Birth: Part Three.

Birthing.

My water broke nearly 2 weeks early, waking me up at 1:30 in the morning on a Monday. I woke Adam and called the midwives, who told me to go back to bed and sleep as much as possible. I didn't manage to sleep at all, but went into a very deep and restful trance, felt the location and intensity of the first contractions introducing themselves, which were like nothing I'd ever felt before, and had heroic preparatory dreams. 

The following morning we drove out to the midwives' office, where Catherine, Leslie’s partner, checked some of the fluid under a microscope to make sure that it was actually of amniotic origin. Upon confirming that it was, she told me that because my water had broken and because of the positive GBS results, they needed me to be in hard labor by nighttime - as I said earlier, a hospital would have given me 18 hours from my water breaking to deliver because of the GBS results, and the midwives didn't need to push that hard, but they did need me to get things moving. 

We came home, our beloved Willa came over and helped us to Mary Poppins our house into a place fit to birth in, and I started drinking castor oil cocktails by late afternoon. Castor oil is a trip: it's a bowel irritant (most hospitals will tell you not to drink it because it can cause diarrhea, which, apart from potentially causing dehydration, creates a mess for them to deal with - they would rather administer a pitocin drip they can control) and is a classic way to intensify contractions which doesn't in any way affect the flow and receptivity of the nervous system to oxytocin, as pitocin does. My former doc's PA had told us an incredible story about using it to bring on labor with her 2nd kid. In her own words: "My first kid was born at 42 weeks and was so big that he gave me a completely new ass, and I didn't want to deal with that again, so I made myself a castor oil and tequila sunrise at 41 weeks, and he was born 45 minutes later. No time for anyone else to even get there, so it was just me and the dog.”

Heartened by all of that, we made the cocktails with top shelf tequila and orange juice. That plus liberal nipple stimulation did the trick: contractions steadily intensified and grew closer together. At some point in the thick of it all, I attempted to use a vibrator to steer the sensations towards pleasure, but it just intensified what was already well on its way to overwhelming rather than making it more fun. It seems possible that if I had tried stimulation earlier it might have been possible to take the labor in a more orgasmic direction, but I honestly have no idea. Needless to say: if you try it, gentle reader, please do let me know how it goes :)

We were graced with the presence of three deeply trusted friends as our doulas through the night: Willa, Liz, and Cynthia, all of whom had attended births before, and the latter of whom is a L&D nurse who's seen a zillion births in hospital but for whom we were the first experience of homebirth. Because there were enough loving hands, whoever needed to could nap or eat or take time and there was always still someone with me, and frequently two or three people. I vividly remember the entire night, the faces and the words, dancing to Whitney Houston with Adam, the beautiful hands on my body, the unendingly generous support of my loved ones: Liz's care and levity, Cynthia's excitement and total confidence in directing me, Willa's unshakeable calm and loving encouragement, Adam's comfort and solid support. There was a lot of giggling and a lot of affection and absolutely no stress on anyone's part.

In the middle of the night, I got into the tub (they had set up a kiddie pool on a tarp in the middle of the living room) and realized that it was wonderful to be in the water because it was slowing contractions down and letting me rest. Cynthia was with me, and I told her that I was starting to consider a transfer because I had no idea whether or not the intensity I was experiencing was actually progressing my labor - this was the crux of the births I had seen rushed into C-sections - and I was fucking exhausted and didn't know how much more I could manage. Cynthia reminded me that I had said to her before going into labor that I didn't want an out, and that if I started talking about a transfer to please remind me that if I had an epidural I wouldn't be able to walk or feel my legs. (She also had been the person in touch with the midwives all night, and was aware that if I wasn't dilated enough to start pushing come morning when the midwives arrived that I would very possibly be transferred - it was Now or Never.) She told me that she would let me stay in the tub a little bit longer, but then we were going to get in bed and we were going to work the baby down, and that it was time to marshal all of my energies into making this shit happen.

