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Nature's Gate

Poor BiB. I thought that when May arrived, I’d have more time to blog, but it turned out to be the opposite. So here I am playing catch-up as always.

Dr. Awesome and I took a childbirthing class for the last five weeks through Realbirth. Like most such classes, it’s oriented to natural childbirth, but it’s more open to what are called “interventions”—such as epidurals—than other similar groups (like Lamaze or Bradley). While it stresses that women have for millennia given birth without such interventions, it also acknowledges that many women today are going to choose them, and screw what grandma went through back in the village. Because I’ve been on the fence about how I wanted labor to go down, it seemed like a nice compromise.

The class was held at a yoga studio near the Smith-9th St. subway station in Brooklyn. Located beneath the elevated station near a scrap-metal recycling center and next to the toxic Gowanus Canal, the area is about as old-school industrial Brooklyn as you can get. And a yoga studio in this environment is about as gentrified as you can get. Well, maybe you could top it with a Montessori school or vegan café.

Anyway.

Before the first class, we the Knocked Up queue for the loo while our menfolk wander around in their socks looking vulnerable, though they make game attempts to seem at ease. They know they are in a realm where they are, paradoxically, both secondary and essential players. After my turn, as I’m washing up I notice the brand of hand soap. It’s called Nature’s Gate.

As we settle into our floor seats—each a minor ziggurat of mats, pillows and folded blankets—I tell Dr. Awesome about the soap: “I got your nature’s gate right here, buddy!”

At least I refrain from pointing to my crotch.

There are seven couples, and we are quite conventional: all heterosexual, all married. Our instructor, Shara, is also a doula, which is a childbirth coach focused on the mother. Her props include illustrations of the growing womb (which makes me seriously grateful to my horribly squished digestive system for still operating pretty damned well); terrifying yet cartoonish charts laying out the three stages of labor; a Caucasian baby doll whose bald head is more Mediterranean toned from all the handling it’s received; and a soft, plush, anatomically correct model of the female pelvis, which she bends and squeezes like defrosting bread dough to show us the flexibility the pelvic bones have during pregnancy and labor.

What makes me immediately like Shara is what she does with this pelvis when she’s not using it: she casually puts her arm through the birth canal and hangs it from the crook of her elbow.

The first class is devoted to the stages of labor. We learn all sorts of practical facts, and some fun trivia too. A few weeks before labor, the baby’s head drops into the mother’s pelvis in a process called engagement. All I can picture is TNG‘s Jean-Luc Picard: “Engage!” Labor begins when a hormone excreted by the baby’s lungs changes the mother’s hormonal balance. Only 10 percent of births are actually accompanied by the water breaking; most “amniotic membrane rupture” is done by a doctor or midwife with a hooked-end rod. One of the criteria for the Dalai Lama is that his mother’s water must have broken naturally, with the classic movie gush. (Who knew?) Contractions hurt because they pull the cervix up and open, and the pain can range from menstrual-like cramping to a “hula hoop of pain” encircling the body. Oxytocin, the “love hormone,” is produced at only three moments in life: after orgasm, in the mother during breastfeeding, and toward the end of labor, when the baby crowns. Finally, the most awful phrase in all of childbirth—perhaps in all of life—is “mucus plug.” Like a wax seal on a bottle of wine but infinitely less pleasant to break, the mucus plug seals the cervix to prevent infection. It can break at any time up to a few weeks before labor begins, often leaving a quarter-size, pink-tinged, egg yolk-like blob in the toilet.

Blech.

I don’t know if Shara was an actor in the past, but she’s comfortable role-playing a laboring woman. “Dads, these are some of the behaviors you can expect to see from Mom,” she says. Her first depiction is the first stage of labor, which can last for 4 to 24 hours—or more. But, who knew (again), contractions are usually mild and last only 15-45 seconds, and are followed by up to 20 minutes of rest. She puts her hands on the small of her back and paces slowly around the room. “Okay, I think this is it,” she says. “I think this is really happening. But I’m okay.” She tells us about various coping techniques: walking, leaning against a wall, sitting on a physioball, listening to music, hanging out with a good friend, having something to eat or a glass of wine, getting a massage from Dad.

