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Bringing Homebirth into the Hospital
By Debby Titlebaum Neuman
Issue 141 - March-April 2007
When I was pregnant with my first child, I knew that I wanted to birth at home. I also knew that in Israel, a country with socialized medicine, homebirth was costly. We couldn't afford it. So I became determined to do whatever it took to have a "homebirth" in the hospital.
As I began reading natural birthing literature, I resolved to tap into my instincts, connect with my child, and ensure a delivery free of intervention. I realized that my chances of natural birth were greater with the right doula. Luckily, I found Ruth.
As my pregnancy progressed, my husband, Avi, and I spent a lot of time with Ruth, who gave us our own personal childbirth education class. We talked about our expectations and fears of birthing. She gave me shiatsu massage treatments. We spoke about the ways in which each of us wanted to be supported, and the need for all of us to be open with one another throughout the birthing process. The three—four—of us were building something, and over time it grew more and more solid.
I was also building something on my own: spending three mornings a week in regular yoga practice, walking daily, eating well, giving and receiving massage, and always checking in with my baby. While walking to and from work, I would talk to her and ask her things, or simply tell her what I was thinking and doing.
Two weeks before I was due, I remember telling the baby that I would be sure to do everything to help her come into this world in the smoothest possible manner. Suddenly, I had a realization. I said, "Actually, you have to lead me—you are much purer and closer to knowing what is real. So I will listen to you. I will open myself and hear what you have to teach."
A week before my due date, while I was hanging out at home with Avi, my water broke. We stayed home cooking, listening to music, getting excited, enjoying the rush of energy we were feeling. We told Ruth we wanted some time alone, and she joined us four hours later. We had noticed that the birthing waters contained some meconium—a dark-greenish substance found in the digestive tract of the fetus that is usually discharged shortly after birth—and decided that it was safest to head for the hospital.
I had already packed bags full of things to make my hospital time more like home: food, music, candles, pillows, oils, books, and birthing cards I had made with words of inspiration and visualization exercises. Ruth drove, and Avi and I sat in back. During the 45-minute ride I had two contractions—incredible rushes of raw energy. All of my bodily senses were on high alert—the city lights were shining so brightly, and the world was so beautiful. I felt calm, and determined to bring this beauty into the hospital with me.
Once admitted, I was hooked up to a fetal monitor. I took everything in stride, knowing that being in a hospital meant dealing with some technology and procedures. When I needed to go to the bathroom, the monitor was taken off. We told the nurses that I had to use the bathroom a lot, and therefore it would be easier if we could hold the monitor in place by ourselves. They agreed, and I was free to roam as I pleased.
At this point I was having few contractions. I had told the admitting nurse that my water had broken just before we arrived, but the truth was we were already about five hours into labor. Ruth felt that if contractions did not begin to come regularly, the hospital staff would want to chemically induce labor.
Ruth began using acupressure to encourage stronger, more regular contractions. It was amazingly effective. Ruth and Avi would push on points, and within seconds I would feel the wave as a tingling in my fingers and toes. The energy would then build and slowly overtake me. Ruth advised me to close my eyes and invite the contractions to get stronger and last longer. I did, and was soon experiencing regular contractions. Avi and I walked outside under some trees, and when a contraction came I would grab a branch and squat. It felt so natural, primal, and true to the essence of birthing.
When we came back inside, we put on some mellow music and ate some beans and rice. I sat on a birthing ball and we hung out. Meanwhile, the contractions continued. Up to this point no one had checked my dilation, and now one of the nurses came in to do so. I had always joked that I would be a woman whose cervix would be dilated ten centimeters and not even know it, but the nurse discovered that I was dilated only three centimeters. I could have accepted this with ease, but she seemed to feel that the baby's presentation was not head-first. Three days before, I had been at the doctor and the baby's head was down. The nurse called for an ultrasound, which revealed that our baby was presenting breech. The doctor's exact words were "Your baby is breech. You will have to have a cesarean section." We were in shock. My pregnancy had been healthy, and up to this point the labor had been relatively smooth. We didn't know what to do. I sat on the bed, still surprisingly calm, aware of my surroundings but maintaining connection inside.
Around me began a hustle and bustle. A nurse approached with an IV. I refused, saying that I'd been drinking plenty of liquids and would continue to do so. She told me I needed to stop drinking because I would be having surgery. I retorted, "I have not yet decided that I am having surgery." The doctor then said, "We will not deliver your baby at this hospital any way other than C-section."
