Birth as an Art
by Ute Carson
New Look, Vol. 5, No. 2, December 25, 1977

When I became pregnant for the first time nine years ago. I had no idea which manner of delivery would be right for me. I did not think myself a likely candidate for natural childbirth. I don't like r and the two prior examples I had of what birth night be like were not encouraging.

There was Lisa, a good friend from my college years. I visited her in the hospital the day after she had delivered a healthy nine-pound son. "This will be my first and last child," she insisted after I asked how it went. I assumed she meant she would not want another nine-pounder but was immediately told otherwise. "No," she answered, "I would not go through such an ordeal again -- ever!"

Then there was Annie. She lived on small communal farm in Vermont and attended classes at the college where my husband taught. I saw her during pregnancy and about her preparation for childbirth. She decided to have the child at the farm with the other members of the commune to assist. She had her baby and was up the next day preparing a feast, without a thought to the risk she had taken with herself and her child. Annie's rhetoric about pregnancy and birth being little mo than everyday events in a woman's life seemed too immature to deserve earnest consideration. But neither was I willing to accept Lisa's description of childbirth as a dreadful experience. For the time being my attitude was "wait and see."

My physician took a similar approach. Two factors made him skeptical of my candidacy for unmedicated childbirth--my age (I was twenty-nine by the time I delivered), and several complications had occurred during pregnancy. "But," he said, "We're willing to go along with your wish to give natural childbirth a try. We can always step in if we deem it necessary." That's the way we left it. Meanwhile, I continued to read about all the possible turns a delivery can take. I also never neglected to practice my breathing exercises on our daily walks on the beach. My husband became an expert at detecting false sounds in either deep chest breathing or the panting reserved for the final stages of labor.

My first delivery was a triumph over uncertainty. It also had its comic moments, as well as touches of naivete. My husband and I were living in city on the Gulf Coast of Florida. The municipal hospital there had an unalterable rule: no fathers in the delivery room! Not even a reasoned petition from enthusiastic couples could change that. My own doctor added his veto to the proposal. (Recently the image of the father running out of the delivery room to phone the good news to his relatives has even crept into television ads. Watching those commercials, the doctor's kind but unapologetic words come back to me: "We have enough to do with the mothers and the newborns. What if we also had to cope with fathers unaccustomed to such an experience?" Natural childbirth was tolerated in that setting but never practiced, and gas was administered as a matter of course since, as one nurse explained, "nobody refuses when it's offered."

I happened to have a doctor's appointment the day before I delivered. I was dilated four centimeters but no one was able to predict the time onset of labor. As was my custom, I walked home thinking nothing about the extra stops I had to make to do my breathing. All I felt were some irregular cramps. I went ahead with my normal activities, leaning on the kitchen table whenever I felt uncomfortable. When, that evening, I ordered a second ice cream sundae (ordinarily I can't finish my first), my husband didn't give it a second thought. . He became suspicious only after I insisted he return the movie tickets we had just bought: "I don't believe I can sit in one spot very long anymore."

Back at our apartment we tried various distractions. A warm sitzbath felt good for awhile. Fearing that Lisa's childbirth experience might be closer to reality than Annie's, I didn't dare admit that it was becoming difficult to enjoy the warm water and to relax with my breathing.

My husband had placed himself in front of the bathtub and was reading aloud from John Holt's How Children Learn. "Are you listening. . .that's an interesting point. . ." He tried in vain to draw my attention away from myself. I was not taking in a single sentence. Suddenly I jumped out of the bath, only to be caught by my husband. What felt like a mini explosion made me pass out for a few seconds. Warm fluid gushed down my legs and onto the bathroom floor, soaking the book's pages. My membranes had ruptured with a bang. Now we knew! My husband phoned, and the doctor's reply was, "Bring her over right away." The memories are blurred from then on. In the car I faintly heard my husband's coaching: "Blow out. . .don't hold your breath. . .don't panic. . .go on. . .you are doing just fine. . . "During this crucial period, when I wasn't in full command of the situation, he was my helpmate and intermediary. After encouraging me in moments of near-panic during our drive, he became my liaison with the hospital staff.

