On Hospitals, Hellraising & Homebirth
As a low-risk pregnant woman myself, I personally wanted nothing to do with hospitals, and plotted my birth to avoid them unless absolutely necessary. I wanted to optimize my chances of having a simple vaginal delivery, which meant starting in the place where that was the most likely. Beyond that, based on all that I'd seen in hospitals, it was clear to me that they are an inappropriate place for me to labor and birth unless I had an actual medical need for intervention, because hospitals are where I feel the LEAST safe - I wanted to know that any interventions that came down the pipe were truly an issue of safety, and had seen enough weirdness by then that I had very little faith in that being strictly true in a hospital setting. It's my nature to fight hard to be in charge of my experience and my body, and I’m capable of being a noisy and potentially violent asshole to defend my space if I feel like I'm being dominated or threatened - or, much worse, to submit in fear and then feel deeply injured. I wanted total autonomy, control over who was in the space and who my caregivers were, and was willing to endure a completely unmedicated process in order to ensure that.
So I decided to birth at home. Which, I found out, is rare - barely 1% of births in the United States happen outside of hospitals, including both birthing centers and homebirths. In choosing a homebirth, I let go of any possibility of pain medication during labor and delivery, and began to do a lot of research on other forms of pain management, planned transfers, the potential for needing an emergency transfer, and on what I could expect with regards to the safety of birthing in my apartment.
I was lucky to know moms I greatly admire who had birthed at home in LA, and two of them recommended their midwives to me, as well as others they had liked but not chosen, and advised me to interview a bunch of different people, to check out birthing centers and to do some research on what I might want and who was a good fit for me. I went to three different birthing centers and interviewed 4 homebirth midwives: 7 midwives in all, all extraordinary people. While on the fence deciding between two of them, my partner and I were blessed to have a very frank conversation with the physician's assistant in my doctor's office, a knowledgeable, clever woman who has been a birthworker and educator for 25 years and knows everyone in town, and she essentially made the decision for us, saying that all of our choices were excellent but that one in particular was, in her opinion, the best she'd ever seen, by far the most experienced and the most deft in extreme circumstances.
At our next meeting with that one, Leslie (the aforementioned gangstress who's been catching since the mid 70s), she described delivering a 12 lb baby in a bed with no tearing. And that was that, because for fuck's sake. Sold.
Preparations.
Early in pregnancy, I started to receive acupuncture from a genius DoM who specializes in women's health and fertility, and got fantastic advice from her, which I now humbly & gratefully pass along to you:
The cure for nausea is PROTEIN. Which is a weird switch from normal nausea, and goes against most of what I'd ever been told I should eat and drink when nauseous (I heard a lot about saltines and ginger ale, and my usual go to when nauseous would be something like bread.) If nauseous while pregnant, have a couple of bites of something protein-dense: cheese, chicken, a boiled egg. Better yet, don't ever let my body be without enough protein already in my belly, and I won't get nauseous to begin with. I found this to be 100% true, and the only 2 or 3 times I felt sick enough to puke during the entire pregnancy were when I didn't eat protein in time. And I'm a delicate flower generally, prone to horrific motion sickness and emotional nausea.
I do eat meat, and eating animal was a big deal while pregnant - I would recommend to anyone who is vegan and set on remaining so while pregnant to work with a nutritionist, even briefly, in the beginning of pregnancy (or better yet while planning their pregnancy) to figure out how to get the proteins and fats one needs to give a growing fetus everything good it needs for optimal health.
I also saw my acupuncturist twice for something called Golden Needle sessions, also called Happy Baby or Beautiful Baby treatments in the traditional literature. In her words, these are energetic treatments to help differentiate the baby's stream of karma from the mother's. They're given at the transition from 1st into 2nd trimester and 2nd into 3rd. I hugely appreciated the concept, and in reality found both sessions deeply transformative.
