A Womb of One’s Own: Practical vs. Political

Everything women do with their bodies is politicized, and one of the most discussed, dissected, and judged acts we may choose to participate in is that of birth.  While society may pay lip service to the idea that the only important part of the birth process is ending with a happy and healthy mother and child, the reality is much different.

I am six months pregnant, and my midwife has begun discussing the actual labor and birth process with us.  Because the midwifery practice is associated with a hospital, our location is limited to the hospital.  Because I chose to go with a midwifery practice, my birth process is automatically limited to no elective inductions or Cesareans.  We’ve started discussing options for pain management, from “no medication unless I ask” to “GIVE ME ALL THE DRUGS”.  And while people will say that their main goal is just for me to end happy and healthy with a happy and healthy son, anyone who has read comments on a birth-related article online know that there’s an extreme amount of judgment attached to every move a woman makes once her labor begins.  What I find striking about the people doing the judging is that many of them admit they’ve never been pregnant or given birth, so they have no personal experience with the process, yet it’s never stopped them from passing judgment on me or any other woman dealing with the process and its associated issues.

I’ve chosen to give birth in a hospital, so some may see me as complicit in the medical-industrial complex, a participant in my own oppression.  My gynecologist only practices at Planned Parenthood, so I needed to find someone who could practice at the hospital I chose (which is conveniently located less than a mile from my home).  I wanted my provider to be a woman, and I felt that my pregnancy would be low-risk, so I chose a midwifery practice associated with the hospital.  If at any point my pregnancy became high-risk, the practice also employs an OB/GYN, so I could continue seeing them.  What was most important, more than all of these things, was that they would all be covered as much as possible by my health insurance provider.  As an unemployed grad student living off of her husband’s income, I don’t have the financial privilege to go to anyone that strikes my fancy, I have to make sure they’re covered by my insurance.  Even as I use preferred providers for all of my prenatal care, I have still paid hundreds out-of-pocket for what isn’t completely covered, from blood tests to ultrasounds.

I’ve chosen to try to attempt to give birth vaginally, and hold off on using medication for as long as I think I can stand it.  This is for a variety of reasons: I’m afraid of surgery, I’m afraid of the process of an epidural, I’m afraid of the side effects of Pitocin, I want to see if I can do this.  Maybe viewing the birth process as some sort of personal challenge isn’t the healthiest way to view it, but for me, it’s a lot more relatable as a challenge than as some sort of mystic sorority initiation the way I’ve heard some talk about it.  And yet again, quite frankly, I’m trying to keep the costs of the birth and hospital stay down as much as possible.  I know that the moment I decide I want pain management, I then have to pay for the anesthesiologist.  I know that for every step away from a very bare-bones birth process, I have to pay.  Some of the mothers I know have had unplanned Cesareans, and they’ve cost literally thousands of dollars out-of-pocket.  As much as I’d like to say that money isn’t a factor in my birth and pregnancy decisions, it very much is, and anyone who wants to judge me or any other woman for making decisions based on financial concerns must be very, very lucky to not have to worry like we do.  Though truly, in the end, all I want is to hold my happy and healthy baby in my happy and healthy arms, surrounded by my happy and healthy family.  The politicization of that moment can wait until another time.

What about you, mama commenters?  What was your birth experience?  What would you have changed in an ideal world?

 

Published by

Jessica Werner

Free-range librarian in Seattle. A sucker for happy endings, teen angst, and books that make me want to sell my possessions and travel the world. Incurable homebody and type A. Send love letters and readers advisory requests to jessica.werner@gmail.com

16 thoughts on “A Womb of One’s Own: Practical vs. Political”

  1. I was with a midwifery practice for my son’s birth. Safety tip: don’t have children with a man who wears a hat so large you have to special order them from the Big Hat Store, because his children will totally get all snagged up in your pelvis. (My son’s head at birth was in the 98%ile. NOT FUNNY, DNA.)

    Because of the snagging of the head, I ended up transferred from the freestanding birth center to a hospital, which means my birth was actually less expensive for me. Also, the attending midwife threw down with the OB on call, who wanted to get in there with a C-section. (She won, and I got an epidural so that I could sleep for a few hours, then pitocin to restart my labor, which had stopped because of uterine exhaustion, which I did not even know was a thing until it happened.) Result: successful, if not simple and uncomplicated, vaginal birth.

    I’m now pregnant again, and I gotta say, I hope this one inherits its head size from my side of the family.

