Off Her Back

By Cynthia Overgard
Issue 145, November/December 2007

The author with her husband and newborn sonThe summer I learned I was pregnant, the notion of making a commitment to natural delivery in a birth center—without doctors or pain relief of any kind on the premises—was furthest from my mind. Like many other newly pregnant women, I reluctantly envisioned my hospital birth to mirror that of every other actual and fictitious birth I had ever heard about: Agonized and disoriented, I would be rushed urgently into a medical scene amid bright lights, confusing equipment, and an assortment of intense, unfamiliar faces. I envisioned myself in the usual, dreaded position of lying on my back, my knees bent, nobly trying to resist an epidural for as long as possible before acquiescing to that temptation, praying all the while that my baby and I would not be harmed by the anesthesia. This vision, unsettling as it was, had been far too deeply ingrained by society and mainstream media for me to have realized that I actually had a choice in the matter.

t the same time, I had become haunted by the number of cesarean sections—both emergency and elective—I was hearing about. I dreaded the possibility that my obstetrician might choose to deliver my baby by C-section without irrefutable evidence that the procedure was necessary. It stunned me that the rate of C-sections had quintupled in my lifetime,1 and while I had met some women who spoke positively of the procedure, which had quickened their labor and eliminated the daunting effort of having to push out a baby, my own simple curiosity held me to the opposite position: If my body was capable of doing something so astounding as producing and delivering into the world another human being, then I intended to experience that miracle for myself.

The myth of my first trimester: childbirth requires medical care
One evening, while conducting research on the Internet about pregnancy and childbirth, I happened on a website in which a mother shared the details of her natural homebirth. Within moments, a longing formed within me—I saw that easy, natural birth was indeed possible; I just didn’t believe it was possible for me. Emotionally unready to consider it further, I gave myself precisely what I needed in that moment: permission to stay on course with a conventional hospital birth, like every other rational, educated, metropolitan New York woman I knew.

I did, however, take something away from that website—recommended reading: Henci Goer’s The Thinking Woman’s Guide to a Better Birth.2 Like the moment I shook my husband’s hand for the first time, my purchase of the book presented itself as a casual gesture rather than the life-shaping blessing it turned out to be.

With Goer’s book as my primary resource, I began to educate myself about the complexity of our nation’s obstetrics industry. My education came at a cost: an ever-increasing fear of the very hospital birth I had planned. Stunned to learn that doctors were held to revenue targets at the hospitals in which they practiced, a cynicism grew within me. Soon I understood the risks associated with medical intervention in the delivery room: Even seemingly innocuous procedures, such as the use of an electronic fetal monitor, suddenly looked like threats. I discovered that each form of intervention would increase the odds, often dramatically, that a further, more drastic procedure would then be necessary. Electronic fetal monitors, Pitocin, cesarean sections, amniotomies, epidurals, episiotomies—they all formed an entanglement of interdependent risks and complications.

At my 12-week checkup, I asked my own obstetrician a straightforward question: her cesarean rate. Her response was that she had no idea; the obstetrics practice hadn’t bothered to calculate those numbers in years.

“The national average is around 27 percent [2003],”3 I said. “Would you guess this practice comes in higher or lower?”

“Definitely higher,” she said.

Anxiously, I demanded to know how much higher. “Is it greater than 30 percent? Thirty-five percent?” She looked at me regretfully. I pressed on. “Forty percent?!”

She finally nodded. “Yes, at least, but I don’t have exact numbers.”

Incredulously, I asked why they were performing such an extraordinarily high rate of C-sections. Were they elective, or did the obstetricians in her practice really feel that life-or-death situations were so frequently at hand?

“Yes, some are elective,” she began. “Many women feel they would prefer to have their own doctor perform a cesarean rather than take the chance of delivering vaginally with a less familiar doctor from the same practice.”

And you actually give merit to that choice? I wanted to ask. Major surgery, unnecessarily performed as a matter of familiarity and convenience?She continued: “As for emergency C-sections, for starters, the baby could be breech, the placenta could be too low in the uterus, or the cord could be wrapped around the baby’s neck. The mother could be too old, too heavy, or too thin. Or she could experience failure to progress—we like to see at least one centimeter per hour. Other concerns arise when the baby is overdue, premature, too big, or if the mother has a condition such as gestational diabetes or is carrying multiples. And I’ll be honest with you: Litigation plays a big role.”

