need to care for the baby and herself: diapers, a diaper pail, baby clothes, sanitary pads, and an oil lamp.
Things slowed down around four in the afternoon. I suggested she use the time to nap, but she was all business and suggested using “the combs.” I had never heard of this so she showed me the pressure points along the base of my thumbs, which she said can be stimulated to help with contractions. She made two fists around two small hair combs and, sure enough, she got the contractions going again in no time. About an hour later she made a beeline for the bedroom, had Joel light a kerosene lamp and hold it up for me, and propped herself up on the bed, though I could not detect by her breathing that things had picked up that fast, but after a couple more rather sedate, lady-like puffs, she started pushing. Bef
ore I could dribble oil on my hands to support her perineum, out barreled an eight-pound wood chopper who promptly howled his arrival. Leave it to efficient Emma! They hadn’t really needed me at all. They knew exactly how to do this.
Joel cut the cord, then picked up and held his baby while I helped deliver the placenta, which in Amish tradition would be buried under the eaves of the house. Then Joel spoke for the first time all day. He told me how with their first baby he had been so afraid of poking him with a pin while diapering him that when he finally finished and tried to pick up the baby he found him stuck to the bed—he had pinned the diaper to the sheets!
Joel looked down at Emma and said in his slow drawl, “Well, Ma, what should we name him?”
Emma said, “Oh, Pa, I dunno. What do you wanna name him?”
He replied, “Well, I dunno.”
After seven kids, surely they knew how to do this, I thought.
After a minute or so he added, “Maybe we should get the hat.”
Handing Baby Boy back to Emma, Joel got his black Sunday hat from its peg in the kitchen by the woodstove and set it on the bed. Then he cut up little pieces of paper and they both wrote down their favorite boy names, folded them, and dropped them in the hat. I still didn’t know where this was going.
Then Joel picked up the baby and gently put a little hand into the hat. When he did, the baby’s hand opened up as his arm was extended and then shut into a fist when it touched the bottom of the hat. He was supposed to pick his own name!
His father pried the scrap of paper out of the tiny fist, opened it, and announced, “His name is Elmer!” They both positively beamed at each other then, a long loving look into each other’s eyes.
Elmer could never blame them for the name if he didn’t like it. He had chosen it himself.
“F0r far too many women pregnancy and birth is something that happens to them rather than something they set out consciously and joyfully to do themselves.”
~Sheila Kitzinger
Chapter 5: A Circus of a Birth
Fast forward a few decades across the border in Minnesota. It was more of a circus than a birth. Bah’s family had recently emigrated to the United States from Southeast Asia. As was normal in their culture, her parents had married at fifteen; life expectancy in their experience was about forty-five. Bah was foruteen.
The family slept on homemade platforms at home, squatting on the floor to play cards, like in the old country. Gold jos papers were stuck to the walls to placate any bad spirits that might be lingering there.
Bah (not her real name) called me late on a Friday night to tell me that she was having contractions and wondering if it was time to go to the hospital. I offered to go to her home and hang out with her until it was time to go. She agreed.
The contractions weren’t very strong and by 4:00 a.m., now Saturday, they had petered out. They stopped altogether after a breakfast of whole fried fish, eggplant soup, and steaming piles of rice. I went home after breakfast, suggesting she rest and call me when the contractions were three to five minutes apart for a whole hour or her water broke, whichever came first. The call didn’t come until 11:15 that night. She wanted me to come.
Bah’s mother had given birth to nine full-term babies. Three had died simply because no one knew how to resuscitate them at birth. Her last baby was born shortly after they arrived in the U.S. She didn’t understand English, her labor stalled, and she ended up needing interventions that terrified and traumatized her. In the end, she jumped off the bed—IVs and all—and gave birth to her baby while squatting in a corner, surrounded by doctors and nurses screaming at her.
When I arrived back at their home, Bah’s mother told me that no one was to touch her daughter—no internal exams, IVs, Pitocin, medications, C-section, and no men, including male doctors. Understandably, she was projecting her fears onto her daughter. I told her we would try to labor at home as long as we could, though I couldn’t promise what she was asking.
Though Bah spoke English, her mother still did not. I had learned a bit of their dialect over the years, which helped a lot. I explained to Bah that her labor was going really well and she and her baby were healthy. We stayed at her home until things picked up about 2:00 a.m., now the third day.
I settled Bah and her mother into the hospital room and went out to brief the nurses. The head nurse wanted to know why Bah’s mother hadn’t been able to resolve some of her issues in counseling. I explained that she was from another part of the world where they don’t talk about these things, and certainly not with strangers.