And then she revealed herself as my Jedi master. It was fucking incredible. What followed was among the most painful experiences of my life, and it was without question the furthest my nervous system had ever been pushed, and I have no idea how it would ever have happened if I hadn't had this profoundly capable woman ordering me around like a cosmic drill sergeant. Everyone got into bed with me, and Cynthia had me turn one way on my side and focus on the eyes of the person in front of me, and I howled my way through several contractions, and then had me turn onto my other side and repeat the howling with someone else, and back and forth for what felt like thirty years until the midwives arrived at 6:30 in the morning. I looked up and saw Catherine smile at the ruckus I was making, was aware of her slipping on a glove to check my dilation, and felt an utter jubilation erupt in the room upon her finding that I was at about 9 cm. She pulled the lip of my cervix that remained out of the way and brought me to 10, and told me it was time to start pushing. 

I pushed in the tub for a while, but it was a huge and slippery contraption that made it difficult for anyone to support my body without actually getting in with me, so I moved to the floor, where I realized what exactly the quality of an effective push was, which was more or less that the hand of God was doing the work. Catherine suggested that we move to the bathroom, because the toilet is an ideal place to push, both because of its birthing stool shape and because it’s a place where the body is well accustomed to letting go. Pushing took on a lightninglike quality once I was on the pot, which scared the hell out of me, and I asked to move to the bed. 

Once on the bed, I had the central realization of the entire experience: namely that as mammals we are wired to flee from pain, but that the only way to move the baby out of me was by diving directly into the pain, into the lightning. Upon understanding that, I committed myself fully to riding through it without hesitation, and asked to move back to the toilet. I felt the baby move down and crown, and felt her head with my hand (there is no crazier sensation) and at the point that her head was emerging, Adam came and sat under me and held me while I pushed Kora out. At some point I felt my tailbone snap, and simply made a mental note that I would deal with it later. The hardest part of the entire labor was pushing out her body after her head had emerged - I scraped the bottom of the barrel of my energies, and tapped out the last of myself moving her all the way out. As soon as she was in my arms, she cleared her own nose and throat, let out a single yowl, and opened her eyes to see. 

After it stopped pulsing, Adam cut the umbilical cord. I watched that, saw all the blood on the floor, and because my nervous system had reached its limit (but probably also because I'm a fainter when it comes to blood) I passed out. Becky, Catherine's marvelous assistant, took the baby and passed her out to Cynthia and Willa (where Willa held her skin on skin), and lay me down on the floor, where I delivered the placenta. I’m told that everyone slapped me, Catherine gave me two shots of pitocin in the thigh to stop the bleeding, and finally after I passed out a couple more times she jerry-rigged an IV and gave me half a bag of fluid. It took about an hour and the threat of calling an ambulance for me to get it together enough to crawl out of the bathroom and into bed. Willa gave Kora to me to hold and I gave her the nipple for the first time. We missed the golden hour for breastfeeding because I was out cold, but we caught up without any issues.

Nursing.

I didn't know it, but milk doesn't come in for three to four days, and the baby is fine just having colostrum during that time - please call bullshit on anyone who tells you differently. Kora and I began to figure out nursing, and I realized that what is a strange and gorgeous and crazy process at the best of times has the potential to be downright nervewracking to a new mom who is utterly exhausted and has inaccurate judgement. So I made a lot of phone calls and asked everyone who had offered for help. I was advised by a family friend who is a lactation consultant to use Vitamin E on my nipples to prevent problems, which it absolutely did. When my milk started coming in 3 nights later, I became unbelievably engorged and used cold cabbage leaves in my bra to soothe the hot spots and hard places in my breasts while the tissues adjusted to the flow of milk. I asked for a lot of counsel until we got the hang of it. Once we did, and ever since, breastfeeding has been a deep pleasure.

Recovery.

The postpartum body takes time to heal. Time as in weeks and months. The landscape of the body is significantly changed by birth. There are huge amounts of ill-conceived pressure and shame, private and public, on postpartum women to pull themselves together and get back to whatever they was doing before all that, and it is frankly a fucking tragedy. There is nowhere near enough space created for the healing and rest and brand new life-giving intimacy that begins the moment a baby is born, and that, more clearly than nearly anything else I’ve ever come across, reflects the cultural demonization of the female body. There is little regard for the recovery of women after the fundamental act is complete, and little thought given to what we need to return to an active life with our health intact and our experiences integrated. 

