This article was originally published by WIN Magazine Online, Issue 37, October 2000.
WIN Magazine is now defunct.
ISABELLA'S GREAT START
By Anita Obermeier, United States
In 1999, my newborn daughter, Isabella, became one of a small
statistic: She was among 9,000 American babies born in a labor pool, a
Jacuzzi-like swimming pool which eases birth for both mother and child
as the infant transfers from the body-temperature water of the
amniotic sac to the pool’s body-temperature water. Even fewer of these
births shared Isabella’s entry into the world at home with a midwife.
My delivery, highly unconventional by American standards, was the most
empowering female and feminist experience of my life. I have never
been so sure of my abilities in any other situation.
I decided to have this kind of delivery soon after becoming pregnant
when I was catapulted into the overly medicalized, sterile, and
assembly-line treatment in a Health Maintenance Organization (HMO)
environment. Here, the insurer’s financial interests dictate much of
the care. Quickly, three major attitudes became clear: One, pregnancy
is primarily perceived as an illness or a negative circumstance; two,
women, it is implied, neither know their bodies nor are up to the task
of birthing a child without a barrage of high-tech interventions. Even
much of the physician-centered language people use signals that. For
instance, one hears "physicians deliver babies" more often than "women
birth babies"; and three, systemic negativity surrounds pregnancy
without much celebration of such a life-altering and wonderful event.
Moreover, without fail, every woman I talked to shared with me aspects
of her pregnancy and hospital birth that were negative. But then one
weekend in January 1999, three unrelated women friends of mine spoke
to me about their own home birthing experiences. They unanimously
recommended a midwife-assisted home birth.
In the US, such births are very unusual, because women have been made
afraid of their bodies and natural functions. After I decided on this
delivery, it was often tacitly implied that I was going to harm my
unborn child with this choice. But I found statistics showing that
planned home deliveries have superior outcomes for mother and child.
The US ranks a shockingly high 23rd in infant mortality and morbidity,
even though 95 percent of births happen in hospitals and are attended
Countries with much lower infant mortality numbers in this World
Health Organization statistics have more midwife-assisted births. For
example, in Holland, midwives attend 70 percent of all births, and 40
percent of births are at home. In my native Germany, midwives and
labor pools are part of the standard hospital environment. A midwife
had attended both my own hospital birth in Germany, and my siblings'
and more recently my nephew’s and nieces' birth, too.
In the US, different tiers of midwives exist, with most of them
prohibited from practicing in hospitals. Furthermore, according to the
Midwife Alliance of North America (MANA)
<http://www.mana.org/statechart.html/>, direct-entry midwives, those
with experience but only some formal training, are legally prohibited
from practicing in nine US states. I even read about midwives getting
arrested and prosecuted for helping women in Barbara Harper’s Gentle
Birth Choices, (Healing Arts Press, 1994).
But immediately the care provided by Mary Henderson, the midwife my
husband, David, and I chose on the advice of many, was highly
personalized and respectful, in great contrast to what we had
experienced in the clinical settings. During our 15 prenatal HMO
visits, the providers had greeted him at only three of those visits.
With Mary, we felt like human beings: he as half of the equation and I
as more than a mere belly.
Even though it was our decision to contract with a midwife, Mary could
have turned us down. Midwives, because of their medical status in the
US, screen their prospective patients' health carefully and will not
contract with women having problem pregnancies or jeopardizing
complications. Since I had had a perfect pregnancy up to that point, I
was a shoo-in. We much anticipated our appointments with Mary, while
dreading the ones with our HMO providers. We kept them both, just in
case there was a late complication and to keep the hospital as a
The midwife clinic fostered a certain sense of self-reliance: patients
weighed themselves and took their own urine test. During the exams,
David was encouraged to listen to the baby's heartbeat and to feel my
tummy for the baby's position. I received a highly individualized
pelvic exam to determine my exact bone structure, which would help the
midwife to position the baby during the birth. No such exam was done
at the physician's office. I was also given advice on certain
exercises to ensure Isabella's correct birth position and on
supplements and herbs to prepare the cervix.
