Home births can be magical experiences, but what happens when the state doesn't allow them?Madeline Holler
First, we wanted to know how to dispose of the placenta.
“Most of my moms bury them,” the midwife said. “Placentas are great fertilizer.”
My husband Wayne and I rented the upstairs apartment in a two-unit block. Our fenced-in yard served mainly as a dog run for the downstairs neighbor’s chocolate Labrador, who I doubted could leave a decomposing organ to rot underground. I pictured the playful pup yanking at my umbilical cord, a one-sided tug-of-war game whipping placenta through the air and snagging bits of human tissue on the bristly bushes lining the fence. “Can’t we just throw it away? We’re moving a few months after I have the baby.”
“Freeze it and move it with you,” the midwife offered, not hearing our reluctance to dote over the very flesh and blood that nourished and connected our baby to me. Wayne and I are as unsentimental as we are squeamish. A placenta in the freezer was equivalent to nail clippings in a Ziploc, only more nauseating.
Wayne and I were on the verge of making what felt like an impractical, if not reckless, decision: giving birth to our second child at home. I had come to prefer midwives to doctors during my first pregnancy, but the laws in Missouri, where we moved from the East Coast the year before, kept midwives out of hospital delivery rooms.
Through an underground network of women and families across the state we found Alice [ed. note: this piece uses pseudonyms], a trained and experienced midwife. Seated on her living room sofa, eight weeks pregnant and yet to have an initial prenatal exam, I worked through a list of questions about the logistics, safety, cost and outcomes of pregnancy and birth in her care.
Alice had been a midwife for twenty years. She had seen it all: cords wrapped around necks, preemies, breech deliveries, stuck shoulders, twins, babies born weeks beyond their due dates, stillborns, newborns needing resuscitation, rapidly detaching placentas, the occasional uterus following the baby and placenta out of the mother. Her clients included the obese and the underfed, women in their forties and those in their late teens. She had attended the birth of a couple who were themselves a pediatrician and an obstetrician.
We liked Alice and her hands-off style. She would not break the amniotic fluid sac before or during labor. She did not perform cervical exams routinely. She did not cut episiotomies. Weight gain did not concern her, so long as the mother ate a healthy diet. Due dates helped gauge fetal development and size, Alice said, but they were not deadlines. She spewed out facts, illustrated with anecdotes and sometimes even pulled out photographs. She was easy to talk to, relatable, more like a nurturing big sister than the dowdy earth mother homebirther I had expected.
She told us a third of her $1,500 fee was required up front, the rest to be paid at each month’s visit. Prenatal check-ups were at her house and included urine tests, blood pressure checks and weigh-ins. She charted belly growth and listened to fetal heartbeats after twelve weeks. Her intelligence, self-assurance and friendly openness tempted Wayne and me. Still, we felt reluctant.
Wayne caved in first and asked what had been on our minds since we scheduled the interview.
“What about the police?” he said. “Could we be arrested?” In Missouri, midwife-assisted homebirth is illegal – a felony.
“You can’t be arrested,” Alice said. “But I could.”
I laid a check on her coffee table.
Pregnancy books and websites, which aim to demystify childbirth and reassure the first-time mom, encourage women to choose a doctor whose philosophy of childbirth aligns with her own. This requires that (1) a first-time mom already has birthing philosophy and (2) doctors are available and interested in talking about theirs. My first pregnancy caught me completely off guard. I hadn’t seen a gynecologist in several years, much less lined up an OB who could clarify the pros and cons of an epidural. Instead, as I paged through the listings in my insurance provider’s handbook, I picked out the first female OB.
After an initial exam, I got dressed and met Dr. Wheeler (not her real name) in her office. She outlined the appointment schedule for each trimester and which tests to expect. When it was my turn, I pulled out the list of sample questions I had cribbed from the growing stack of pregnancy books next to my bed: she had only ever missed one client’s birth, did not give enemas early in labor, and had never used Cytotec for induction of labor. (I had read that it could melt my uterus.)
Her cesarean rate? Unknown. Episiotomies? Only when indicated. I failed to ask for indications. I deemed a c-section rate to be too clerical for a busy doctor. Then she recommended I take a childbirth class.