The staff left us pretty much alone. After awhile the nurse asked if she could check Bah’s dilation. I told Bah’s mom very simply that the doctor wouldn’t come to deliver the baby if she wouldn’t allow a check. She said okay, but only one finger, and very gently. The nurse agreed. (Normally a vaginal bimanual or two-finger exam is done to track the progress of the cervix’s dilation from zero to ten centimeters.)
Bah was at eight centimeters. Great news. Though pretty worn out having now been up two days and two nights, I was surprised how well she was doing with the pain. Labor was slow but not unusual for a first baby.
An hour later an aunt showed up with an herbal potion that she claimed would speed things up. The doctor didn’t want to speed things up, especially since waiting can allow the baby’s head to mold well and stretches the mother naturally, but they insisted. So Bah drank the brew, which immediately started coming back up. I got to hold the bag. Just as she was getting cleaned up another aunt came and proclaimed that the reason her baby wasn’t coming was because she ate sweets and made her baby too fat. As soon as I could, I whispered to Bah between contractions that her baby was just the right size for her, not an eight- or nine-pounder, and her labor was going really well and how very proud I was of her.
Great Aunt showed up next and told Bah that her baby wouldn’t be born unless she apologized to her parents for the times she talked back to them. She apologized. They gave her more brew.
Then—I swear this is all true—three chubby middle-aged tribal pastors arrived, sent by the baby’s father’s clan, to pray over her. They walked in the door without knocking, looking like the Three Stooges in pinstriped suits that were too big for them. I asked Bah if I should send them away. She said they could come in for just a minute. They trooped to the bed, laid their hands on her head and prayed, on and on, through at least two contractions with Bah trying valiantly to hold still. Finally I said, “Amen!” and physically ushered them out, thanking them profusely: “Ua tsaug rau koj heev npaum li cas. Sib ntsib dua”— “Thank you so very much, bye bye.” Then I got a door sign directing all visitors to check in at the desk first and closed the door.
Finally Bah was ten centimeters and could push. Between the next two contractions she leaned into me and whispered, “No more babies. Never!” It took another hour but her little boy was born, crying right away. Grandma told us she would hold him first because the placenta wouldn’t come out if Bah held him, so we wrapped him in warm blankets and she held him after she cut the cord. She cried when she cut the cord and thanked us. I had tried to involve her as much as possible, hoping this birth might help heal some of her memories.
So Grandma was holding the little guy, who wouldn’t be officially named for a couple of weeks (the bad spirits might hear his name or hear someone say how cute he was and could take him away.) At this point, Bah started bleeding a bit too much and promptly fainted. An IV was started while another nurse massaged her uterus to control the bleeding.
Grandma had a total meltdown, threw the baby onto the lounge chair, and started shrieking not to touch Bah. The doctor had me explain hemorrhage and what they needed to do but Grandma was beyond reasoning with. She called the clan elders on her cell phone to hold a palaver (confer) and take her side. In their culture, no major decisions are final until the clan ministers have been consu
lted and pass down their decisions.
In no uncertain terms I told them that there were mothers dying in China after childbirth every day because they don’t know these procedures! At this point the doctor and nurses were all vigorously nodding. Finally, we got her to stop yelling. I helped Bah get the baby latched onto her breast properly, which would help the uterus clamp down and reduce the bleeding further, and he started nursing. Things settled down.
The next day I went back to the hospital to figure out the next step. In their tradition, a mother can’t return to her family after birth; she is “unclean” for thirty days. We wouldn’t want to incur the wrath of the bad spirits, but she couldn’t go to her boyfriend’s family either, because Child Protection was involved and wouldn’t allow it. The baby’s father, who was only fifteen, had a hearing scheduled that month; he was charged with statutory rape because Bah was under fifteen, the cutoff age for a “consensual relationship” in the U.S.
I had heard of another family in a similar predicament. They had built a hut in their backyard for the new mother and baby, probably something they had done in Southeast Asia, but this was in the middle of a Midwestern winter and, of course, the courts got involved then, too.
Bah’s doctor wouldn’t discharge her unless she was okay with whatever arrangement we could get the family to agree to. Finally, Mother Teresa’s nuns at the Missionaries of Charity shelter agreed to take Bah and her baby.
We had all learned a lot about cultural differences.
“However much we know about birth in general, we know nothing about a particular birth. We must let it unfold with its own uniqueness.”
~Elizabeth Nobel
Chapter 6: Due Dates or Guess Dates
One of my clients was told she was overdue and was becoming increasingly nervous, but unless a baby is conceived by artificial or in vitro fertilization, or the couple chart basal body temperatures and see ovulation occur, it is almost impossible to predict the exact date of conception and then calculate the due date.
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