I’m extremely lucky in that I have the kind of support that allowed me to carve out for myself what wasn’t given to me - but which is, for example, freely provided in a country such as France, which seems to have an entirely different model of medicine than we’ve created in the US - and I had enough of an education to know what to seek out. 

Briefly, these are the circumstances of my postpartum recovery, and the details of the care that were the most indispensable:

My entire pelvic floor was sore for about a month in ways that are difficult to describe to anyone who hasn’t experienced it: the entire structure of my pelvis had shifted in the most extreme fashion and I felt terribly bruised and torn. I didn’t want to be touched at all for about 6 weeks. The snapped tailbone took longer to heal, and I was in wincing discomfort, sitting and standing slowly and with extreme caution, for perhaps 3 months. At the point that I felt healed enough that I could tolerate deep touch, I began to work with my own hands into the scar tissue at my perineum where I had torn and been stitched, soaking with hot water to warm the tissue and then massaging myself intravaginally and externally around the scar as firmly as I could manage with castor oil using my fingers and thumbs, whenever I was in a bath or shower. This was something I had studied as a sexological bodyworker and thought about within the context of the protocols of Holistic Pelvic Care, and it helped a lot with the general discomfort and especially with the pinchy, sharp discomfort I would experience with any penetration. I also began to practice the Arvigo self-care protocols, which are delicious and simple and incredibly restorative, and the Holistic Pelvic Care exercises detailed by Tami Kent in her amazing book Wild Feminine.

It’s worth writing a little bit about castor oil packs here, because they are so wondrous. 

The topical action of the oil of the castor bean is a goddamn miracle. There has been precious little study in scientific quarters about why it does what it does, but its primary action seems to come from a component called ricinoleic acid, which has been shown in clinical studies to reduce pain and inflammation. It’s thought that castor oil helps to flush lymph, clearing toxins and excessive waste from the area where it is applied. What I do know firsthand is that castor packing has consistently reduced my recovery time from sprained ankles from a month to less than a week, that it does beautiful things to my digestion, that it visibly reduces inflammation in surface tissues, and that it makes deep tissue and myofascial bodywork much less painful when it is used. It’s a recommendation in the annals of Arvigo, and it has nearly unbelievable results with internal scarring in mucous membranes - Ellen Heed and Kimberly Ann Johnson, with whom I studied scar tissue remediation, reported having felt intravaginal scar tissue dissolve from a single application of castor oil. And it was hugely helpful to me in doing internal work on myself. 

After a while, I had two internal scar tissue sessions with Ellen, who brings a beautiful combination of laserlike, merciless focus and exquisite attention to her work, and found that receiving internal work was a major key to recovery. I believe this is true for all births - a significant amount of scar tissue is created by the act of birth, whether it’s a vaginal delivery or a caesarean, and scar tissue has to be addressed to maintain fluid and energy flow through the abdomen and pelvic floor. 

Another common postpartum situation is diastasis recti, in which the abdominal muscles separate. This can be a minor separation, a finger’s width across, or a major one, four or five fingers across. It’s not a thing to ignore, and it’s a strange and amazing road back to a normal abdomen - DRs don’t knit back together from crunches or any of the usual abdomen-building exercises, and in fact are made worse by most normal exercise. The best things I found to resolve mine were binding my belly with a splint from the Tummy Team and doing the one kind of abdominal exercise that works to resolve DRs in which one engages the deepest layer of abdominal muscle, the transversus abdominus. Katy Bowman talks about it quite a bit on her excellent blog.

The return of a body that feels like mine is ongoing - when I’m back in aerial training, I feel sore in all the right places, flexibility returns, and my core bounces back to what I know it to be. And: the time to train is dear right now, because making time for myself is a whole new equation with a baby. I end up doing yoga at home as often as I’m able. 

Also, kegels are real. They aren’t a thing to overdo in general - their effectiveness has everything to do with whether or not the pussy in question is lacking in strength from lack of engagement or over-engagement, too little tone or too much tone - but as a postpartum exploratory exercise, they’re pretty essential for beginning to feel like oneself again. I prefer the exercises associated with the use of jade eggs, as having something inside the vagina to provide some interoceptive feedback is wonderful, and the practices develop sensation and control involving both engaging and letting go, rather than just repetitions. 

