The French Male Midwife
By Barbara Thomas
Issue 143 - July/August 2007
There are planned homebirths and, occasionally, unplanned homebirths. Mine was somewhere in between. My daughter, Ingrid, was born at home in Lyon, France, in the company of two men: my French husband and our French midwife. I'd originally intended to give birth in a clinic with the same midwife, but somewhere along the way, I changed my mind.
Already six months pregnant when I arrived in Lyon from Paris, I found my way to Cyrille Philippe, an independent midwife. Cyrille offered what's called "global accompaniment"—a highly personalized and holistic approach to pregnancy and childbirth in which a woman has the same caregiver before, during, and after the birth. The alliance can begin as early as with a couple's first questions about fertility and conception, and last through the first several months of a child's life.
I imagined a male midwife as a middle-aged hippie with a greasy ponytail, but Cyrille turned out to be a clean-cut man of about 35, who carried a Palm Pilot and rode a motorcycle. His gender, while unexpected, didn't bother me. I just hoped he'd take me on. When I arrived for our first meeting, his brightly painted office was buzzing with pregnant women and breastfeeding mothers. Beyond the waiting area were a changing table and a small kitchen with an assortment of tea and cookies. It was more like a home than a hospital.
"This is the way I see it," he told me. "Giving birth is like climbing Mt. Everest, and I'm your mountain guide. I'm here to help you get to the top." There are different ways of getting there, he explained. You can walk on your own two feet; or you can get someone to carry you (an epidural, an episiotomy).
And if things get really tough, there's a helicopter that will take you all the way up (a cesarean or forceps). In any case, you enjoy a beautiful view at the top.
How could I pass up such an opportunity? I'd never had my heart set on a homebirth, which sounded messy and inconvenient, so I opted for a small private clinic in the suburbs. (Surprisingly, France has no freestanding birth centers.) In choosing a midwife who practiced with full autonomy in a hospital environment, I figured I'd have the best of both worlds.
During Cyrille's birth-preparation classes, we went over such topics as rudimentary anatomy, the first hours of a baby's life (he suggested wrapping the baby in a piece of silk), breastfeeding, and the role of the father. In addition to Mt. Everest, my midwife offered more similes: Giving birth was like running a marathon, where you pace yourself before the final sprint; or like a game of cards, in which the mother, baby, and midwife are each dealt a hand; or like swimming at sea, alternately treading water and battling ocean waves. At times, these meetings were like acting classes in which we slowly shed our inhibitions.
Cyrille dropped by our apartment toward the end of the third trimester to make sure we had adequate sleeping, bathing, and changing arrangements. As amusing as the birth classes were, I felt seriously unprepared, intellectually, about how I was going to get the baby out. The two-hour home visit—during which Cyrille was part midwife, part psychologist, and part interior designer—was a big turning point for me.
I admitted to him that I was afraid—afraid of the pain in general, and of tearing in particular. At the same time, I was wary of any medical intervention. For some reason, it reassured me to hear that Cyrille could himself perform an episiotomy, if necessary, and that if I did tear, he could stitch me up afterward. Even I, a believer in the midwifery model of care, found it hard to appreciate the full extent of a midwife's training until it had been spelled out for me.
Just when all that had sunk in, Cyrille said, "You know, Barbara, what you've done so far and what you're going to do is beyond me. It blows me away. I know the mechanics of it, I've seen it a thousand times, but I'll never know what it is, really."
I beamed with pride. Instead of intimidating me with his medical authority, Cyrille was defending my natural capacity as a woman—which, in fact, had been at work all along. I began to understand childbirth not as an isolated event but as part of a continuum. Pregnancy prepares you to give birth, which in turn can prepare you for later challenges. There just may be some significance in allowing the natural birth process to unfold. I realized that I couldn't control the timing or intensity of my labor, and that no matter how many books I read, my body would always be more prepared than my mind. At last I felt ready to take this leap of faith.
Had I had more time and choice, I probably would have chosen a woman midwife. But the dynamic of having a "midhusband" grew on me—this combination of strength and humility, and the unique sense of empowerment it gave me. The term midwife ("with woman") and its French equivalent, sage-femme (sage referring to wisdom or knowledge, in this case, regarding childbirth), are actually gender-neutral, though they have come to be understood as feminine. Because it feels funny to refer to a man as such, some male midwives in France, including mine, have adopted the term maieutician. From Greek philosophy, maieutics is the art of giving birth to ideas or truth, using the dialectical method devised by Socrates and named after his mother, a midwife (maia means mother, maieutikos means midwife). Philosopher as midwife, midwife as philosopher: The idea has come full circle.
Cyrille proposed to all his clinic-bound patients that he first come to the house, and then escort us to the clinic, an idea that pleased me immensely. Yet on two different occasions, when talking about recent births he had attended, Cyrille intimated that the transfer to the clinic had interrupted whatever rhythm they'd begun at home, which took a while to resume. It made perfect sense, and it made a profound impression on me. I wanted to stay home as long as possible, but could I really have it both ways? Already, the plan was changing from "Midwife will come, then we'll go to the clinic" to "Midwife will come, then we'll see ..." It was a thought only half-formed, but it stuck with me.
