A Tale of Two Births

Posted on January 18, 2016 by CNF • Posted in Articles Page, Highlights, Slider Content • Tagged healthcare, hospitals, labor, Mary Widdicks, midwives, op-ed, postpartum • Leave a comment

A Tale of Two Births: How the U.S. Fails to Deliver Adequate Postpartum Healthcare

By Mary Widdicks

My daughter was born on a snowy Saturday morning. We were released from the hospital Monday, and as is the case for most new mothers in the U.S., my husband returned to work the very next day, leaving me alone to care for our newborn daughter and our two- and four-year-old sons. At three days postpartum, my bones ached as I stepped out of the car and onto the frozen pavement of the parking lot at my doctor’s office. My deflated uterus contracted under the strain of the baby’s car seat; I braced myself against the car to keep from slipping on the icy ground. For a moment I thought I might not make it the 25 yards from the parking lot to the door. I remembered the hospital’s recommendation not to lift anything heavy for a few weeks, and almost laughed. If only that were possible.

My labor had been induced due to high blood pressure and pre-eclampsia, which hadn’t resolved by the time I left the hospital after the baby was born. Puzzled, the doctor asked me to return to the clinic a few days later to recheck my vitals. When I arrived, my toddler jumped eagerly from the car, beaming with a frenetic energy that my combined six hours of sleep over the last three days couldn’t match. My heart was pounding in my ears as he ran ahead of me in the parking lot of the clinic, my broken body too heavy and tired to keep up with him. I arrived at the nurse’s station gasping and shouting at him between breaths.

Unsurprisingly, my blood pressure had not returned to normal and the nurse asked me to repeat the journey again in two days for yet another checkup. There was talk of bedrest, anti-convulsive medication, and the possibility that I wouldn’t be allowed to continue breastfeeding my three-day-old baby. The nurse looked into my wild, tearful eyes and urged me to get more rest. I laughed out loud this time, hoisted my limp toddler onto one hip, slung the baby carrier over my opposite arm for balance, and dragged our tired bodies out of the exam room so that we didn’t all collapse in a heap on the floor.

I wanted to be angry at my husband for leaving us so soon, angry at the doctors for making me come into the office days after my baby was born, and angry at my own body for betraying me at a time when I needed it to be nothing less than super human. Instead, I sat nursing my squalling infant and watching my son put everything within a ten foot radius in his mouth, and reflected on how different the postpartum experience is in the U.S. compared to the rest of the developed world.

When people find out my first son was born in the United Kingdom, the first question they ask is how was it different giving birth in the UK compared to the United States. While there were a few notable differences in labor and delivery, for me, the most glaring discrepancies are in what happened afterward: the quality and accessibility of postpartum care. Britain’s National Healthcare System provides everyone living in the country with the same level of support, even moms on student visas like I was. Additionally, in the UK and throughout most of Europe, fathers and domestic partners are entitled to at least two weeks of paid parental leave, allowing them time to bond with their newborns and care for their wives as they recover from the harrowing experience of childbirth.

Then again, had my daughter been born in the UK, there would have been no need for me to haul my newborn out in the cold weather, expose her to countless germs, and risk rupturing my own stitches simply to check my blood pressure. For two weeks after my son was born in the UK, he and I were assigned a team of local midwives who would visit us at home whenever we required a checkup. There was no need to book appointments with a pediatrician or schlep a carseat around town every time my son had a rash or a cold. If I had a question about my health or the health of the baby, I could call the midwives 24 hours a day for a phone consultation, or ask them for a home visit during working hours. When I had difficulty breastfeeding my newborn, I simply called the midwives, and a lactation consultant arrived at my home the next morning and stayed for several hours and multiple nursing sessions. I never even had to put on a bra or leave the house.

After two weeks, my husband returned to work and I was discharged from the midwives’ care, but my support system was not entirely disbanded. My son was assigned a specially-trained nurse, called a health visitor, who would look after his well-being for the next five years. At first, his health visitor dropped by our house several times a week, then gradually spaced her visits further apart until she only checked in every few months. However, she was available by phone or text message whenever I had a first-time-mom moment of panic or insecurity.