The open portal.

I understand that this isn’t the case for everyone, but birth blew me open in a way I had never experienced and didn’t anticipate. My sensitivity to sounds and energies was on hyperalert for weeks, and as a result I became extremely private, still, quiet, and slow in the first weeks with the baby. The midwives had left a sign on our door when they left which asked that guests wash their hands upon entry, make themselves useful while visiting, and limit their visits to 15 minutes, and although that sounds unnecessarily draconian from a normal state of being, those rules actually saved my sanity. It was absolutely exhausting being with anyone but Adam and Kora. We rested, took a lot of space from the world, stayed in bed, watched Orange is the New Black, moved very slowly, read books, shnookled, and rested some more. Going outside for the first time 8 days after the birth was unbelievably overstimulating and brief - I could hear everything for several blocks around, and felt like a wild animal suddenly released into the middle of the city.

From that perspective, the care I’d recommend for new families is this:

Respect their space, and help them defend it if necessary from people like guilt trippy relatives, as best you can. Move slowly and with sensitivity. Speak quietly and gently. Ask them what kind of food they would like, rather than bringing food that you want to bring them, as digestive distress will affect both the nursing mom and the breastfeeding baby. Offer foods that support nursing: raw, clean fats like avocado and salmon, bone broth (if the mom is a carnivore) and coconut water are all incredible support to the recovering body. 

And, if you REALLY want to help, friends: offer to clean. Wash 4 dishes. Do a load of laundry. Get in there and clean. It is, in fact, the greatest and most intimate kindness. 

Resources.

These are some of the books I found to be especially wonderful.

Spiritual Midwifery and Ina May’s Guide to Childbirth by Ina May Gaskin

Heart and Hands by Elizabeth Davis

Birthing From Within by Pam England

The Birth Partner (Adam found this one absolutely invaluable - it’s also a required text in many doula trainings) by Penny Simkin

Orgasmic Birth by Debra Pascali-Bonaro and Elizabeth Davis

The Gentle Birth Method by Gowri Motha

The Thinking Woman’s Guide to a Better Birth by Henci Goer

The website that was far and away the most useful in preparing for the birth was www.evidencebasedbirth.com

In learning about breastfeeding, both www.kellymom.com and www.lalecheleague.org were awesome.

I STRONGLY recommend taking a birthing class, if you can, with a partner if you have one or with another loved one if you don’t. Ask around, go online, find out who’s really wonderful who is teaching in your area. The one we went to in LA was at a birthing center called Gracefull, taught by Elizabeth Bachner and J.J Brake, and it was tremendously helpful for both of us.

Your best resource, full stop, is your local community. Face to face as well as online. Ask around about midwives, hospitals, birthing centers, doulas, books. Talk to friends. Ask for support from people who have comparable priorities to yours and who you respect. I stopped speaking to people who I suspected would freak out about my plan to birth at home, because pregnancy really does render one more permeable than usual, and I was clear that internalizing other people’s terrors on any level held no benefit for me. Instead, I surrounded myself with people who could get with my program and support me in planning a fierce, unmedicated birth - and, better yet, with women who had already had such births. Talking to educated moms who are ahead on the curve is the single best medicine there is. 

Similarly, going into online forums can quickly become overwhelming - everybody on earth has a strong opinion and will want you to benefit from their wisdom, which cascades rapidly into oversharing and storytelling, not necessarily the most useful for a pregnant person just trying to do a little research. Set your filters properly when venturing into the jungle of the internet. 

And that, my loves, is all I have to say about that for now.

Thank you for reading. Please reach out with any questions or if I can support you in any way.

May you experience all phenomena as fodder for your growing awareness and deep, amazing joy.

Birth: Part Two

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

Birth: Part One.

Dearest Loves.

I'm writing this note to offer whatever useful information I can to any of you who will ever give birth, or help facilitate someone else's birth, and to anyone who is interested in a very personal take on the ins and outs of homebirth in the modern world.

