Pregnant people and babies deserve a positive, affirming, supportive birth experience. We should set the bar for birth care higher than “not dying.”
My partner and I were so unprepared for a hospital birth, we didn’t even have a bag packed. We spent 42 weeks planning for my partner to give birth to our daughter at home, reading every book on the topic we could, practicing support positions, and having regular checkups with our home-birth midwife Jen.
“Aren’t you scared?” our friends and family members asked us over and over. And truth be told, we were. We were scared of exactly what ultimately happened: ending up, despite all our best efforts and intentions, in a hospital. Charlie wanted a physiological birth – no epidural, no episiotomy, no C-section. We envisioned a quiet, intimate transition to parenthood, attended only by ourselves and one birth worker: someone who knew us well and respected our queer family and Charlie’s role as a genderqueer birth dad.
A few people did try to talk us out of our birth plan. “If something goes wrong, you want a doctor there,” they said. “In the end, nothing matters except that the baby is healthy.”
Can everyone stop saying that to pregnant people? Please?
Of course the health of the baby is at the top of the priority list, but that doesn’t mean everything else is meaningless. The experience of giving birth matters. If the baby is healthy but the birthing parent is mistreated, injured, or traumatized in the course of giving birth, that is a suboptimal outcome. The final decision, after considering the risks and benefits, can only be decided by the parents in question – but parents should be offered more information about, and access to, the available options. In a perfect world, birthing parents would be able to receive a more physiological, less interventive approach to prenatal and perinatal care in hospitals as well as at home. Unfortunately, many hospitals just don’t offer that kind of care – but a new study suggests that doing so could improve outcomes for parents as well as babies.
According to this study, states with greater inclusion of a midwifery model (allowing birth to happen on its own time, with continuous care but minimal interventions) onto their health care system have fewer obstetric interventions and less adverse neonatal outcomes. The best scenario for parents and children is one in which midwives and OB-GYNs work together for the good of the patient. But in too many cases – our own family’s included – the midwifery model is totally unwelcome and treated with hostility in a hospital birth.
In our state, a midwife cannot legally attend a home birth more than 13 days past the due date. So two weeks after we’d expected to greet our daughter – but with no other complications – we found ourselves checking into the labor and delivery ward. We brought a change of clothes and a box of crackers, but no toothbrushes or other toiletries. I spent most of our daughter’s first day on Earth weeping from Prozac withdrawal. Stay on drugs, kids!
Our midwife, who we had already paid out of pocket because Kaiser doesn’t cover midwifery care at all, came with us to act as our doula. Although we were clear that she had been providing the majority of Charlie’s prenatal care, the doctors working that night didn’t consult with her at all. Neither of our doctors had ever – not once in their careers – attended an unmedicated birth.
In the midwifery model, the same caregiver is present for the whole birth, or as much of the birth as possible. In the hospital, there were two doctors to a whole floor of patients in labor. The nurses wanted to hook Charlie up to a fetal heart monitor, so they could track the baby’s vitals without actually being in the room. When he protested that he wanted to stay in the hot shower and asked that they check the baby’s heartbeat with the handheld Doppler instead, they handed the device to Jen and left us alone for three hours.
Finally, I went out into the hallway to see if any doctors or nurses felt like joining the party. Two physicians and a couple of nurses bustled in, snapping directions as though we were the ones holding things up. They tried to get Charlie to lie down in bed, but he crouched next to it, supporting himself on the bedrail. Jen and I squatted down next to him and, at her instructions, squeezed his hips to help open his pelvis. “I hope you don’t think I’m getting on the floor to deliver this baby,” the attending physician fumed.
Finally, the doctors convinced Charlie to climb up on the bed, still squatting. “This is not a safe position for giving birth,” the attending insisted. “She’s going to have third-degree tears.” “He’s fine,” said Jen. Charlie reached down to support his tissues, and one of the nurses pulled his hand away. “He’s fine,” Jen said again, and they let Charlie’s hand go. The resident caught our daughter’s head in her hands as she burst into the world. No one caught her body; she just sort of slithered out and flopped onto the bed.
Despite the OB’s dire warnings, Charlie had only mild tearing and ended up needing just one stitch. But rather than wait to suture until he delivered the placenta on his own, our doctor started tugging on the umbilical cord. This resulted in a partially evulsed cord, which is bad news and means you have to remove the placenta manually, right away. This procedure is very rarely performed on someone who has not had an epidural. There is a good reason for that.
After all that, Charlie lost two liters of blood in a postpartum hemorrhage. It was noted on his chart that he had refused a blood transfusion; in fact, he was never offered one. He spent the weeks after our daughter’s birth severely anemic and scarcely able to walk.
You could argue that if Charlie was going to have a postpartum hemorrhage, better that it happen in the hospital. But I doubt the bleeding would have been nearly as severe if we’d had the delayed cord clamping we wanted and let Charlie deliver the placenta on his own time. Nothing the doctors or nurses fought us about actually made our daughter safer, and they may have even caused an avoidable complication with their impatience. Our midwife was the only person who consistently checked in with Charlie about his needs, rather than just telling him what would be most convenient for her. Charlie and I are more determined than ever that any children we might have in the future will be born under our own roof.
I know people who have had hospital births that were much more gentle and respectful. I wish I could believe that that was the norm and our experience was the aberration, but if anything, I think we got lucky. Pregnant people and babies deserve a positive, affirming, supportive birth experience. We should set the bar for birth care higher than “not dying.” Making midwifery care more accessible would be a good place to start.
Lindsay King-Miller is a queer femme who does not have an indoor voice. Her writing has appeared in Bitch Magazine, Cosmopolitan.com, Buzzfeed, The Hairpin, and numerous other publications. She lives in Denver with her partner, a really cute baby, and two very spoiled cats. She is the author of Ask A Queer Chick (Plume, 2016).