That early in my pregnancy, I still wasn’t aware of the medical risks associated with cesareans for both mother and baby, nor was I aware of the respiratory benefits a baby receives from its passage through the birth canal. I was also unprepared for the “litigation argument” so frequently used by obstetricians, which, though arguably legitimate, successfully manipulates pregnant couples into inferring that a cesarean is actually the safer method of childbirth.

I nodded soberly as she spoke, reminding myself that I was strong and adaptable, and that the only outcome that truly mattered was a healthy baby.

In the following days, as I became increasingly uncomfortable with my obstetrician’s aggressive approach to C-sections, I learned that hiring a doula—a labor assistant—would reduce my odds of experiencing medical complications during the birth.4 My husband, Eric, and I decided that we had nothing to lose. When we hired our doula, we unknowingly took our first step away from conventional labor preparation, and we began our eventual transition to childbirth independence.

The myth of my second trimester: doctors act in my best interest
At the completion of my 16-week checkup, my obstetrician caught me off guard when she requested I come back for a visit between our regularly scheduled visits. Rather than return at 20 weeks, she suggested I squeeze in an extra checkup at 18 weeks so she could perform another “routine” sonogram. With four fetal ultrasounds already under my belt, I was both confused by and uncomfortable with her request. I had recently learned of the controversy surrounding fetal ultrasounds, and understood that three sonograms during an entire pregnancy was the standard recommendation.

I insisted on knowing why I was running such a high tally, and why she was requesting biweekly appointments during my second trimester.

“Don’t worry, everything is perfectly fine. We just want to make sure that baby of yours isn’t getting too big.”

Too big, at 18 weeks’ gestation? Even so, what could she possibly suggest we do about it?

Bewildered by the sonogram discussion, I suddenly remembered to ask if our doula could attend the birth with us. She shrugged. “Sure, if that will make you more comfortable. Just make sure your doula remembers who’s in charge, okay?”

I nodded obediently. On my way out, I passed the appointment desk without scheduling the 18-week sonogram.

That evening, I called our doula to report what the doctor had said. She stated plainly, “Of course I remember who’s in charge. You are.”

I am? I nearly cowered at the thought.

The following morning I telephoned my obstetrician’s office and asked them to prepare a copy of my medical file: I was leaving the practice. And, just like that, I allowed room for an alternative birth choice to present itself.

Later that night, I wound up in a disheartening, circular thought process: Where would we deliver our baby? Then my husband and I discovered that Connecticut’s only freestanding birth center was an hour’s drive away from us. We decided to visit the Connecticut Childbirth and Women’s Center the following day to take a tour of the facility.

After an enjoyable, hour-long question-and-answer session with the midwife director, we were led away from the examination rooms and upstairs to the beautiful birthing suites. I was struck by the setting—the plush double bed, hardwood floors, and floral window dressings were reminiscent of a New England bed-and- breakfast. We walked through the bedroom and into the large, marble bathroom, complete with a freestanding shower for two and Jacuzzi bathtub. As we walked, the midwife said, “You can deliver on the bed, in the birthing chair, on the floor, standing up, sitting down, lying on your side, in the shower, or in the tub. We ask only that you not deliver lying on your back—it would be uncomfortable for you, and it’s least optimal for the baby.”

“Is it ever difficult for you to receive the baby if the mother chooses an unconventional position?”

“No,” she smiled. “Remember, this isn’t about our convenience and comfort; it’s about yours.”

From that point on, I kept every remaining prenatal appointment at the birth center, cheerfully driving an hour each way through the cold winter.

The myth of my third trimester: childbirth must be painful
Perhaps to strengthen my resolve, I immediately began telling everyone—friends, business colleagues, relatives—that I was planning a natural delivery in a birth center. All the while, I quietly nursed the hope that I would come across another woman who had experienced her own drug-free birth. Initially, it was a discouraging process.

Aside from my own family, who had unanimously applauded our decision, the general lack of encouragement I received—particularly from other women—was staggering. Finally, a well-meaning friend told me she was sure I would succeed if natural labor was what I wanted, before adding, “But just so you know… being in labor literally feels like having your insides ripped out.”