I had an amazing, well-supported pregnancy and the most ideal birth I could have imagined this past July, followed by easy breastfeeding and a relatively quick postpartum recovery. Some portion of that is certainly luck, but the rest is the result of several years of research, planning, and sticking to my guns. If there's any part of my experience that could help anyone else make the necessary choices to have their version of the same, I want to provide the straight story of the things that worked: good advice I received, my understanding of choices, preparations and outcomes, things to consider, and things to avoid. I discovered a lot during the months of pregnancy that I never found in any book. (There was also a ton of great information in particular books and websites, & I'll name those here as well, as there are countless forums with wildly conflicting opinions and books claiming to be The Book and it can be a loaded and confusing rabbit hole to navigate, so I can at least recommend the ones I found especially great.)

Again: I'm aware of what role good fortune played in my outcomes and certainly don't take any of this for granted, and also must champion the role of preparation to meet and elicit good fortune as much as possible.

Please take this for what it is, which is one person's highly subjective perceptions and opinions. It goes without saying that every birthing person is completely different, and what worked for me may have nothing to do with what will work for you. My intention is for anyone reading this to please take anything that feels right, and to let go of the rest. Nothing to fight about here.

Also, this contains a lot of information. Among other things, I'm going to be talking about my VAGINA. Because that is where babies - at the time of this writing, the majority of babies - come out, and it is where my baby made her grand exit from my body and into the open air. Dig? If that is TMI for you, don’t read this. You have been warned.

I went into my pregnancy having trained years before as a doula and then having assisted a handful of the births of close friends, all first births, all in hospitals in Los Angeles. Out of those handful, 3 went to an unplanned caesarian section (meaning that those women had not intended and scheduled it, as many do - they had wanted vaginal deliveries), and I think it's fair to say that those women were traumatized to one extent or another by the way they were handled. The 4th went beautifully until a resident (a doctor in training doing his clinical rounds) decided, without the attending midwives' knowledge, to try to dislodge the placenta: he pulled the umbilical cord and prolapsed my friend's uterus (which resulted in her needing to have her second baby as a scheduled caesarian some years later to avoid the risk of another prolapse.) The 5th was the best possible outcome, a beautiful experience with only relatively minor hassling and rushing on the part of the hospital staff: she was given a slowly elevating steady dose of pitocin to move things faster, asked for and got an epidural when the many hours of intensifying labor became overwhelming, and managed to get some sleep; we went through 3 or 4 shifts of nurses during the 24 hours we were there, and most were helpful and sensitive and kind; upon being checked in the morning after some hours of rest, her cervix had dilated beautifully; the doctor showed up in time to suit up and catch the baby. Everyone was healthy. 

I learned a great deal from doctor #5 about waiting during pushing, and saw that my friend barely tore at all as a result of not rushing, giving her tissues ample time in between contractions to stretch around her emerging baby. From nearly every other primary caregiver, I learned a great deal about what NOT to do: how not to scare a birthing woman or her family, how not to abruptly deliver bad news to the birthing person, how not to rush the placenta delivery, how not to lie, how not to refuse to pass a birth on to one's partner despite exhaustion after several deliveries in a row, how not to look at one's watch and push for things to hurry along based on one's own desire to make it to a date that night (yes, that really happened.)

I saw that the culture of each shift of nurses is distinct from the shifts that preceded and followed it, and that the nurses, unless challenged directly by another caregiver, will often make somewhat arbitrary decisions based on what they believe is the best care. Some will lie and be assholes to defend their decisions. My job as a doula with those nurses, who I've found to be a consistent minority, was to run interference and defend the space and agency of the birthing woman. With caregivers who were genuinely supportive of the birthing woman's own process, I helped, watched, and learned a lot as an ally and another set of capable hands. There are plenty of both kinds in the hospitals, as there are good and bad practitioners in any profession. The difference in a hospital setting is that it is completely unpredictable who will show up and when - and when someone unsympathetic to your needs shows up as your nurse in a hospital, it’s can be a hell of a lot of work to move the necessary pieces around to not have to deal with that person, or with those who are invested in them and their authority.

My conclusion is that, as a doula, I want to support everyone I love who chooses to birth in a hospital. For many of us, it really is the place where we feel safest, especially in as wild a state as one is in going through labor for the first time - it's great to be somewhere that feels so utterly capable of determining normalcy and handling problems. And for those of us with high risk pregnancies and predictably complicated births, those of us who encounter emergencies, and those of us who just want to schedule a caesarian, hospitals are a godsend. 