A few weeks before my due date, we picked up the rented labor pool
from Mary's office. A labor pool is a collapsible little swimming pool
about 1.5 meters (4.8 feet) in diameter and 60-80 cm (24-32 inches)
deep. David set it up in the dining room where we could easily get
water from the kitchen and where the light had a dimmer switch. A few
days before my due date, on the night of a full moon, my water broke
at 2:30 a.m. But since I had no other indications that birth was
imminent I went back to bed. One of the best things about our home
birth was that everything was done calmly without artificial frenzy.
The next morning, I took a walk with a friend and then began picking
out music to be played during the delivery. I found a CD called
"Following the Moon," which seemed fitting as the full moon had
initiated the birthing process. I even danced before the contractions
became too strong. David filled the labor pool, which has a heating
element that maintains the water temperature around 40C (104F) but
cannot heat it. Lying down made the contractions rather strong and
patterned. A previous in-house visit by the midwife had confirmed our
location and ensured the correct supplies. All we had needed to get
were towels, rags, and a plastic sheet for the bed in case I did not
like the water, and baby necessities.
When Mary arrived, I had dilated to four centimeters and was allowed
to get into the water. The warm water acts as an antidote to the pain,
but the most salient feature is one's weightlessness. So when the
contraction hits, one can quickly change position, sitting, kneeling,
or hanging over the edge of the pool. It was much more cumbersome with
my big belly to go through the contractions outside the water.
After the dilation phase, which took two and a half more hours, Mary
told David, who had been busy getting me water with orange-juice
cubes, to get his swim trunks on and join me in the water. It was time
to push. I was sitting in his lap, and he supported my weight. Mary
gave me breathing instructions for each stage of labor and delivery.
The pushing phase lasted three hours and was the toughest job I've
ever done. Instead of a fetal monitor that hooks into the baby's
skull, the midwives used a fetoscope on my abdomen to check for the
baby's heartbeat, which never showed distress. A fetal monitor
restricts the woman's movement, as the monitor's line hangs out of the
vagina and is attached to an apparatus. Midwives are more low-tech and
prefer the less intrusive fetoscope. They do, however, also bring an
oxygen tank with them, along with a scale, measuring devices, and
utensils to cut the umbilical chord.
Throughout the entire delivery, I drank over four liters of alkaline
ionized water, which provided me with electrolytes to keep the muscles
functioning. In American hospitals, birthing women are not allowed to
drink anything except for ice chips and in, some cases, a soda, rather
a nonnutritious and dehydrating abomination. Instead, they are hooked
up to IVs to provide fluids, further restricting their movement.
During my labor and birthing experience, I was in all positions except
prone, and was so always mobile and unrestricted.
After six and half hours of labor, while I was sitting in David's lap
in the water, by flickering candlelight and soft music -- eagerly
awaited even by our five watchful cats -- Mary eased out our little
Isabella Maria onto my belly. Isabella opened her blue eyes within
seconds and calmly looked at us. No pained statement marred her face,
no cries of discomfort or fear because of strangers and bright
florescent lights pierced the magical moment. The first person to hold
Isabella after the umbilical chord had been cut was David, who had
been ordered out of the tub. After Mary had pulled out the placenta, I
climbed out of the pool and the three of us were packed into our own
bed. The midwives examined Isabella, cleaned up, and did the laundry.
Our neighbor, Carrie, brought us food, which I savored while phoning
my mother in Germany. I did not have painkillers in my system, thus
rebounding quickly. Postnatal care was also highly individualized,
with 24-hour cell phone access to Mary and several house calls during
the first two weeks. We partially attribute the great disposition of
our daughter to the gentle way in which she was born.
Although my midwife-assisted water birth cost only a fraction of the
hospital birth, my insurance did not cover it. Mary reduced her $1,300
fee to $1,000 for us, as we had already done the major tests; the
rental for the labor pool was $150. David and I agree that it was the
best money we ever spent and that we would do it again in a heartbeat
for our second child.
I'm not suggesting that every woman should abandon
obstetrician-assisted hospital births for midwife-assisted home water
births, but it was the best choice I could have made, a choice often
undiscussed in the United States. My experiences and research should
also raise some concerns about health care, women's reproductive
rights, and birthing options. The decline of midwifery in 19th-century
America and the rise of male-dominated obstetrics harbor a systematic
bias against women. Considering all this, I'm not so sure we've come a
long way, baby.
Anita Obermeier is a Senior Lecturer of Medieval Literature and
Women's Studies Affiliate at Arizona State University who also
extensively researches health issues.