After the midwife's home visit, I didn't expect him back so soon. When my water broke one evening around ten o'clock, two weeks before my due date, I was incredulous. It wasn't a gush or an "Ah-ha!" experience, just the feeling that my bladder had failed me as I was on my way to the bathroom. But the water kept coming, and as I walked back down the hall, I left a wet trail behind me. Still, I was determined to keep cool. It could be a false alarm, and besides, I wouldn't necessarily start having contractions right away.
When I called Cyrille, he, too, remained calm. Reminding me that, once the water breaks, it's important that contractions begin within the next day or so in order to avoid infection, he told me to clean up, go to bed, and call him if I started having contractions. Otherwise, we'd talk in the morning and arrange to go to the clinic for a test.
As I settled into bed, preparing for the big day ahead, my husband, Emmanuel, paced the room. "You're going to be a mother!" he cried. Grabbing my hospital bag, he ran out to pull the car up to our building. When he finally came to bed, he refused to remove his shoes or turn off the lights. I was trembling with anticipation, but I didn't want to get hysterical. I didn't want to rush to the clinic, or call my midwife in the middle of the night, for nothing. I didn't want to be the one to cry wolf.
Sure enough, I began having mild contractions at midnight. After an hour of cramping about once every ten minutes, the next phase of stronger contractions got me out of bed and into the living room. Like a wild animal in retreat, I pulled a wool blanket over my head and curled up on the sofa, but rest proved impossible. I began to make noise. I was down on my knees, groaning through the sharp pain in my lower back. I made frequent trips to the toilet, hoping in vain to relieve the pressure. Finally, I stripped off my sweat pants, and that was that. I was going nowhere.
I became very single-minded. I just needed to be here, in this room, and get through this. Everything else became superfluous. I'd already dismissed the idea of car and clinic, both unattractive options at this point, but I knew that, sooner or later, I'd have to call the midwife. As amazing as it sounds, I wasn't sure I was ready for his presence, so fierce was my desire to be alone. I didn't want any eyes on me, and even pushed my husband away. Emmanuel was no doubt also thinking of Cyrille's marathon analogy, but he read my cues perfectly. He became practically invisible, supporting me by giving me space and never second-guessing me.
I looked at the clock and fretted. Almost 1:30 a.m. Couldn't I just hold out till five, a decent hour to call? At the very least, I would gather some data before I called. But it was no use trying to time the contractions. They were coming so fast and so strong that I couldn't get my head around any of it. In fact, my labor was such a perfect crescendo that, once it began, I never looked back. I was completely inside it.
When I finally called Cyrille at two o'clock, he must have sensed my reluctance. Through a yawn, he asked, "Do you really think the baby will come tonight?"
"I don't know," I replied. I put the phone down and grimaced through another contraction.
"OK," he said, unconvinced. "I'm going to come over." He would come over and faire le point—take stock of the situation.
As soon as I hung up, I panicked. Faire le point? That wasn't it at all! We were way beyond that—and yet I had grossly understated my case to him. I had misled him, and now he was going to take his own sweet time getting here.
Emmanuel stepped in just as I was moving into a higher gear. He immediately called Cyrille back, and I was so grateful. He told him to hurry, that this time we were serious, then handed the phone to me. Cyrille's voice sounded completely different, startled and alert. We were on the same page now. I asked him if it was OK to scream. He said it was, and then he gave me one lovely piece of advice. "Welcome the contractions. Let them come in."
And that's what I did. My heroics consisted not of pushing and heaving, or an eye-popping burst of will, but simply of releasing and staying out of the way. Of saying, "Yes, this is good, let it come in"—even though there was good reason to feel otherwise. My job was to not resist or interfere with these primal forces, not to tense and close up when my body wanted to open and the baby wanted out.
There was too much action, too much life force for me to feel that we were in any danger. But I did have a fleeting moment of regret: Now I understand why women have the epidural. What was I thinking? I've made a terrible mistake. Then, without skipping a beat, I thought, Thank goodness I'm at home, where I don't have to make that decision and no one is undermining my efforts. So I may as well get on with it. Perhaps through some inner wisdom, or just plain pride, I had managed to simplify my task, to labor in the utmost privacy and create what turned out to be optimal conditions for me.
At three o'clock, Emmanuel greeted Cyrille on the street as he pulled up on his motorcycle, and from there they heard the sounds of the marathon's fast-approaching final sprint. When Cyrille examined me, he found that the baby's heartbeat was fine, my cervix was fully dilated and effaced, or stretched, and he could feel the baby's head just above the perineum.
"Wow, Barbara," he said, his eyes shining. "The baby is right here and ready to go. I don't think we're going to make it to the clinic." Emmanuel and I exchanged glances. That wasn't news to us, but Cyrille was excited—these were the moments he lived for. As for me, I knew the worst was over, and was glad not to be alone anymore.
When the midwife first walked through the door, I felt very powerful and womanly in the throes of labor. Cyrille calmed me down, harnessing and directing my energy down toward the birth canal by having me breathe in short, deep breaths and make low guttural sounds, rather than diffusing my energy through high-pitched screams.