  2. Disclamer: I’m one of those people who hasn’t given birth. But even as a non-parent, one part of your post struck me– attention toward financial details. You’re going to be financially responsible for your child for his/her entire life. Thus, it seems pretty logical to start making those decisions now. You’re going to be doing the same thing for years, and unfortunately, public scrutiny will persist. From what I’ve seen, you’ll be getting “helpful advice” left and right about everything from diapers to discipline.

  3. I have an experience that seems to be a polar opposite of the experiences I have read so far.

    I CHOSE to have the epidural ready once labor started. Do I fear pain? No, I feared stressing myself and my child to complication when I was dealing with the pain. I couldn’t have predicated what happened, but thankfully the epidural help me spend over 23 hours actively in HARD labor before I was dilated enough to start pushing.

    And the pushing? (Oh… the pushing.) Over 3 hours. After this I changed to a female OB/GYN and she was appalled at the amount of pushing I did and for how long. Eventually my son had to have the little suction cup put on his head and with a mighty big push, he was gently assisted out of my exhausted body. My son came out looking like the new born for Coneheads.

    I would have changed several things about the labor and delivery, but the only one change I know that would have changed the entire experience? My OB/GYN.

    I know that the hard labor time lapse of over 23 hours would not have changed regardless if I chose to NOT have the epidural, have my baby naturally or if there was Pitocin involved. I do know that my epidural fell out THREE times and each of those times I experienced a contraction without the drugs?? OMG! I cried and screamed throughout the whole thing and ended up noticeably stressing out my unborn child.

    What impressed me about my entire pregnancy and labor/delivery? Honestly? I had choices. I could decide if I wanted to get an epidural and who I wanted in the room. I choose not to have a midwife nor did I choose not to grab that mirror and watch my vagina expand with my large headed baby. No judgement felt. This was slightly impressive once I had digested and examined the whole experience.

    I think it takes more courage and fortitude to have a child without the assistance of pain medication. But I think having the choice to delivery your child however you damn well please is imperative.

    I had relatively good insurance, but even with good insurance I ended paying over $3k of medical expenses incurred during the labor and delivery. This is upsetting and I file this discouragement into the fact that health insurance covers prescription viagra but not maxi-pads and tampons. Health insurance will cover a vasectomy without any sort of hesitation, but will question (and deny) the need for a hysterectomy when medical advantageous.

  4. “My gynecologist only practices at Planned Parenthood.”
    I so envy you. The only gynecologist who accepts my insurance in my tiny town likes to spend the time he is scraping at my uterus telling me about how much he misses Bush. :sigh

    Re: fear of the epidural process: I had one after 20 hours of labor my first time (successfully did it all natural the second time, yay!), and I was astonished to find out that I didn’t even feel the needle go in. Literally, not at all. Whatever topical anesthetic he put on first completely numbed the area. I was very relieved by that, because I have a *very* low pain threshhold.

    In fact, the only bad part about the epidural insertion was that the exact moment he said, “Okay, now I’m going to put it in. DON’t MOVE A MUSCLE OR I COULD PARALYZE YOU!” is the exact moment my water chose to burst in an explosion that scared the shit out of me (almost literally–it felt like a water balloon popped inside my vagina, and gushed off the bed and onto the floor!). But I didn’t move!

  5. I was unemployed and my husbands small CPA practice had not opted for maternity coverage so this birth was going to be on our own. I also chose a mid-wife associated with the hospital and was going to try to go as long as possible with no drugs. It worked out well. I went natural all the way although it was very difficult and long.

    The thing is, I did the same for the next two, going with a mid-wife, and each birth was different. Each personal.

    Please, if you decide to get an epidural, don’t judge yourself. I did for the last baby at 8 cm, just to see what it was like. Close to the end, the mid-wife says “Do you want to pull her out?” And because I’d had the epidural, I was able to lean over, hook my hands under her armpits, and pull her out.

    Now I know you are going “Oh my god, really?” But honestly, it was the most fantastic thing, although I’m not sure I could have done that with my first.

    In any case, you’ll do great! Having a mid-wife is awesome. Being in a hospital offers a physical/mental security that is important.