So. I would recommend to anyone reading this who DOES feel the safest in a hospital to BY ALL MEANS PLAN ON A HOSPITAL BIRTH. 100%.

Feeling safe is necessary for feeling relaxed, and relaxing as much as is humanly possible - not having to vigilantly ensure your own safety while trying to birth a baby - is the best way to have an uncomplicated and successful birth. Feeling in control and well taken care of, whatever that means to you, is the golden key to the best possible birth experience.

In no particular order of importance, I passionately recommend the following to anyone who wants a hospital birth:

1) Do proper research into the policies and outcomes at the different hospitals in your area - they vary enormously. 

Unless you're planning a caesarian, where do they really work their asses off to ensure vaginal delivery whenever possible? Where do they offer walking epidurals, in which the anaesthesiologists will scale down the intensity of the numbing to let the birthing woman feel her legs and control her own movement, which is essential for moving the baby's head into an engaged position in the pelvis and dilating the cervix? Where do they train their nurses to help position a laboring woman with an epidural to effectively move the baby down into that engaged position in the pelvis? What is their position on routine episiotomy, which should be that they do not perform them unless absolutely necessary? What are their recent statistics on C section outcomes? Will they allow you to eat and drink as much as you wish during labor to keep up your calories and energy, as they should?

Be very thorough with your questions, even if you feel like you're being a pain in the ass - please remember that you are considering who to employ to assist you with one of the biggest events of your life. You are beholden to no one. 

2) It must be said: births, especially first births, can be scary as fuck. Birth is beyond psychedelics. It is beyond extreme sports. It is the great leveler. So intense is it that, having now done it unmedicated, I have great respect for all of the reasons that that is a rare decision. It is a tectonic rupture in time and space, unprecedented in scope and depth, heralding an entirely new reality, comparable to a one way ride to another planet. 

That said, it is COMPLETELY UNDERSTANDABLE that most of us, raised as we are in a medicalized culture - raised to accept the authority and expertise of doctors, and to feel profoundly reassured by it - are much more comfortable having that experience managed for us. A doctor will tell you, from their experience, whether or not everything is normal and healthy, what to do and how to do it, and has in their back pocket a lot of tools for shaping the labor and delivery, including drugs and surgery. 

That said, PLEASE: CHOOSE YOUR DOCTOR WISELY. They're really not all the same. They have extremely different opinions on how things should go down. Please put your care into the hands of a person you agree with and trust, preferably someone who's recommended firsthand by someone who has comparable priorities to yours. Don't assume a doctor will rise to the occasion to do something different for you in the moment than they normally would, because they won't. They will do exactly what they have consistently done all along. So find out what that is. Ask around. If you want to work with midwives, ask them which doctors they love and recommend to have as their backup - they'll always know the best ones. You want to know in your gut that whatever interventions are being recommended are actually necessary, not merely convenient. 

3) At the risk of repeating myself: if you have never had a baby or seen a birth, you might not really know that it will be the most bonkers experience of your life. We've all seen the movies, but movies are always about something happening to someone else.

So: in all births, but especially in a hospital setting, you want to build in everything you possibly can to ensure that you will have all of the peace and support that you want. You will not be able to keep people out of the room in a hospital, but there are wonderful tricks to making sure it goes as well as possible. Mammals are not built to give birth under observation, so ensuring a maximum of privacy and quiet for your ease in a setting where there is generally very little of either is absolutely key. It is the trick of building a dark cave in the middle of a busy train station.

One such trick which I learned in a birthing class, the best I have ever heard and one I for sure would have used had I ended up in hospital, is to have whoever is filling out the intake paperwork state front and center that the birthing woman has PTSD. Whether she actually does or not (and it's really not for anyone else to say, frankly), saying that she does will ensure that the hospital staff act with much greater care and quiet and respect for space than they ordinarily might: i.e., they will knock before entering, keep voices down, and in general act in a manner that they should be acting anyways, in order to not trigger a freakout. This is a buffer that you want and need. Please don't underestimate the value of this.

