Above: It really can be like that.
Joanne came out to meet us as we were pulling up in the driveway and parking. By the time I emerged from the car, she was at my side.
“Hello,” she said and smiled warmly. She turned her body to walk in the direction of the birth center and put her hand on the small of my back. Wordlessly, she guided me to the room she had prepared: the blinds were closed, the curtains were open, the linens on the double bed were turned down and the pillows – four of them – were fluffed. I slipped into the cool, soft sheets.
She stood back, beside my husband, and whispered to him, “Isn’t she beautiful? I wish all our mothers were this relaxed.”
Hearing this after all the other signs of her care and respect – the way she met me, her warm smile, the way she guided me, prepared my room, kept quiet, and didn’t immediately ask to examine me – my body leapt with joy. I knew I was safe here.
I was deep in labor with my second child. Joanne was my midwife. I’d had a midwife, too, for the birth of my daughter two years before, but it was in a hospital. I wanted a softer experience for my son’s birth – a home-away-from-home feeling – and relished the opportunity to be cared for at an independent birth center.
But it wasn’t until I was all the way through the experience that I really understood just what a difference the context makes: it shapes the practice of the provider, and it shapes the mother’s experience, which affects the outcome.
According to the CDC, 98% of American women give birth in hospital. Hospital is therefore the default context for birth. We unconsciously accept its terms: that birth is a medical event which is best managed by the hospital machinery; that our desire for a great birth is at odds with our need for a “safe delivery”; and that the pain will be so great that we’ll need the medical relief only the hospital can provide.
Labor and birth are affected by a multiplicity of factors, and I acknowledge that plain old luck may be one of them. Still, my two experiences showed me that, when you get the context right, it’s possible for birth to take care of itself: that it can unfold organically, not mechanically; that the more loved and supported we feel during labor, the more physically comfortable and actually safe we are.
The departure point for my comparison of the independent birth center context and the hospital context is the moment of arrival at each facility. I phoned both places from home to tell them I was coming. Both times, I arrived in advanced labor, 10 cm dilated. It’s worth noting that while I labored at home, I was comfortable – working very hard, yes, but not in pain.
At the birth center, Joanne welcomes me in the parking lot and, in about the time it takes to walk from the street to your front door, I am in a comfortable bed in a quiet, dim room that was readied just for me. My midwife is warm, quiet, respectful, and whispers that I’m wonderful. I love her.
I give birth within 45 minutes. It only hurt a little at the very end.
At the hospital, the vast parking structure is stuffed with cars. Something about that hits me hard. I am daunted by the sheer volume of humanity here. I feel that we are just one little family among all these others, and upon entering the hospital I will become a number. For the first time since my labor began, I am afraid.
In the parking structure, we walk and walk to the elevator, then walk some more to the hospital entrance, and then walk more down brightly lit and noisy corridors, before finally arriving at the Labor & Delivery Reception. I have made it! But the nurse on duty does not reward me with even eye contact.
Instead, she challenges my husband, “She doesn’t seem like she’s in labor.” Somehow he and the doula convince her that I am. Her eyes flick over to me and she tilts her head toward a seat in the waiting room, where a TV is on.
“They’ll call you in a few minutes,” she says, as I sit in a white plastic chair and wait with the others. I am soon escorted to a triage room, where my labor is summarily confirmed with a cervical check, and I am left alone to wait for a room is ready for me. I notice my contractions weaken and slow.
An hour later, I am taken to my room and then attended to in a flurry of activity. Lights on, two nurses on either side of me – one doing my vitals and the other struggling to place an IV line (“just in case”) – chatting to one another as if I’m not even there. I ask for water and they give me ice chips (“just in case you need a C-section”). They finish their work and walk out without a backward glance, switching off the lights as they go. I feel uncared for, a stranger in a strange land. Labor begins to feel interminable, a mean trick, and I doubt my ability to do it.
Five hours after pulling into the parking structure, after being threatened with Pitocin and a c-section, and with tremendous effort, I give birth.
My doula thinks that maybe all that pre-admission walking moved my labor along, and that the hospital’s threats focused my efforts and gave me a surge of adrenaline at the right time. Maybe she’s right.
But I’ll never forget the way I felt when my care provider treated me with respect and admiration, rather than with clinical indifference. It felt like joy – relief, relief, release, strength, power, groundedness, profound safety, love.
And, as it happens, a much shorter and vastly more comfortable birthing phase.
Same end. Different journey. You do have a choice. Which would you choose?