Okay, I think. That’s not so bad. Food. Friends. Wine. Massage. I can do that. It’s like the perfect Saturday! I can do this!

It’s when she depicts the end of the first stage, when the contractions intensify and come more frequently, that I start to sweat it. Bending over to place her hands on a physioball and swaying back and forth, she says, “This is where you might use other coping techniques like controlled breathing or vocalization.”

“Vocalization” sounds so cool and removed, so anthropological. But what she means by vocalization is far more base: the uncontrollable noises emitted by a creature in distress. “Ohhhhhhhh, ahhhhhh, ugghhhhhh,” she moans and groans so realistically that every one of my animal senses go on high alert. These are the sounds of a being in pain, in trouble, in fear, and I am an utter mammal in response. I want to thump my foot like a rabbit signaling the warren, raise up on my haunches like a startled meerkat, screech like a monkey warning the others that an eagle is circling above. I would flee but I’m too paralyzed by the intensity of my reaction. I’m not alone. The room is utterly still. No one, it seems, even breathes.

Shara breaks out of the role-playing easily and says god knows what. My heart is racing. I can’t hear her. Dear lord. If someone else’s fake labor can so purely freak me out, what the hell is my own real labor going to do to me?

Transition is, as the name suggests, the bridge between the first and second stages of labor; it is then that the cervix dilates to 10 cm, the magic number after which pushing can start. On Shara’s chart, the contractions of transition are depicted as angry, red, jagged peaks coming in quick succession, with little time for rest; the cartoon face to the right of the illustration, which is supposed to show you how the average laboring woman feels during this stage, is twisted in pain and misery. Her skin is red and sweaty. It is seriously not helpful.

Transition is often considered the most difficult part of labor. It is also the shortest, which makes sense, because otherwise we as a species may not have made it. I mean, goddamn it! How is any of this practical? Why is does it have to be so painful? Intelligent design, my ass. If your Sky Dad (’cause He sure ain’t mine) thought this was the best way for humans to reproduce, He really isn’t too bright.

The second stage of labor is when a woman actually pushes, and most report that this stage is better by far than transition, because there is a direction (down) a point (baby out) and some control (said pushing). It is then that a woman feels an intense urge to move the kid along.

Shara forgoes the role-playing and leaves it to the birthing video to show us what this looks like. As soon as the film begins, I too feel the urge to move, but I can’t decide whether it’s to be closer to or farther from the screen. I’ve seen labor films before, but can’t remember in what context. Tenth-grade health class? A National Geographic documentary? Some self-punishing PBS night?

We see three births, two natural and one with an epidural. Ohhhh. Now I want to do some moaning myself. Because it’s immediately clear that the baby storms Nature’s Gate like a Vandal sacking Rome. Because when the baby crowns–meaning you can see the crown of its head–the vernix-slimy hairy skull presses against the so so so so so so so so so small opening with an unstoppable persistence, a demand to be born that will not be denied. Such will and force from so small a being stuns me. I want to burst into tears.

“Babies come out. Babies come out,” Shara had told us earlier in class, mantra-like. “All over the world, every day, babies come out.”

Every time the baby comes out, I’m completely overwhelmed. It’s only the presence of the others that keeps me from breaking into howling sobs. It’s not fear, or at least not entirely. It’s not amazement, or at least not entirely. It’s a confusing stew of heightened emotion and sheer physical response that has me around the bend. When each mother pulls her purple, wiggling, crying child to her chest with unadulterated relief and joy, I can barely contain myself. I gulp to try to loosen my tightened throat. I simply can’t stop myself from responding so intensely.

No matter how smart I like to pretend I am, no matter how much I try to be rational and thoughtful, when it comes down to it, I’m a complete fucking mammal. I’m one of Pavlov’s dogs.

The third stage of labor is delivering the placenta, which sounds a lot more genteel than it is. Because the placenta, though a remarkable organ that the female body grows only during pregnancy and which nourishes the fetus, is also a horrific blob of blood, veins and various other unknown (to me) viscera. I appreciate its awesomeness and functionality, but Jesus Christ! It is a foul-looking thing. Note to future producers of birthing videos: LESS PLACENTA, PLEASE.

