A blissful birth — it’s possible with support

Three weeks shy of my 36th birthday, I gave birth to a beautiful and healthy little girl. The odds (given my age, family history, high blood pressure, and a late-stage breech baby) were that I would have a complicated and painful delivery — most likely ending in a C-section at 37 weeks. But that’s not what happened.

Instead, I was allowed to go to (and past) my due date. Despite needing an induction, my labor was smooth, fast, and unmedicated. I pushed for 5 minutes. My husband was able to catch our baby, place her on my chest and cut the cord. It was incredible, even euphoric experience for both of us, and one we’ll always treasure. It was not likely to go this way.

Our birth team — midwives and a doula — made all the difference

I firmly believe the only reason we had the positive birth experience (versus a more physically and emotionally taxing one) was because — based on advice from a trusted friend and my sister — we decided to deliver with a Certified Nurse Midwife (versus an OBGYN) and to employ an experienced birth doula.

Obviously pregnancy, birth and parenthood are highly personal experiences with an infinite number of “right” answers. I simply offer this example as an option worth considering. I personally didn’t know it was an option until late in my pregnancy. Now that I’ve had the experience of working with a supportive team of women, highly skilled and knowledgeable in birthing babies —I believe they can make all the difference in your emotional and physical wellbeing — no matter what type birth you have.

An overview of the status quo*

Before diving into the alternate path my husband and I ended up choosing, it’s important to provide an overview of the status quo for birth in the U.S. In sum, if you’re afraid of giving birth here — there’s a lot of data to back you up.

ProPublica, which did an extensive study of maternal mortality and morbidity in the U.S. finds that despite spending more per capita on health care than any other country, the US has the highest rate of deaths related to pregnancy and childbirth in the industrialized world and an even higher rate of maternal morbidity (or severe complications for the mother like hemorrhage and infection).

In part, these grim statistics are due to a culture of intervention that has developed in American Obstetrics. The rate of both inductions and C-sections have skyrocketed over time in the U.S. Today, one in five pregnant women have their labor induced (a figure which has more than doubled since 1990) and C-sections are now the most common type of in-patient surgery. In the 1960s, less than 5% of all U.S. births were by C-section. By 2016, almost one in three women had the procedure (twice the rate of Europe).

Some factors explaining the exploding rates of C-sections in the U.S. include the convenience factor (because C-sections can be scheduled), indirect financial incentives (C-sections normally take much less time than vaginal deliveries and are therefore more cost effective for hospitals) and the rise of “defensive medicine” — when doctors perform unnecessary procedures for fear of being sued for not doing enough if something goes wrong.

While C-sections are often lifesavers, like any surgery they also increase the likelihood of immediate complications like hemorrhages, blood clots and infections. Stunningly, experts have found that only about one third of U.S. C-sections are medically justified.

They’ve also found that the type of care pregnant women receive makes all the difference in eventual outcomes for both mother and baby, and that empowering midwives (similar to the model in Europe where midwives oversee the majority of births) is strongly associated with lower interventions, cost effectiveness and better outcomes in maternal and infant health.

An alternate path — choosing to deliver with a midwife and a doula

Before expounding on the benefits of choosing an alternate path, I want to be absolutely clear that OBGYNs played a critical role in my pregnancy and birth plan. I was able to get pregnant in the first place because of the work of an incredible OBGYN. who performed multiple surgeries to remove a problematic fibroid. And, my birth plan included delivering in a hospital setting with an OBGYN on-call to perform a C-section if I needed one.

I wasn’t trying to avoid a C-section if I needed one. I was simply trying to set myself up with the best chance of delivering naturally if I could, the confidence to know that if I was being advised to get interventions like an induction or C-section that I really needed them, and finally the emotional and practical support to have the best possible experience no matter what kind of birth I ended up with.

My birth team — the Midwives

After doing research and taking extensively to a friend and my sister — both of whom delivered in hospital settings with Certified Nurse Midwives and a birth doula — I decided to switch from my traditional Stanford-affiliated OBGYN to the Bay Area Maternity practice which is located at the El Camino Hospital in Los Gatos.

BAM (as it’s known) was created with funding raised from powerful, wealthy women unhappy with the standard care options available to them — biotech CEO Anne Wojcicki and Angela Buenning Filo, Yahoo co-founder David Filo’s wife.

BAM is run by two highly experienced Nurse Midwives who have delivered more than 15,000 babies between them. They aim (and in my experience succeed) at providing women “compassionate, respectful and caring support resulting in the safest, healthiest and most satisfying births possible.”

BAM midwives Lin and Maria have participated in literally every kind of birth and have a fantastic relationship with El Camino Hospital — which fully empowers them to drive labor and delivery, and make the ultimate decisions on if and when to bring in the on-call anesthesiologist (for epidurals) and the O.B. (for C-sections).

To make it real — here are some practical examples of the care I received and the difference it made.

Breech and high blood pressure at 37 weeks: With an O.B. the standard of care would have been an immediate induction or C-section, likely resulting in a premature baby who would need to stay in the NICU. Instead, for the breech my midwife Lin sent me to a specialist chiropractor and prescribed a set of “spinning babies” exercises. I was skeptical but within a few days the baby turned on her own, without need for more serious intervention. For the warning signs of preeclampsia, Lin monitored my blood pressure, fetal stress and liver function (via blood tests) daily — ultimately letting me continue to and past term (41 weeks), at which point she recommended an induction.