When my son was six months old, I called her crying because he’d started violently resisting breastfeeding. She knocked on my door two hours later just to check him over and reassure me that he was happy, healthy, and chubby as a cherub. Her words of encouragement put my mind at ease and probably kept me from banging down my pediatrician’s door in a blind panic at 2am. So too studies have shown that when a new mother has adequate support and help during the perinatal period, she is less likely to suffer physical and mental health complications such as postpartum depression.

The stress of trying to “do it all” takes its toll on new mothers, and having a support network built into the medical system relieves some of that pressure. When my daughter was born in the US, the responsibility of caring for three children under five years old, running the household, cooking meals, and getting all four of us to various appointments throughout the week drained me of every ounce of healing energy I had left after labor and delivery. I was drowning, so of course my body was locked in a fight or flight response. I needed help to come to me, and the American healthcare system wasn’t delivering.

Sitting in the waiting room of my OB/GYN’s office that day, surrounded by expecting mothers, I was overwhelmed by the realization that many of them would be forced to return to work after only six weeks or risk losing their jobs. Those who stayed home might wind up so exhausted and isolated from solely caring for their babies that they would succumb to the darkness of postpartum depression. How can we call ourselves a civilized nation if we can’t even do something so basic as to care for mothers after the birth of a child? It’s time for the U.S. to catch up with the rest of the developed world and recognize that it is in everyone’s best interest to raise happy and healthy children, and the first step to achieving that is by giving mothers the time and help they need to heal properly after giving birth.

Once a cognitive psychologist in the field of memory, Mary Widdicks now spends the majority of her time trying to remember if she fed all her children each morning. The irony is not lost on her. Mary’s writing has been featured on sites such as The Washington Post, Scary Mommy, and The Huffington Post. In February of 2015 she gave birth to her first daughter and is now happily drowning in a sea of pink. Follow Mary on her blog, Outmanned, or on Facebook.

When Her Life Passed Through

Posted on January 12, 2015 by CNF • Posted in Blog, General • Tagged Ann Tepperman, childbirth, death, family, home birth, loss, midwives, motherhood, mothering • Leave a comment

By Ann Tepperman

It’s been 485 days since my mother died.

Four hundred eighty-five days ago I sat next to her on her bed, the only sound in the room the breathing machine and her heavy, thick, watery breaths. Her body was gently propped up with pillows so that she could face the setting sun through her bedroom windows. Her eyes were open and wild and she could no longer move or talk. The blood cancer had seeped into every cell of her. It had won.

I held onto one of her limp hands with one hand; the other rested on my swollen, nine-month pregnant belly. Inside me, swimming in quiet bliss was the daughter who would never meet my mother, her Nonna, except perhaps as spirit floating through the veil into the other world. I recall my mother having two final breaths: the second to last was from this world and the last seemed to be her breathing in the atmosphere from the other. Then she stopped. Then she was gone. And she is gone forever.

We were guarding my mother’s body, sitting next to her until the men in the truck came to pick her up. They wrapped her in a white sheet, preparing her to be taken away, and it was then that I turned my tearstained face to my husband and in agony asked him to help them carry my mother away.

“Will the circle be unbroken by and by Lord by and by, there‘s another home awaitin‘, in the sky Lord in the sky…”

I watched my husband carry her body away in the most reverent and loving way. Even though we had been together for nine years and had (almost) two children together, at that moment we created a deep, inexpressible bond that carried us through this horrible tragedy and everything that was to come.

Three weeks after the death of my mom, my water broke. It was the middle of the night, and I was awoken by a surge of warm liquid pouring onto the bed from between my legs. We called the midwives and my husband began filling the birthing pool with water. Then we waited. And we waited, and waited. But labor did not come. So with a quiet, desperate longing to meet our baby, we retreated back to bed.

A few days later the midwives called. “We are coming over,” they said. “Today you are having your baby.” I scoffed. I was already past due, walking around with a broken bag of waters. I had decided this baby would stay put indefinitely. How could I possibly give birth without my mother?