The surgeons arrived and waited outside the door. Amid all the noise, Avi, Ruth, and I were trying to maintain communication. Every few minutes a new doctor would come in and pressure us to get moving toward the operating room. Avi asked one doctor to tell us the exact presentation of the baby. The doctor responded that it was breech and that the exact presentation was not important. Luckily, my husband and I were well informed. When Avi then described the four types of breech presentation and their varying degrees of danger, the doctor began to take us a bit more seriously. It turned out that our baby was a complete breech—sitting in lotus position. While considered not as easy to deliver vaginally as a frank breech (butt first, legs straight up), this was certainly a less risky position than a footling breech, in which the first part of the baby to be born is a single foot. When our daughter was born, the first parts of her to emerge were her butt and one heel, followed by her legs, then the rest of her torso, and at last her head.
Other doctors came in—I think we met the entire staff that evening—and each delivered a monologue about the dangers of vaginal breech delivery. Finally, the fourth doctor admitted that they would assist in natural delivery if that was our choice, though of course she strongly advised against it. By this time I wasn't sure that I shouldn't have a C-section. But I was sure that I needed some time and space to make the decision that would be right for me and my baby. The doctors refused to give us that space, so Avi, Ruth, and I locked ourselves in the bathroom to focus and think. Ruth told us that she had been present at successful vaginal breech deliveries, but that, ultimately, we had to make our own decision. The most important thing, she said, was that once we did decide, we look only forward, without fears or regrets. Locked in that hospital bathroom, the three of us were remarkably focused and calm. Over the next hour we stalled in many other ways. Avi was tough with the doctors, letting them know that they needed to stop bothering us so we could think.
I was in labor during all of this, and regularly had to stop the talking around me to focus with my baby and breathe through the strong contractions. My seven months of yoga and meditation really paid off. I was actually capable of blocking out everything and being totally present with each contraction.
After an hour had passed, the doctors stepped up their pressure on us. They were frightened that if we waited too long, we might have to have an emergency C-section. But we were still uncertain. Luckily, Ruth suggested that we take things one step at a time. I requested that, before we made any decision, a doctor check my dilation and see how the labor was progressing. I got on the bed and one of the doctors examined me. "Oh my G-d!" he exclaimed. "How do you feel?"
"Fine," I told him.
"She's fully dilated!" he announced. Despite the chaos all around me, in just an hour my cervix had opened from three to ten centimeters. All indecision dissipated. I knew that this baby was doing her part to come into the world naturally. I looked at Avi and knew that he was thinking the same thing. There was no fear, no confusion, no questioning—only certainty that we should listen to the cues our child was giving us. I told the doctor that I wanted to deliver naturally. He left, and quickly returned with a pile of release forms for me to sign. I walked to the delivery room, a few doors down the hall. At my request, Avi put on repeat play a song based on Psalm 121: "I lift my eyes to the mountains. From where does my help come? My help is from G-d the maker of heaven and earth." The song played continuously.
At this point the staff requested that, even though I felt a strong urge to push, I restrain that urge. They wanted to allow the baby time to travel farther down the birth canal. But my entire body was begging to push the baby out. During each contraction, Avi forced my pelvic bones together as I looked into Ruth's eyes and did focused breathing.
It was so intense. But I knew I couldn't ask for a progress report, and I definitely couldn't complain. I needed to cooperate with my baby, the same way she was cooperating with me. After each contraction we sang along with the music and I closed my eyes, relaxed, and smiled in anticipation of meeting my first child. Seeing how effective our teamwork was, the doctors gave us our space and the freedom to do whatever we needed. Finally, I was told that I could begin to push. I pulled on a sheet tied above the bed as I pushed the baby out. In the background, the song was still playing. At one point the doctors said, "We can see the butt and your baby is pooping." I laughed. All of us—the doctors included—started singing the song from Psalm 121.
It was so powerful to be in a hospital delivery room with doctors who were entering our energy. After only a few pushes, I could feel a burning sensation. I knew the baby must be very close to being born. I pushed once more and the baby was through! It was such a relief. Then Avi said, "You still have to push out the head." I mustered all my strength and, with one more solid push, her head came flying out.
Avi smiled and burst into tears. I held our baby, looked deeply into her eyes, and thanked her for her strength and partnership. The doctors sat around us in awe. While serving on a routine night shift, they had been privileged to witness the intense raw power of a homebirth—in a hospital. Now that all was safe, they freely spoke about how intoxicating the energy had been.
Our daughter sat in Avi's lap while I delivered the placenta. She gazed slowly around her, relaxed and peaceful.
She had entered the world with tranquility and song. At a time that might have been full of fear, noise, intervention, and trauma, we had tapped into the certain, quiet, natural force of birthing.
Debby Titlebaum Neuman is a mother, massage therapist, teacher, gardener, cook, and writer. She lives on the edge of a wadi outside Jerusalem with her husband, Avi, and two incredible daughters, Kirvayah Maayan (2 1/2) and Anayah Ohr (9 months). She is studying to be a doula.
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