“Don’t get me wrong,” she said. “Drugs kill pain. Breathing doesn’t kill pain.”
I laughed with her; of course breathing doesn’t kill pain.
At first, I loved the first monthly appointments with Dr. Wheeler. She rolled her eyes at the indignity of paper gowns. My birth plan stayed tucked in my purse from one appointment to the next. She performed pelvic exams swiftly, spoke kindly of my soft uterus, praised even the most mundane. “Your urine looks great!” she said. “Your uterus is growing exactly according to schedule!” But as the fetus developed from an olive to a lime to an orange, I developed a childbirth philosophy that encompassed more than a disdain for enemas. Dr. Wheeler and I needed to talk.
The childbirth canon acknowledged such discussions could be stressful and suggested that women offer up birth plans as a way of starting a dialogue. Dutifully, I drafted one. Though I now saw Dr. Wheeler every other week, I spent less time with her as she rushed through appointments. I noticed her irritation when I asked about a sonogram. I was already twenty-two weeks along and she hadn’t yet mentioned one. She silently wrote up the referral and slipped out of the room.
My birth plan stayed tucked in my purse from one appointment to the next. I strategized how I could ask about hospital protocols and her approach to, say, turning breech babies, while she stretched a tape measure across my taut belly. But she spoke mostly to her assistant during exams.
With one foot out the door, she asked whether I had any questions. Once I said yes, but when she whipped her head around in a double-take I stammered and mentioned constipation. Her assistant handed me pill samples. Dr. Wheeler dropped my file in the door and left.
The childbirth classes would start soon. I could ask for tips there.
The instructor’s most urgent tip: leave Dr. Wheeler. I was already thirty-three weeks pregnant. The instructor, a labor and delivery nurse who was openly in favor of drug-free labor, had attended births with Dr. Wheeler in the hospital where I had planned to deliver my baby. She was not optimistic about my chances of getting support through the pain or of avoiding the episiotomy I dreaded. Switching caregivers so late in the pregnancy felt reckless, but so did continuing care with a woman whose scalpel I had been coaching Wayne to protect my perineum from.
So I called a recommended midwifery practice. A few days later, I canceled the rest of my appointments with Dr. Wheeler, had Wayne wrest my file from the angry assistant’s hand and printed out a fresh copy of my birth plan.
My first appointment was with Nanette, one of three nurse-midwives in the practice. I gave Nanette the short version of my story, why I was transferring to her practice so late.
“I want to be in control of the birth,” I said, waiting for an assuring nod.
“Get one thing right now,” Nanette said, “you can’t control childbirth.”
“Oh, yes, of course,” I muttered, “what I meant was that I didn’t want a lot of interventions. Like an episiotomy.”
“I’ll make the determination.” she said. “If there are indications, I won’t hesitate to do one.”
“Yes, I know,” I said. “I just meant I didn’t want one.”
My forty-first week of pregnancy came and went without a single contraction. I was flat on my back when I pushed my daughter Beatrice out. At the end of week forty-two, I checked into the hospital for an induction. Cervix softener did the trick – I was in full-blown labor by the next morning and managed to avoid “Vitamin P,” Nanette’s nickname for Pitocin.
A few hours later, nurses brightened the lights and scurried in and out, prepping for the birth. I was flat on my back when I pushed my daughter Beatrice out. Nanette put her on my chest, but she didn’t cry, so the nurses took her far away to be cleaned, photographed and tested for health. Beatrice wailed. I missed her profoundly.
The second pregnancy, the one four years later in Missouri, had been planned. And this time I had a childbirth philosophy. I knew I wanted as natural a labor as possible.
The provider directory for our insurance plan, which included midwifery care, turned up no midwives within a hundred miles of our home. A guy at the company’s 800 number couldn’t find a list of midwives either.
After three days of posting messages all over the Internet, I learned a midwife-attended birth in Missouri would be possible, but with a few caveats: I would have to be discreet, pay for all costs out of pocket and prepare to give birth at home – an option I had never once before considered. Still, I set up the meeting with Alice.