When the midwives arrived, they handed me an herbal cocktail to induce labor. We sat together on the floor of my living room and I placed the tinctures in front of me. I closed my eyes and imagined opening up the space between the two worlds, a doorway I had locked, unknowingly trapping my daughter. And although fearful and reluctant, I took the herbs, practiced my hypnosis and waited. Slowly, after several doses and a forced inward focus, I began to feel the first twinges of labor.

I had been laboring for a few hours but my labor was inconsistent. I decided that I needed to be alone. I went upstairs, removed my clothing and sat on my bedroom floor. I began to sing. Slowly and quietly at first, the words of one of the oldest prayers from the Torah moved past my lips: “El na refa na la. Please God heal her. (Numbers, 12:13).” This small and powerful prayer was said by Moses to God after his sister Miriam had fallen ill. Like Moses, I was now surrendering to the most powerful force I could imagine. I, too, was asking for help and healing, and the surges of labor increased dramatically with every word of my heartfelt prayer.

Naked, on my hands and knees, my giant, pregnant belly brushed the white, wool carpet. I was gliding in circles, riding the long, strong surges of labor that arose from deep inside my being. I sang out louder and louder into the Universe, my voice embodied with full power and force.

Then time became surreal. I remember the midwives looking down at me from above. I remember the warm tub water. I remember stumbling deep into my husband’s compassionate eyes as I pushed and pushed and pushed. And just when I thought I could go on no longer, I gave one final push.

And she was born.

I had now stood at the gates of the death and birth of two of the most important people in my life.

I looked down at the baby in my arms. I had no idea who my daughter was. Up until then I had only been able to feel her through the veil of my own perceptions. I didn’t understand that the grief and suffering I had felt from losing my mother had been holding her back from entering fully into this world and into her own being.

It’s now been fifteen months since her birth. She’s talking and running, fiercely independent and full of warmth and compassion. I still grieve the way her birth transpired and often wonder if the loss of my mother and the emotional turmoil I suffered has left a mark on her. But just when I am doubting her strength, she shows me her spirit, her individuality and perseverance, and I am amazed. Independent of my life’s story, of all my grief, sadness, joys and losses, she is her own person and I just need to get out of her way so she can be born into herself and thrive.

Ann Tepperman has dedicated her life to raising the consciousness of others through her holistic psychotherapy practice and personal essays. She lives, loves, parents and meditates in Columbus Ohio. Learn more at www.anntepperman.com.

Photo by Scott Boruchov

Home Birth

Posted on January 6, 2015 by Lauren Apfel • Posted in Blog, General • Tagged childbirth, home birth, Jessica Smock, Lauren Apfel, midwives, parenting, pregnancy • Leave a comment

Of the many questions that surrounded my children’s births, “where” was simply not one of them.

There was my house, with its carpeted floors and plush interiors, its tight corners and two flights of stairs. And there was the local hospital, a sterile purpose-built environment. The former I considered a place where people live and watch TV and cook dinner. The latter I considered a place where people go to have medical procedures as safely as possible. Because I counted birth as an essentially medical procedure—a procedure, that is, during which lives are at stake—the distinction between the two locales couldn’t have been clearer in my mind.

So when Jessica Smock approached me with the idea of a feature-length article on the topic of home birth, I was dubious. Jessica and I had already written a pair of essays that turned on the issue of what constitutes a “good” delivery, a debate that illuminated the divide between those of us who view a baby’s entrance into the world as a means to an end and those of us who place a primacy, often a high one, on the process itself. As a woman who is firmly in the means-to-an-end camp, I had to admit to conceptualizing home birth as a rather extreme option on the “process” side, lingering somewhere at the far end of the natural-birth continuum alongside lavender candles and placenta-berry smoothies.