I learned a great deal from studying British OB and Ayurvedic doctor Gowri Motha's Gentle Birth Method - she has very specific things to say about how to eat to support pregnancy and prepare the body for birth which made a lot of sense to me. The main points that stuck with me are:
a) Contrary to the stereotypical pickles and chocolate cravings narrative, pregnancy is exactly NOT the time to eat whatever crap you might want whenever you want it.
b) Sugar and refined flour and other sticky foods create an inflamed body, pelvic congestion, and babies whose size is disproportionate to the pelvic size of their mothers.
From her I absorbed the notion that a pregnant woman should gain between 25 and 35 lbs total over the 40 weeks of pregnancy, should stop eating refined sugars and flours and other mucus-producing, inflammatory foods altogether, for sure by the third trimester, and FOR SURE in the final month, and that pregnancy is, actually, the time to change one's diet for real, as everything that goes into a pregnant woman's mouth is an offering of raw materials for their baby for build a perfectly healthy body.
The supplements I took throughout pregnancy, which additionally had the effect of clearing up minor chronic things like skin infections and making my digestion fabulous, were a food-based prenatal vitamin, a lot of probiotics, and fermented butter and cod liver oil pills. I ate a ton of butter and other oils, drank a lot of bone broth and whole milk, and in general stuck as much as possible to the Nourishing Traditions recommendations for pregnancy, which served me really well and supported a generally simple, super healthy pregnancy.
Another piece of good advice I got from a wonderful midwife was to walk 3-5 miles a day: "Stop doing aerial, because you don't want to be building your core right now, but if you walk 3 to 5 miles a day, that baby will fall right out." Which I did, and while it would be downright absurd to tell you that my baby fell out or anything like it, my labor was of a totally reasonable length, tearing was very minimal & recovery was pretty damn fast, all told. I also read a lot of Katy Bowman's blog, which has a lot of great recommendations on what particular forms of exercise best prepare the body for birth - she's a big proponent of squats, which I did a lot of. I have never had such a commitment to regular yoga, but continued to do a brief practice as often as possible, and found that it strengthened and stretched my hips better than anything else.
Perineal massage is a great idea and a lovely thing to do as birth prep. Ask your loved one or hire a sexological bodyworker or a women's health PT. There is also a device for perineal stretching that we can't yet get here in the US called an Epi-No - you can get it in Canada, but not here, stupidly - which is a hand-inflatable bulb doodad that I've heard is pretty wonderful. I have been advised by a more experienced kink player than I that it is essentially a glorified kink toy, so it's probably findable here in that form. Because the internet is simply amazing.
What Went Awry
My particular issues during pregnancy were mostly incredibly annoying recurring vaginal infections, primarily yeast infections, which is very common: the body's pH goes bonkers during pregnancy, and all the normal flora goes wild right along with it. Then, late in the game, I tested positive for BV, yeast AND Group B Strep (more commonly referred to as GBS.) I took antibiotics for the BV, as it could have caused pre-term labor, and took Candex for the yeast, and took a shitload of supplements to help my body process all of that. But the one that was truly unfortunate was the GBS.
GBS is a normal part of healthy vaginal flora for a third of women. If you ever wear a thong, chances are that you are among them. The bacteria comes and goes - a person will test positive and then negative 2 weeks later without having done anything differently. No one cares unless you are pregnant, at which point it becomes an issue for anyone who delivers a baby vaginally: the baby can be colonized in his or her passage through the vagina and vulva (it's a bacteria that resides primarily on external tissues), and a colonized baby can then develop an infection, which in a tiny percentage of babies can lead to serious problems requiring antibiotics and hospitalization. An extremely tiny percentage of infected babies die.