In the darkness after the video ends, I try to wipe away the tears streaming down my face before anyone can see them. “Watch your eyes,” Shara says before turning the lights on. This gives me an excuse to keep my eyes closed, hoping the tears will be reabsorbed, that no one will be able to tell I kind of became a fucking mess right there. I’m not sure why it’s necessary to hide it, but it is. Dr. Awesome has long described me as a quarter-inch of steel covering pure butter. Maybe that’s why.

After class we go to Jakewalk, a bar on Smith Street that serves some 40 cheeses and meats, along with a huge selection of international beers and wines. At this point 33 weeks old, The Kid isn’t storming Nature’s Gate anytime soon, insh’allah. But just in case he’s getting any funny ideas after all those videos, I have a really expensive glass of red wine with the cheese and meat platter—a makeshift nepenthe for me and The Kid. By morning, we’ll both forget that babies come out, babies come out, that all over the world, every day, babies come out.

Because I, for one, am not ready.

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The Corkboard of Rage: What Would You Write?

One thing I neglected to mention in Are You Woman Enough? is that the women I’ve spoken to (or read about) who chose natural childbirth did so for reasons I understand. Most cite a desire to be fully present, to experience every moment no matter how difficult, and to complete labor with not only a newborn child but a profound sense of accomplishment.

“Maybe I’m a masochist,” said SK, a writer and long-distance runner (two self-torturing endeavors, so there’s your evidence). She said she hadn’t wanted to be dulled during the experience, and that she had a purist streak. While I’m far from a purist—it’s the mutts of existence that compel me—I understand not wanting to miss a thing.

But even those most committed to natural childbirth need some encouragement. SK told me about getting to a point during the labor of her second child when she was so overwhelmed by pain and exhaustion that she was considering asking for a C-section. Forget the epidural, she thought: get this kid out of me now.

Her husband gave her a great pep talk urging her to hang on a little longer, she said. He told her, “This baby has to be delivered one way or another, and you are the only one who can do it. You have to go through this experience.”

And that got her through the roughest part. Like her first, her second daughter was born au naturel.

“It’s good that you reacted that way, because there was always another option,” I said. “Which was to say, ‘You have no fucking idea what you’re talking about, so shut the hell up.'”

Which is probably what I would say. Maybe that’s why I reacted so strongly to the idea of a Corkboard of Motivation. I became aware of this innovation in the natural childbirthing room courtesy of BiologyLady, a science teacher and my best friend from childhood, whose sister-in-law is due in a few weeks. BiologyLady’s brother called her last week asking her to come up with some motivational phrase; he would write it on a slip of paper and pin it to a corkboard that would be placed in his wife’s labor room. Then, whenever his wife was feeling like natural childbirth was too much, that she couldn’t get through it, she could look to the corkboard for supportive messages from family and friends.

BiologyLady was fretting about what to write. “I’m no good at these things!” she said. “That’s just not who I am. I mean, even with a birthday card I don’t write anything. Just ‘Love, BiologyLady.’ And what am I supposed to say? ‘Keep pushing’?”

I suggested she skip over the labor and focus on the results: “Maybe something like, ’24 hours from now you’ll be holding your newborn baby’.”

That seemed reasonable to her, so we dispatched with the advice and starting wondering what the fuck was up with this Corkboard of Motivation. BiologyLady has a 3-year-old daughter herself, and happily gave birth with the help of an epidural, thankyouverymuch. “I know I have only my experience to go on, but she’s not going to be looking at a freaking corkboard! She’s kind of going to be occupied.”

“If it were me, I can only imagine it being a Corkboard of Rage,” I said. I tried to picture it. It would be propped up on the windowsill, its mealy-brown surface fluttering with scraps of paper. I imagined the increasing pain and exhaustion, and trying to take heart from those chipper messages written by people having beers or answering email or sleeping—doing anything but being split open.  I envisioned eyeing it with twin beams of hate, throwing darts at considered messages of encouragement, lodging knives in notes expressing the beauty and wonder of birth. I imagined one long howl of fuuuuuck youuuu.