4) Get an experienced doula. Seriously. Whether a partner is present or not. Having a seasoned advocate and badass support person whose entire job is to have your back under all circumstances is a tremendous, amazing boon in a situation where the birthing woman is very vulnerable and in a setting where things can happen very quickly. No to mention the arsenal of tricks that doulas have for relieving pain and moving the baby and every other thing one needs in labor. The doula is the person who will stay with you most or all of the time, whereas the doctor and sometimes even the midwife will arrive in time for the pushing and the catch. 

5) Birth is a hurricane of raw emotions and huge sensations and high stakes, and success relies upon being able to relax without self-consciousness into the wildness of all of that.

Therefore: Do Not Have ANYONE Present In Whose Company You Will Not Be Comfortable In An Altered State.  

What this means in reality is that if your mom, for example, wants to be there, but you know in your heart of hearts that you do not have a relaxed and easy time with your mom, NO MATTER WHAT, EVEN IF IT HURTS HER FEELINGS, DO NOT ALLOW HER TO BE PRESENT DURING YOUR LABOR. If she knows anything about anything, she will support you in whatever you need at this time, even if she doesn't necessarily like it. Because it's YOUR BIRTH, and is therefore about YOU. Please accept this Get Out Of Emotional Jail Free card from me. At no other time are you more wholly allowed to be entirely selfish in your choices, so - I implore you - don't let anybody get away with guilt tripping you about this. I have witnessed firsthand and heard endlessly about this exact dynamic: usually parents (but sometimes partners or siblings or others whose closeness "should" be OK but frankly isn't) in the room or at the hospital somewhere waiting and whose presence creates enough stress that the birthing body cannot relax enough to do its thing. The direct and quantifiable result of this is that the labor will stall. It won't happen to everybody this way, but it is frequent enough that it's a commonly told story. 

So: your mom, or whoever fits this description in your world, can come when the baby has been born and bring food and kvell with you. Find a way to say no. Create the buffer. Even if it's your partner. Even if it's your BFF. Examine your heart with great honesty about this, and only allow people to be with you in whose presence you can relax, for real.

6) If you would prefer to not have a C-section, I strongly strongly recommend prepping and birthing with a midwife, as they offer very different care than OBGYNs, and have a skill set that incredibly few doctors in this country are able to match. It was explained to me by an MD while I was pregnant that MDs are trained to intervene in a problematic birth, but not really ever trained in how to facilitate a normal healthy birth without intervening. Many midwives are able to administer drugs (although epidurals are only available in hospitals, as they are delivered by a line into the spinal cord rather than by injection or IV and are therefore more complex to deliver and monitor appropriately.) However: the midwife's expertise is how to employ every trick in the book to get things moving in the right direction without resorting to the surgery and drugs which are the doctor's provenance and are at best never needed, in my opinion. Midwives know how to do a ton of shit most doctors have no idea about and will tell you cannot be done. A perfect example is that it's a rare doctor who will deliver a breech baby - and yet midwives abound who, upon checking and finding out the position of the baby some weeks before the due date, can do a number of things to turn the baby into a more optimal position and/or deliver a breech baby without blinking an eye about it. 

And - you can absolutely have midwives as your primary caregivers in a hospital setting. There are a number of hospitals where that is on offer. So, again: research your options. 

7) Routine episiotomies are, in my opinion and in the opinion of the most experienced midwives I've ever met, a bunch of bullshit. They do not prevent tearing and in fact make tearing worse. There are women whose perineums are so godalmighty muscular and gangster that an episiotomy may be indicated during a delivery, but those occasions are rare. The comparison I was given by my midwife was the notion of trying to tear an intact piece of fabric versus trying to tear a piece of fabric that already has a cut in it - if you've ever tried to rip through something, you know how much easier it is when there is already a cut. Her opinion, as a midwife who's been catching babies since 1975, is that episiotomies performed routinely cause some of the worst damage and the most horrible recovery periods for birthing moms of anything that could happen, including caesarians, and are to be avoided. And, having pushed an average-sized baby out myself now, I concur: I had 2 stitches, was able to have sex after 6 weeks or so, have had minimal scar tissue formation, and my pelvic floor is more or less fully recovered at 4 months out. It is to some extent luck of the draw, but that doesn't make precautions and preparations irrelevant.

Part Two coming soon. Stay tuned, family.

xoxo