Placed in a wheelchair at the emergency entrance and rushed upstairs, I thought, "If things get much worse I won't be able to stand it. "But they didn't. After the receiving nurse discovered how far the birth had progressed I was quickly taken to the delivery room. Having arrived at my destination, calm set in.

A nurse said, "You're in good hands now. The doctor will be here any time. Try not to push yet. We will give you some gas to get you through the con- tractions." I managed a composed reply: "No thank you. I don't need anything. I am just fine."

Nothing was done until my doctor arrived. He repeated the offer of gas. After I declined again he instructed a nurse, "let's get to work. I used to do home deliveries this way when I started out as a young man in practice. We didn't have much choice in those days." And, to me: "We won't get around an episiotomy, Ute. Sorry, but we don't want you to tear." I was touched that he told me this and consequently suppressed the urge to correct his mispronunciation of my foreign first name, a feat I would not have managed under normal circum stances.

When he held up the bloody bundle that was our daughter I burst into tears. There was joy as well as relief after the physical and mental tension of the previous few hours. When they brought our daughter to us in the recovery room I whispered in her ear, "tonight to us a girl is born and her name shall be Caitlin." It was two weeks before Christmas. The floor had been decorated with greens by the staff.

Thus converted to natural childbirth, I had to resist becoming a zealous advocate and the temptation toward one-upsmanship. I faced the birth of our second daughter two years later in an elated mood. It was easy and a joyful event--as close to my friend Annie's experience as I would come. The doctor who delivered Caitlin also helped bring Claudia into the world. He had had no change of heart about my husband being in the delivery room but, because I had proven to him what I could do, the atmosphere was relaxed, even jovial. From beginning to end I was confident. When we left our house we looked up at a full moon and wondered aloud whether there was something to the belief that more babies are born during full moon than at any other time.

We did not stop at the emergency entrance but parked the car and walked the distance together. It was 7 a.m., the night shift was just leaving, the morning shift arriving. Leaning on my husband's arm, halting every three minutes to do my breathing, we caught inquisitive glances. More than one person asked if we needed assistance.

This second time around my husband was also more relaxed. At one point I had to remind him why we had come. During the elevator ride to the maternity floor he had engaged the attendant in a conversation about natural childbirth which continued while I changed into my hospital gown and which might have gone on and on had I not interrupted. My membranes began to leak just then and the fluid slowly trickled out.

In the delivery room, between contractions, I talked with the doctor about his new house. He in turn left my hands unrestrained, something he had not been willing to do previously. ("When you are in pain you might touch the sterile sheets by mistake," he had said.) Claudia was born within fifteen minutes of my arrival in the delivery room. Having pushed her out halfway I couldn't wait to ask, "What is it?" "We're still not there," my doctor answered. "We are just rotating the shoulders out." The nurse was in greater sympathy with my impatience. "With that much black hair it must be another girl." Claudia's first cry sent chills of joy down my spine. Again we were the happy parents of a beautiful daughter. Later, the doctor held up the placenta so that I could see the marvelous, complex organ which had sustained our little girl during her gestation period.

Our third daughter, Cecile, was born almost a year ago. Attitudes, I found, have changed and more women today opt for natural childbirth. Many hospitals have classes to prepare parents, and it is now more commonplace to see fathers in the delivery room. This last birth fulfilled my fondest wishes. It was a spontaneous birth in a supportive, cooperative setting which I was able to share with the man I love.

I would not have gone to a teaching hospital had it not been for the fact that there my husband was allowed into the delivery room. The drabness of its corridors and rooms seemed out of tune with my desire that even my surroundings should resound with joy at the birth of our baby. No colorful curtains or brightly painted walls were to be seen. But because all else was "in place," the unattractiveness of the setting lost significance.