In my first few appointments, I took all the worst labor and delivery stories I had heard of or seen on TV to Alice and asked what she would do. Umbilical cord wrapped around the baby’s neck? (You slip it off. It happens in about twenty-five percent of all births.)
What about a head that’s stuck? (That happens when you’re flat on your back. You need to be up to push the baby out.) What if the cord slips out before the baby? (We go straight to the hospital.) Bleeding? (Hospital.) Premature labor? (Hospital.) If can’t stand the contractions? (Get in the tub.) If I change my mind at the last minute and want to go to the hospital? (Hospital.)
Each appointment lasted well over an hour.
There were trade-offs in going off the grid to have a baby.
My due date came and went with this pregnancy as it had with my first, but post-date pregnancy did not concern Alice. “Some babies just take longer,” she said. Still, at the end of week forty-two, she wanted to perform a test to ensure the baby was doing fine. I had done “stress tests” with my first. Then, I sat comfortably on an exam table with a fetal heart monitor strapped across my belly and another belt sensing pre-labor contractions. I held a joystick with a button that I was to depress any time I felt the baby kick. The test determined whether the baby’s heart rate accelerated, as it is supposed to during contractions or after it kicked. Acceleration meant all was well.
“Some babies just take longer,” Alice said. Alice’s low-tech stress test required me to manually stimulate my nipples to bring on pre-labor contractions for her to monitor. My husband played with my daughter across the room, as I self-consciously reclined in her sofa to fondle my breasts. Alice waited at my knees with the fetal heart monitor, one hand resting on my stomach to feel the onset of a contraction. It was weird.
No doctor meant I couldn’t get a flu shot, since clinics required written permission from pregnant women’s doctors. And in any case, Alice adamantly opposed inoculations of all kinds. She also shunned most medications, preferring homeopathic remedies. And sure, flaxseed oil and white oak bark alleviated constipation and hemorrhoids. But for a rash on my breasts, why yogurt in my bra? Couldn’t I just use an ointment?
And then, there was God. In Missouri, devoted Christians were commonplace and Alice was no exception. When my due date passed without any sign of labor, she recommended, in addition to her close monitoring, prayer and patience. The latter, I could handle – even then, I didn’t mind being pregnant – but the idea of assistance through prayer made me cringe. I was comforted more by statistics, countless ten-month mom stories on the Internet, the biology of the human body and my very kicky baby.
At forty-three weeks and a day, I finally felt the pinch of early contractions. Eventually, I lowered myself into the birthing tub – an inflatable kiddie pool covered with colorful cartoon fish and warnings in seven languages. I sat in the warm water for hours through varying levels of painful contractions.
Alice checked the baby’s heartbeat each hour. She napped a bit while I concentrated on contractions, noticing the increase in intensity with each hour that passed. My husband sat nearby giving me hands-off, wordless support. Periodically, he stood next to the pool and poured in a pot or two of hot water.
Alice checked my cervix for a third time. I leaned against the chair and waited for my cervix to stretch one final centimeter. I had reached nine centimeters. She helped me out of the pool to an oversized chair across the room. A vinyl tablecloth covered the floor and waterproof hospital pads lined the chair. On my knees, I leaned against the chair and waited for my cervix to stretch one final centimeter.
The amniotic sac still had not broken, so I pushed a couple of times to break the bag. Soon after, the baby’s entire head hung between my legs. Alice instructed Wayne to get in position while I pushed. The baby slithered out. Alice pulled me back onto a short stool sitting behind me. Someone handed me the baby. Another daughter, a satisfying ten pounds and fourteen ounces.
Everybody was alive and healthy. No one got arrested.
A few days after Frances was born, while my two daughters and I snuggled on the couch, the garbage truck moved slowly down our street scooping up oversized trash bins with its automatic arm. We watched the lids fly open and the neighborhood’s weekly debris fall into the open top of the roaming truck. In front of our apartment, I watched as a green Hefty bag covered with gray duct tape rolled out of our can through the air and into the back of the truck.
Tucked safely inside the truck, my placenta, my daughter’s afterbirth, rolled away.