The way United States medicine handles this is to give birthing women who have tested positive preemptive IV antibiotics. Had I gone to a hospital, that would have happened, and I would have let it - the alternative being that the baby is whisked away for observation after the birth. A hospital will insist upon prophylactic IV antibiotics if you have EVER had a positive GBS result on your record (even if a more recent test is negative), including one with a previous baby. No hospital will let a GBS-positive birthing woman sit in water, which is sad for anyone desiring a water birth. Also, if the event that begins labor is the water breaking (as opposed to contractions starting or the mucus plug coming out), hospitals will put a birthing woman on a clock for delivery - I believe they will give you 18 hours from water breaking to have the baby out - and this will frequently be the reason given for inducing with Pitocin. The wisdom of that timing is subject to quite a lot of debate, and 18 hours is on the short side in the spectrum of care worldwide. The threat of infection spreading up the birth canal and into the uterus is real, and can certainly happen if caregivers are penetrating the vagina with instruments or fingers to check for cervical dilation, or for any other reason - meaning that no one should check until they absolutely have to, as late in the labor as possible - but there are many things about an 18 hour deadline that make very little sense, particularly when there are already antibiotics involved which should, if they are working, make infection a non-issue.
At a home birth, I had the option of refusing IV antibiotics and treating it instead in the way that is common in Europe, which is to do frequent peribottle rinses with a dilute solution of an antibacterial wash called Hibiclens, which you can get at any drugstore for a couple of dollars. (Note: NOT a douche, which rinses internal tissues. Peribottles are basically squirt bottles which are used to give a focused rinse to the external tissues of the vulva and perineum.)
I did a lot of research on this, and found a ton on the internet, most notably an AMAZING website called Evidence Based Birth. Out of everything I read, the statistic that jumped out was that 61% of infected babies are born to mothers who tested negative - as in, the birthing women who tested negative at 34 or 36 weeks developed the infection thereafter but weren't tested again, and then passed it on to their babies unknowingly. If no one was properly observing those babies, infections went untreated and became complicated and potentially fatal. That number clinched it for me, and luckily I had still had time to prove to myself the Hibiclens washes worked by retesting well before I was due.
So, at 8 months pregnant, I stopped having any sort of penetrative sex or touch (i.e. no perineal massage) to avoid spreading the bacteria into my vaginal canal, took antibiotics and a ton of probiotics for the BV, and crossed my fingers that they would also work on the GBS (there are various strains of GBS that respond to different antibiotics, but we were unclear which I had). I then started the peribottle washes, and when I was tested again I came up negative. I kept doing the washes on a daily basis until labor began with my water breaking, and then did them every 4-6 hours during labor. I refused IV antibiotics during labor because I wanted both my colostrum and the baby's gut flora to be intact, and I had concluded from all that I'd read that the local washes were every bit as effective statistically as systemic antibiotics.
And we have been 100% fine.
For which I am massively grateful.
Switching Horses Midstream, or: The Clusterfuck and How It Resolved.
A particularly steep learning curve began at 4 months, when a friend delivered her baby with the same OBGYN I had been seeing, and I was less than happy with the combination of neglect and swift, reactionary overmanagement with which she was handled in labor and birth.
I remained with that doctor for a long while afterwards - I loved everyone else in her office, and I'd only even seen her once or twice, as her extremely wonderful physician's assistant saw most patients for office visits, and so I kept going with the idea that it would be fine for this woman to be my backup doctor, which all midwives require in the event that there's a transfer. The PA, who knew and greatly respected my midwives, said that she'd strongly recommend backing them up to the doc, and that it should be no problem. And I was optimistic. I knew myself to be more informed and less reticent about my desires than my friend had been, and told myself the story that the doc would be different with me.
Then, between 7 and 8 months, I began having the tiniest bit of spotting. My midwives thought it was unlikely to be a big deal but wanted me to be tested for a UTI just in case, and I called my doc's office to arrange a test. I was told by the front desk that the doc wanted me to go immediately to the labor and delivery ward to be monitored for preterm labor. I assured them that I wasn't in preterm labor and that the spotting was negligible, and refused to go in - I had a bad feeling about going in for reasons ranging from unnecessary hospital bills (I had recently accompanied my loved one to the ER, where fuck all was done for her and she accrued a bill to the tune of several thousand dollars) to my distrust of the wobbliness of patient consent in hospital settings. I was again pressured to go, and, reasonably or unreasonably, got a very bad feeling. My midwives told me that they legally couldn't tell me not to go once I had been told to by my doc, but recommended that I go to be tested and monitored to another L&D ward at a different hospital known for being very laid back. I told them that I intended to switch doctors, and they agreed that this kind of reaction was a conveniently timed preview of what would happen in labor if I kept this doctor as my backup.