From then on, I ceased to seek others’ opinions. Their opinions continued to flow freely, but I was becoming impervious to negativity. My doula gave me a pin to wear that read, “Only happy birth stories, please. My baby is listening.” Though I didn’t wear the pin, I adopted a new mindset that prevented words and images from threatening my resolve.

I knew that the birth might be painful. For example, the baby might not be in the optimal downward-facing, anterior position. Also, medical interventions such as having one’s water broken, or the administration of Pitocin, were notoriously painful procedures to which my midwives, thankfully, would not resort, regardless of how supposedly “overdue” our baby was.

Meanwhile, as my husband and I worked privately with a wonderful HypnoBirthing instructor, I learned that my own tension and fear were the greatest threats. A single negative thought during the birth could release enough adrenaline into my body to stall or even stop labor completely. It made sense to me: After all, animals, who are not conditioned to fear labor, don’t cry out during delivery as if trapped or wounded. Thus, the mother’s primary job is to get her mind out of her body’s way and allow nature to achieve what it has set out to do. Eric and I believed in the method, and each night I envisioned a happy, trouble-free labor.

When I went into labor, my contractions were immediately three to four minutes apart, and I was six centimeters dilated when we arrived at the birth center an hour later. The midwives were cheerful on our pre-dawn arrival. One exclaimed, “Just imagine, Cynthia, you’re going to meet your baby today!”

In the warm Jacuzzi bathtub, with my husband and four confident, smiling women encircling me, I envisioned my body opening up. I reminded myself that the more I relaxed, the faster I would dilate. The HypnoBirthing technique apparently worked—I was at ten centimeters within the hour. I had been taking long sips of water and engaging in relaxed conversation between contractions. The pushing stage, however, was more intense, and required all my focus and energy. Our doula held a cool washcloth to my forehead while pouring warm water over my shoulders. She whispered, “Look outside, Cynthia. The sun is rising.”

Her comment awakened me from the intensity of the moment. The March morning was clear; reds and oranges spread abundantly across the mountain range. I was happy for our baby: what a beautiful day to be born. More important, our baby would be born to a mother who felt calm, safe, and loved. I was overcome with gratitude for whatever serendipitous course of events had brought us here, and for the relief I felt when I suddenly thought, If I weren’t delivering here, at this very moment, then where?

From beginning to end, my labor had lasted just three-and-a-half hours—extremely short for a first-time laborer, but precisely the average for mothers who practice HypnoBirthing, I was told. Despite the fast labor, my small frame, and my baby’s hefty size of 8 pounds, 14 ounces, I had one tear so minor that it required only a single stitch.

When the post-birth examination was complete, we were encouraged to take a few hours of private family time to rest in bed. Nestled snugly between mother and father, our son, Alexander, gazed contentedly into our eyes.

Birth is a personal choice that women need not surrender to others. Making that choice takes—and breeds—emotional courage. My husband and I had conducted countless hours of research, challenged one another with complicated questions ranging from the logistical to the moral, and consistently faced opposition from a well-meaning society. Eventually, we quieted the outside noise and discovered our own articulate voices. We discovered a great empowerment, both individually and as a couple. And of all that we learned, one truth spoke most clearly: It is the right of every woman to pursue her own child’s birth—at home, hospital, or birth center—with the information, honor, and freedom to which she is entitled.

NOTES
1. Centers for Disease Control and Prevention, “Rates of Cesarean Delivery—United States, 1993,” Morbidity and Mortality Weekly Report 44, no. 15 (21 April 1995): 303?307; www.cdc.gov/mmwr/preview/mmwrhtml/00036845.htm.
2. Henci Goer, The Thinking Woman’s Guide to a Better Birth (New York: Berkley Publishing Group, 1999).
3. Fay Menacker, DrPH, “Trends in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women: United States, 1990?2003,” National Vital Statistics Reports 54, no. 4 (22 September 2005): www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_04.pdf.
4. See Note 2: 179.

Cynthia Overgard lives in Fairfield County, Connecticut, with her husband, Eric, and their son, Alexander. She is a certified HypnoBirthing practitioner and freelance writer. Additionally, she holds an MBA from Fordham University and teaches finance at the University of Connecticut.