My doctor allowed me great l No IVs, no enema, no prep. I was not flat on my back but on a reclining table, free to move except that my legs were in stirrups. My husband was on one side, a nurse at the other, and a young woman resident stood behind my doctor. She had been there upon our arrival. While waiting for the doctor I had to "blow away" my contractions at a time when the urge to press down was already quite strong. All I saw during the entire procedure were the resident's eyes. In those eyes I could see support as well as understanding, encouragement and approval. In her eyes I saw my own progress reflected.

I announced each oncoming contraction to those present. I felt a great need to let them know that I was in control and only temporarily incapacitated. The doctor had placed himself on a stool directly in front of me. Contraction followed contraction in rapid succession. I had learned to meet each one with my breathing but at last it became strenuous to blow them away. "I have a great urge to bear down," I announced. "Can I push now?" "By all means, go ahead," was the reply. The pressure grew, I pushed, and then relaxed. "Thank goodness for these respites," I heard myself panting. "You're doing great. Keep pushing." A contraction was coming, slowly rising. I breathed evenly. The pressure continued to mount. I started panting fast, faster, as it reached its crest. Sensations raced from toes to fingertips. I shook my hand as if it burned. Then the pressure ebbed, the undulations receded. I blew out and rested until, when the inexorable flow returned, I prepared to meet it and go with it again.

My husband supported my head with his hand, the young resident massaged my calf to alleviate a muscle spasm. I felt my palms turn clammy. "We'll get it with the next contraction ," the doctor coached . "One more time." Flop! At its peak the pressure abated, the blood felt warm, my legs started trembling. "Look at that pretty baby girl! Congratulations!" A squirming, wrinkled bundle was placed on my abdomen. The umbilical cord was cut. The ambivalent process of wanting to retain what has been part of you while needing to let a new person be born had ended.

My husband and I embraced. "Nearly nine pounds. I thought she was big," said the nurse who was weighing her in. "Here, Pa-pa, take her." My husband held her until I was wheeled into the recovery room. I nursed her right away. In more than one way the last birth was special. The two older girls were able to participate throughout the pregnancy in the development of the baby. Each child had her own concerns. The five year old asked questions such as "How can the baby see in your tummy?" and "Where does it go to the bathroom?" The seven year old was more curious about where and how the baby would come out. They watched me expand, felt the fetal movements and took part in the daily exercises. The high point came when they were allowed to accompany me to one of my regular checkups. They watched the doctor measure my abdomen and they listened through the stethoscope to the baby's heart- beat. All the preparation was crowned by the arrival of their baby sister.

Why should a woman face the anxieties and endure the discomforts of birth when a little pain-relieving medication can make her drowsy or let her sleep throughout? For the sake of the child we may object to sedation. But there are other, more subtle reasons. "I had two children without medication," my neighbor told me. "With the third one they put me out. I woke up and it was over. All of a sudden there was my child. I felt strange toward it. And then I touched my stomach. Flat! The change was too quick. There you are, fat and in pain, and out you go. I got terribly moody afterward." Although post-birth blues is a fairly common occurrence, the joy of having accomplished a life-giving task, of having literally brought a child into the world, mitigates against depression.

"Why," I am often asked, "do you have to do it all the way? Why not have a local anesthetic? You are awake and aware during the birth but your senses are numbed" True, any mother can attest to the fact that the transition period, when the cervix dilates; is the most painful time. As a friend put it, "Toward the end, birth is just hard work." But my answer is that you rob yourself of the satisfaction that comes with completion. If you have stayed on top of the contractions throughout the pregnancy, why give in at the last?

Grantley Dick-Read, the founding father of modern natural child-birth, wrote that birth can become an occasion for self-discovery in a woman. Indeed, there were surprises in store for me. I was able to tolerate more discomfort than I had expected. And, I displayed some negative behavior- -I realized that my fear of losing control tempted me to manipulate the people around me as I gave birth. My subtle message as I made small talk between contractions was, "Don't think for a moment that I'm not in command of myself."

A young friend of mine is expecting her first child in a couple of months. I know that natural childbirth is not for everybody. Circumstances intervene. Nature makes mistakes. This natural process can be interrupted by complications. But those are exceptions. I have not told my friend that she should do natural child birth. But I have told her it's worth a try.

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