I went for testing and monitoring at UCLA, where the young doctor let me insert my own speculum (she had apparently never been asked for that by a patient before) and gave me an ultrasound gently enough that the baby didn't squiggle and turn away from the wand, giving us a clear view of her magically familiar profile. I was prescribed 2 different antibiotics and an antifungal before even getting test results back. Upon calling in for results, I was told I had BV and that I should start a 10 day course of Flagyl (a broad-spectrum semiautomatic weapon of an antibiotic), and to call back for the results of urinalysis. 5 days of daily calls later, I was told by a random doctor reading me my chart verbatim that I had, in fact, tested negative for everything (and was therefore taking heavyweight antibiotics because the original doctor, for reasons unknown, had lied about my test results) and that no urinalysis had ever been ordered.
Mystified, pissed off and disheartened, I got a referral from the midwives for their preferred backup doctor, a guy with privileges at Cedars named Dr. Chin, and went to see him for the one visit he required in order to get me in his system and agree to be my backup. He sat me down in his office and said some marvelously direct things: if all went well, we would meet this once and then not again until I wanted him to act as the backup for my next homebirthed kid; this visit was primarily for me to see that he's not super weird and for him to see that I'm not super weird (that is a direct quote); and, most importantly, he needed to say to me that my birth might not go the way I wanted. He wanted to drive home the point that I could end up in the hospital and under his care with a planned transfer for any number of reasons. That it would be the midwives' call if that was to happen, not his, and that he trusted them 100% to know if and when that should happen, as should I. And that if this should happen, he needed me to NOT FREAK OUT, to remain calm and to trust that he and everyone working with and under him would do everything in their considerable power to make sure that I had a safe and connected birth as close to my wishes as possible. OK? OK, i said.
He then gave me an ultrasound, and within seconds caught what not a single other doctor or nurse or PA giving me an ultrasound anywhere had: "I bet you're spotting, huh?" he said. "It's because your placenta is low." Once I recovered my cool, I told him that the spotting had caused me to be misdiagnosed with infections and unnecessarily prescribed a lot of antibiotics, and that I fervently wished I had come to see him earlier, at which he clucked like a disapproving grandma. And upon making sure that I didn't have placenta previa (the placenta has to have a minimum of 2 cm clearance from the cervix in order to safely have a vaginal delivery - any closer than that can cause a lot of bleeding), he said "Yup, you'll bleed a little bit more than most women, and it's nothing to worry about." And he shook my hand, and vanished.
Hypnosis.
In the midst of all of this, I realized that I wasn't just dealing with a reasonable desire to not birth in a hospital, but had in actuality become terrified of the prospect, and upon reflection on Dr. Chin's fantastically rational perspective and the very real possibility that I would, for one reason or another, need to go to a hospital during labor, I decided to enlist the help of a hypnotherapist.
I saw Jim George for one session, and, despite my being a stubborn ass of a person who has never been susceptible to hypnosis or 'going under' or really any sort of suggestion, I cannot recommend him and the practice of hypnotherapy enough in this context. The man is an extraordinary wizard. I have never sat with a more completely present human being.
Many things were said during that session, but most notable to me was his utterly convincing assurance that I was going to give birth at home, and that I knew exactly what to do. He said it, and it was so. I emerged from that session unafraid of birth, sure that I wasn't going into hospital, and knowing I would be calm regardless.
Part Three forthcoming, famiglia!
xoxo