  6. I think you are on the best track possible to a positive birth experience. The most important thing to having a safe, healthy birth, is to have a clear idea of what you hope will happen and what you want, but know that unpredictable things can happen, and be willing to accept the necessary changes in plan when they happen. Planning to go without an epidural, but if it turns out the pain is too much, not beating your self up for ‘giving in’; planning for a natural, non-pitocin spontaneous birth, but if there is a legit reason to need an induction or augmentation, accepting that as well. There is so much that can’t be controlled at the end of pregnancy that being able to go with the flow if nature isn’t giving you a beautiful, spontaneous birth may be essential. You have to trust your providers, and feel comfortable discussing things as they happen and understanding why they are making certain recommendations. If you feel like your midwife or doctor doesn’t explain things well, that bodes ill. You can’t necessarily control certain experiential things – you might get a “bad” nurse whose manner you don’t like, you might happen to be delivering on a really busy day when the staff is stretched thin, the person covering the group for your midwife might be someone you don’t know well, etc – which can sour things, but that’s life.

    I’m surprised to read that you have to pay more for anesthesia; in new york state, at most hospitals the birth of a child is billed as a single global charge, and it includes whatever treatments are needed in labor and delivery and post partum services. If you do need a medically indicated cesarean delivery, there is no way you would get charged more for that by your insurance. Someone without insurance could be stuck with higher hospital charges, but if you have insurance, they are covering your delivery however it happens. I do know that some insurance providers will not cover the extra charges if someone is choosing an elective cesarean, but that is a different ball of wax.

    My tips for a good labor, from the other side of the process (I’m an obgyn resident):
    -write down your birth plan, but keep it simple and focused on the things that are really important to you.
    -stay out of the hospital as long as possible, do as much early labor as you can handle at home with your support partner
    -unless you are gbs positive, again, if you break your water stay at home and wait to see if contractions start; if you turn up ruptured and not in labor, most obs will want to start inducing you pretty quickly.
    -if you want things like intermittent monitoring, no iv fluids, walking around, make sure you chat with your doc/midwife before to be sure its an option, which it should be, though given nurses at the hospital may be more or less on-board with minimal interventions, so you may still have someone on day-of who you need to explain your plan to.
    -know that even if you don’t want fluids they will want to place a hep-lock (iv catheter not necessarily hooked up to anything) and that this is a good thing, it is just to make sure we have quick access to a vein in case of you or the baby needing quick medical interventions. while most deliveries are uncomplicated, when things go wrong they can go wrong fast and have disastrous consequences for you or your baby.
    -if you are at a teaching hospital, know and accept that residents will be a part of your process. It is understandable that you want your primary provider to be there and running the show, but at a teaching hospital the residents are the actual integral staff on the floor. Stating you don’t want us to be part of your care can actually harm you, since we will be offended (we’re human after all) and on a practical level mentally cross you off our long list of patients since you are now not “ours”. We’re the first line of response when a bad thing happens, so you really do want us involved from the start so we know you, you know us, and if a crisis happens you don’t suddenly have a stranger wielding the vaccuum or scalpel over you. Trust me, we are usually busy enough we won’t be bugging you if we don’t have to.
    -Make sure you and your partner are on the same page about the birth-planning – its awful for everyone when the patient is wanting certain things but is fighting with her partner about it. (example: husband or mother who is either pushing the patient to get an epidural or trying to talk her out if it because it wasn’t “what we wanted”).

    1. I’m honestly not sure how my hospital will bill or how my insurance will cover the process– I’ll get a statement from my insurance company saying that an appointment or procedure was covered, but then a month later get bills from a bloodwork lab or an ultrasound-processing lab for what wasn’t covered and wasn’t mentioned in the original bill. It’s usually not a lot ($800 worth of bloodwork at my first prenatal appointment and only $60-ish wasn’t covered), but it adds up. One of the bloggers I follow recently gave birth and with complications, her hospital birth will work out to over $30k. Her insurance will cover most of that, but she said she’s still getting miscellaneous bills for various parts of it, and she’s expecting it to add up to a couple thousand out-of-pocket.

      We’re doing a “Centering Pregnancy” group/program as part of our prenatal appointments through our midwifery clinic, so we’ve been learning about the process together– I definitely feel like Josh is on the same page as me regarding my desires for the birth. He told me yesterday that he was glad I was the one going through it because after watching a birth video, he felt he wasn’t strong enough to go through something so overwhelming, but he knew that I was from experience.

  7. From all the birth stuff I’ve read, hiring a doula is also a good move (and if they’re not covered by insurance, some will work on a sliding scale, or doulas-in-training can cost nothing).