For one contraction, Cyrille got down on all fours, making a table with his back for me to lean on. Then, after the crowning, he prepared me for the emergence of the head, recalling that I'd been afraid of tearing. But I couldn't feel that fear anymore, only adrenaline, and, with me on my hands and knees, the baby's whole head emerged. A flood of relief and excitement overcame me, which I saw reflected in Emmanuel's face—but he also wondered if the baby could stay in that position without strangling. Cyrille assured him we could wait for the next contraction, and we rearranged ourselves—now Emmanuel sat on a chair and supported me under the arms as I squatted before him. And with one last surge, Ingrid slipped out into Cyrille's hands. It had been only about 20 minutes since Cyrille had arrived.
The baby's legs were a mile long. How in the world had she fit inside me? My entire pregnancy flashed before my eyes: every flutter, every kick, every hiccup ... it had been her all along, a living creature inside me! Emmanuel and I were in awe of such vitality, this complete being before us. She looked calm and clean and perfect. It was obvious she was OK. I only had to wonder if I was OK.
Cyrille reminded me that I still had to deliver the placenta. Ingrid wasn't much interested in nursing, and the contractions were now feeble at best. Cyrille massaged my stomach and, as I mustered the last of my energy, I realized that until now, I'd never had to push.
Perhaps the best part of a homebirth is the aftermath. I needed some time to process and let go of the pain I had endured, and with the midwife, there was no rush, no rules, no schedule. I'd fared pretty well—no tearing and no stitches, just some minor lacerations, on which Cyrille sprinkled powdered green clay to help the healing process along. I also took granules of the homeopathic remedy Arnica for the soreness. Ingrid was never whisked away to be bathed or fed. In fact, we didn't bathe her at all those first two days. I'd also learned that a newborn doesn't need to eat or drink in the first 24 hours; she has enough reserves to get by. So while I gently encouraged her to drink the colostrum, we were able to begin breastfeeding at our own pace, without interference.
There are few sights as beautiful as a man holding a newborn baby with confidence and ease. Ingrid seemed so safe in the arms of our midwife that we figured he'd either have to adopt her or move in with us. But nature has its way of propelling us into our new roles. The secret is to stick together. How wonderful it was to lie down to sleep with Ingrid on my chest and my husband beside me. A miracle had just occurred in our little home, but as yet no one else knew it. We would call my family in California later that morning, and our friends and family in France would wake up with a cellular text message: "Ingrid was born at home!" The apartment would soon fill with flowers, including a bouquet from the mayor of our district (because there are no clinics or hospitals near us, Ingrid's was the first birth recorded in our district in over a year). But for now, we had the place to ourselves.
Cyrille came over several times afterward to help with bathing and breastfeeding. On his last home visit, we each shared our version of the birth story. There had been many births in the world that day, and there had been many more since, but it didn't feel that way. Naturally, I worried about the day when all this personal support would disappear and we'd be left on our own.
But the "global accompaniment" our midwife offered allowed us to ease out of the relationship gradually. Until we'd settled on a pediatrician, we went to Cyrille's office for the baby's first checkups, and I signed up for his "perineal rehabilitation" classes, where I was reunited with other women in my birthing group. (In its various forms, this yoni-toning series is available to all women postpartum, and is fully covered by France's health care system—mais oui.) We were still part of this midwife community, only now we were on the other side, with babies in tow.
There are many ways in which our homebirth was unplanned. There were no diapers in the house, and, instead of covering our bed with a plastic sheet, Emmanuel had improvised with bubble wrap and towels on the living-room floor. He found a salad bowl for the placenta, and, as my bag was in the car, rummaged through my closet to find a pair of panties and a nightgown. There was nothing sterile about the scene—no hospital gowns or masks, just a half-naked woman and two men dressed in black. The Southern California clothes I had received at baby showers weren't right for the weather, so we wrapped Ingrid in an old wool blanket, germs and all.
Then again, we weren't entirely surprised, nor was the midwife. We had paved the way for a homebirth through our flexibility, our prepared and open minds, our presumption of health and well-being until proven otherwise. It wasn't an accident. It was a choice.
The Saturday after Ingrid's birth, I ventured out by myself for the first time. As I walked up to the farmers' market, I wondered which of us was the newborn. My senses were so sharp, so aware of everything, as if I were seeing the world for the first time. The sleeping baby at home, the one who looked up at me with those big eyes, seemed so full of intelligence, so close to the source of knowledge. I felt the warm sun on my face. Ingrid had arrived, and with her the spring. I took in the clear blue sky, the plane trees lining the boulevard, the pastel facades, the merchants selling their produce. Everything was as it had been, and yet unlike ever before. Yes, I thought, it's a nice view from the top.
Suddenly, I missed Ingrid. I missed her with my whole body. I turned around and hurried home.
Barbara Thomas lived for ten years in France, where she taught English and Iyengar yoga. She is currently back in her hometown of Los Angeles, California, with her husband, Emmanuel, their daughter, Ingrid (4 years), and son, Aidan (5 months), who was born at home, according to plan.