Induction: My induction was gentle — and not rushed, which greatly reduced stress on my body, and ensured I didn’t have abnormally fast and painful contractions (often a result of using Pitocin). I was placed on moderate doses of Cervadil, manually dilated, and then placed on a moderate level of Pitocin. All in all my induction took 24 hours, but the gentle and slow nature of it meant I wasn’t exhausted and was well positioned for a straightforward and simple active labor and delivery.

Wireless monitoring: BAM allows for intermittent monitoring, which means many women who deliver there are completely free of machines. I was on an IV of Pitocin, however, which requires constant monitoring. The good news for me was that BAM has fully wireless monitors, so despite being hooked up to an IV and fetal heart rate monitor — I could move freely around the hospital for my entire labor and was never confined to my bed.

Family-centered delivery: When it was time to deliver the baby, Lin encouraged and coached my husband Brian to catch our daughter — which meant the first person who ever held her, loved her. He was able to then place her on my chest — and later cut the cord as the baby and I did more than an hour of skin to skin contact. It was a wonderful bonding experience for our new little family — one where Brian had a clear and engaged role.

In sum, the care I received from Lin allowed me to have a healthy, full term baby, to avoid unnecessary medical intervention (in my case, an unnecessary C-section) and for us to bond as a family during the birth. I also completely trusted her — so when she told me I needed an induction, I knew it was necessary and never second guessed the decision.

My birth team — the Doula

No matter if you deliver with a Doctor or Midwife, chances are that you and your partner will be alone for the majority of your labor — unless you hire a birth doula. A doula is a birth coach and advocate. Her role is to provide continuous physical, emotional, and informational support during labor & delivery and the immediate postpartum period.

Similar to with Midwives, studies have shown dramatic enhancement of overall birth satisfaction and positive birth outcomes when a doula is present. These outcomes include: shorter labors, fewer interventions, higher degrees of maternal satisfaction with the birth and with her partner’s role, reductions in postpartum depression and better bonding with the baby.

We had the incredible fortune to work with experienced birth doula Tara Gomez. Tara herself has six children, and in addition to coaching hundreds of women through labor has personally experienced many kinds of delivery, including C-section. She is nonjudgemental, and wise —setting early expectations about the unpredictable realities of birth by having us put together our ‘birth wish list’ (versus plan), which included a standard section on our wishes in the case of a C-section.

Truthfully we hired Tara because we’d been advised by friends to do so, but neither of us truly understood what she did. Here are the highlights:

Created a safe, relaxing space: Laboring under the hospital’s florescent lights and beeping machines for 30 hours is not exactly relaxing. The first thing Tara did for us was to transform the delivery room. She dimmed the fluorescents, set out electric candles, strung Christmas lights, started a diffuser for lavender oil, draped a tapestry over the TV (so I could look at it from my bed), and started a soothing playlist. It might sound hokey but it made a WORLD of difference. The space was suddenly a little spa-like refuge, not a stressful, sterile, clinical room.

Poses to help baby descend: Working with Tara was like having a master yoga teacher coach you through birth. I didn’t lie flat on the bed once. Instead, Tara rotated me through the most beneficial position at that particular point in my labor — with the birth ball, on my hands and knees, squatting, walking briskly down the hospital hallway etc. Under her expert guidance my active labor lasted less than 6 hours and the baby came in 5 minutes of pushing. In contrast, the labor I expected to have was like my mother’s — 36 hours of labor and then an emergency C-section.

Pain management: As she coached me through labor positions, Tara actively helped me manage my pain via breathwork, massage and movement. I always intended to get an epidural, but with Tara’s coaching found that I didn’t need any pain medication. She also coached my husband Brian on how to help support me and lessen my pain. He therefore had an active role throughout the labor and I felt incredibly supported by him throughout the process.

Advocacy with medical staff: Finally, Tara was a powerful advocate with medical staff. She helped Brian and I understand what was normal, and also advocate for our wishes. For example, my IV drip of Pitocin was inserted in a way that kept triggering a beeping warning every time I moved. Tara asked the nurses to take it out and put it in a different vein. They pushed back initially, but she was persistent and eventually they conceded, which allowed me to move freely throughout my room without a constant alarm sounding.

Having Tara coach us through the birth process was an incredible experience, which left me feeling frankly euphoric and with a new sense of personal power in what my body could accomplish.

In conclusion — we had a blissful birth, because we got the right support

I never knew it was possible to have a truly great birth experience, and now that I know — I feel a duty to share that — YES, it IS possible! Not only if you’re young and in great shape and have a totally uncomplicated pregnancy and delivery, but also if you’re older and aren’t in the best shape of your life, and need interventions. I now really believe that with the right support — you can have a satisfying, empowering and great birth experience, no matter what kind of birth it is. Good luck!

*Sources: Data from this section taken from ProPublica’s extensive work on Lost Mothers

Other resources:

A blissful birth — it’s possible with support

Research & References of A blissful birth — it’s possible with support|A&C Accounting And Tax Services
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