    I’m interested in your language, though. “going to try to give birth vaginally” strikes me as a pretty sad reflection of the discourse of fear around birth.

    1. It’s not that it’s a fear, it’s just that I know so many women who went into labor planning on vaginal births and then had unplanned Cesareans, including my mother with me. I want to try to do it vaginally, but I can’t guarantee that medical circumstances won’t arise that require a Cesarean.

  8. Yeah, birth advice can get pretty overwhelming. I remember all the mothers I talked to just saying “TAKE THE DRUGS.”

    My two were polar opposites. My first didn’t want to come out, he took a lot of coaxing. It sucked, but there was some genuine concern about leaving him in there, so I guess I wouldn’t change anything. My second was an emergency c-section. We like to joke that she kicked her way out (my water didn’t just break – it ruptured and she was still breech). It was certainly faster.

    I think the only thing I would change is the post-birth rehab. No one told me that a c-section can mess up your lower back. I found out a year later, when I had horribly bad sciatica, that the surgery can weaken your stomach muscles and your back muscles work harder than normal to take up the slack. That would have been nice to know before I hurt so bad that I could barely walk. (All better now, BTW, I just have to be a little careful lifting heavy objects)

    1. For lots of people it isn’t just the c-section that weakens muscles, but the pregnancy itself. Since the muscles are separated during the surgery, any abdominal surgery can potentially weaken your abdominal wall. But for many women, the stretching of the muscles and fascia that comes just from the pregnancy has the same effect; multiple pregnancies have an additive effect. I’ve seen many women who have had multiple vaginal deliveries have impressively splayed abdominal muscles with big midline hernias, without any surgeries. Pregnancy itself is pretty rough on the body even without the added recuperation from a major surgery……

  9. Being pregnant was the time I realized how freaking lucky I am to have full health insurance that covered darn near everything (including a prenatal program that, if completed, waived the hospital co-pay – a free $300 for stuff I was doing anyway, hooray!). And now I will commence to scaring you, you poor nice pregnant lady, with my story.

    In my hazy pregnant ideal, I would have gone into labor on or around a day or two after LawBaby’s due date, with no drugs and we’d all go home after a day or two. At least the end part of that come out as planned, and ours has that happy “everyone is healthy and thriving” ending.

    Meanwhile, in the real world, LawBaby was overdue, and my OB-GYN pushed hard for induction at 7 days over. I managed to negotiate her up to 10 days, but that meant ultrasounds and “biophysical profiles” every.flipping.day he was overdue (thank you, insurance). Then, still nothing, 10 days later. None of the old wives tales were doing anything to get that kid to budge; so, in for the pitocin induction we went.

    Day one; nothing.
    Day two; no progress, but lots of discomfort.
    Day three; I’m exhausted from no/interrupted sleep, minimal progress and lots of discomfort, then PAIN and lovely painkillers and an epidural, eventually. Our friends and family were pinging our cell phones like crazy (I’m sure expecting the worst, with no “he’s here!” updates). Doctors were confused and wondering how best to spring LawBaby from my ovarian Bastille.

    My contractions got so intense that LawBaby started not doing so well, and an in-hospital ultrasound confirmed Doctors’ concerns that he accessorized with his umbilical cord. So, after three days of really, really trying for a no-drugs birth, it was off to the emergency c-section surgery for us. I will never forget the cold that came over me when my doctor came in and said, “the only way I can promise that you will go home as three is if we do a cesarean right now.” I didn’t even have time to call my mom and dad.

    I felt really, really guilty and upset about how it all went down for a few weeks after he was born; I’m still not sure why, but I think it had something to do with my mind’s expectations not meshing with the actual experience (though, again, we are all happy, healthy, thriving and recovered from the experience quickly and easily, with nothing more than ibuprofen for me and boob for LawBaby). Also, there were some terrible dark thoughts of, “if this were 1750, one or both of us wouldn’t be here.” I felt like my body had betrayed me; the one thing it should have been able to “just do,” it didn’t. Your “lip service” comment is exactly right – even though we were all happy and healthy, I still felt like I had “failed.”

    Happy ending – now we celebrate “Birthday Week.” I figured, it took him nearly a week to get born, I’m celebrating every day of that with a vacation for all three of us.

    Sorry, that was looong and not so cheerful, but I think what I’d change, in an ideal situation, is to not be so hard on myself for not being able to do it without medical intervention.

Leave a Reply