And yet it so happened at the time that a friend of mine was pregnant. This friend, Maria, is one of the most moderate mothers I know, a far cry indeed from the stereotype home birth tends to conjure. She vaccinates her children. They sleep in their own beds; they will attend the school down the road. She is not, in other words, a champion of the kind of anti-institution, “DIY” (do-it-yourself) parenting Emily Matchar describes so well in her book Homeward Bound, the introduction of which contains this gem: “From home births to diaper-free infants to hand-mashed baby food to extended breast-feeding, today’s parenthood often seems to take its cues from Little House on the Prairie.”

Which is why you might be able to imagine my surprise when, on a visit to Maria’s house for tea and cake in the late stages of her second pregnancy, she casually pointed out the pile of birth equipment stashed in the corner of her spare room. It sat there rather ceremoniously, a promise of the major event set to take place a few weeks later in that very spot. It would be an understatement to say I was shocked. But I also became very curious, very quickly. All of a sudden I wanted to understand: what is the motivation to have a baby in your own home?

And this is exactly what Jessica and I set out to discover. We found that home birth, for a certain segment of the population, is not really about answering the question: “Where will my baby be born?” It is about imbuing the birth experience with some sort of meaning that transcends the pragmatic task of getting a baby out of its mother’s womb. Often it is about control and demedicalizing the process of giving life. For once you remove yourself from the hospital setting, with its myriad of medical interventions, there is an inimitable opportunity to let your body lead the way.

Which sounds wonderful, of course, until your body doesn’t quite know the right way to go. Women have been pushing out babies since the beginning of time, fair enough. But women have also been dying in childbirth since the beginning of time, as have infants, in much greater numbers than they do now. A successful home birth might be statistically likely and it’s all well and good if you are in that majority. It can be catastrophic, however, if you are not. And the twist of the knife is that you simply cannot know ahead of time into which group you will fall, however straightforward your pregnancy has been. My sister-in-law, for example, suffered a prolapsed umbilical cord during her labor, a completely unpredictable setback. Had she not been in a hospital, her baby would have been lost.

Risk should be at the center of any discussion of home birth, though as we concluded in our piece, it is a subject about which it is near impossible to draw hard and fast lines. As such, the safety of delivering a baby in your house is one of the fiercest battlegrounds of reproductive medicine: the same data are interpreted variably depending on who is doing the interpreting; new studies with different protocols are drawn up to counterbalance previous studies. Home birth is also an arena that is handled differently in different countries, which affects the perception (and also perhaps the reality) of its safety.

In an astonishing development, announced after our article went to print, the UK has changed its guidelines on home birth and has done so rather drastically. In 2007, the guidelines advised women to be “cautious” about home birth in the absence of conclusive risk assessments. But as of last month the National Health Service is now advising healthy women that it is “particularly suitable” for them to have their babies at home as opposed to in a hospital. That in optimal conditions—low-risk pregnancies of women who have already given birth with no complications—delivering at home is safer because of the lower chances of surgical intervention, accident and infection.

Welcomed here is the idea that certified nurse midwives should play an increasingly important role in childbirth. More suspect is the notion that these midwives should be delivering 45% of Britain’s babies in an environment devoid of certain life-saving techniques should an emergency transpire. According to Amy Tuteur, who goes by the online persona “The Skeptical OB,” “homebirth is no safer than it ever was.” She considers the British development a matter of putting babies’ lives at risk for reasons of political expediency and economic cost-cutting. So too the chairman of the committee on obstetrics practice for American College of Obstetricians and Gynecologists has reiterated the college’s position in respect of the US, a country with a significantly different medical system from the UK: “We believe that hospitals and birthing centers are the safest places for birth, safer than home.”

What kind of practical effect the NICE guidelines will have is unclear. The home birth rate in the UK has been falling in recent years (2.3%), as it has been rising in the US (1.36%). Whether the new recommendations will ultimately put Britain on a par with a country like the Netherlands (where about 25% of births take place at home) is yet to be seen, as is whether the changes in policy on one side of the Atlantic will have any cross-cultural impact on the obstetric practice of the other side. And while home birth is still something I would never choose for myself, I will now be watching with interest as to whether it becomes a more common occurrence among my friends.