So maybe it could serve some kind of purpose: as a focal point for the pain, or apparently my rage over the pain. It’s a better option than throwing stuff at Dr. Awesome, I suppose—though I am in no way ruling that out.

So here’s my question. What would you write on my Corkboard of Rage? And skip the sweet advice. What’s the very last thing you think I’d want to hear?

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Are You Woman Enough to Take It Lying Down?

We were a battalion of weebles accompanied by hovering guards, and we invaded the 11th floor of Roosevelt Hospital not too long ago. “You may hear some weird noises,” our guide said. “There are some women in labor right now.”

Couple by couple we checked out the maternity ward: the modern Labor, Delivery & Recovery (LDR), on one floor, and the Birthing Center, the natural-birth alternative on the 11th. Dr. Awesome and I filed into one after another birthing center room, all of them nearly identical. Each was like a roomy hotel suite with a full-size bed, a small jacuzzi, a few chairs, a TV, natural wood furniture—even a lovely view of the Hudson River.

“Wow, this is really nice,” I said to Dr. Awesome. “Now can we just add drugs?”

Choosing how to give birth is a decision fraught with more complications than you would imagine. For most of history, of course, it wasn’t an issue. You got knocked up, you realized it after a few months, and several months after that you got on with it. A good portion of the time you lived and the baby lived, but frequently enough one or both of you died.

Now—at least for a woman like me, with health insurance, living in NYC—there are lots of options.

What’s interesting is the hand-wringing and moral-wrangling now attached to how one gives birth. Yes, modern human females have been giving birth vaginally, largely without pain relief, for at least 160,000 years. But that doesn’t mean they haven’t tried; various potions and remedies—many of which, like hemlock, are seriously poisonous—have been used by cultures all over the world throughout history to attempt to relieve the pain of labor.

There are lots of other natural events requiring some medical assistance that aren’t yoked by morality. Skulls have been found dating to the Stone Age that show clear evidence of trepanation—the cutting of a hole in the skull to relieve pressure on a swelling brain (or, perhaps, to release malevolent spirits—who knows the motivation, but the effect on the brain was the same). Would anyone today expect you to have a section of your skull cut out without anaesthesia purely because it had been done that way in the past? Or to have a tooth removed without even the minor relief of Novacaine?

Of course, pregnancy is not a disease; in fact, its treatment as a weird malady of the lady parts by male doctors during the past several hundred years, particularly in Europe and America, is one of the main reasons so many women today are reflexively suspicious of the “medicalized” birth. For sheer physics alone, lying on your back in labor—a position that does nothing but give birth attendants a better view—makes no sense: gravity can’t help, and there’s nothing to push against. Rushing the process of labor can lead to (oh god stop my brain from even thinking about it) episiotomies and increased cesarian births. Epidurals can slow down labor and make it difficult for a woman to know when to push.

As recently as the 1950s, laboring women in the U.S. were given general anaesthesia; while they were under, the baby was simply removed like any other excessive growth—like a tumor. Countless women (and their frustrated partners) tell horror stories about feeling helpless as they were shunted around the maternity ward like pieces of howling meat, with little attention paid to their preferences for labor or the level of medical intervention they want. We are all scared shitless by the endless images of laboring women in movies and TV screaming their heads off—while lying down, of course. For years, every time I’ve seen some scene of labor, I’ve crossed my legs and squeeeeezed hard. Because the message is: Labor is trauma. It is pain. It is terror and emergency and the unknown. And only by having the experience tightly controlled by the professionals can you and the baby get through it.

But there is also a romanticizing of childbirth by many natural-birth advocates that is equally not based in reality. First of all, let’s take this concept of “natural.” Here are some perfectly natural elements of the world: Cancer. Cavities. Getting eaten by something faster and stronger than you. Flesh-eating bacteria, macular degeneration, fungus, great white sharks. And, of course, dying in childbirth.

Mother nature has been picking us off during childbirth for forever. It’s a risky proposition for many women and babies around the world even today, from those suffering from malnutrition and disease to girls who give birth too young, before their pelvises have fully developed—often as a result of stunted growth from said malnutrition or disease. There’s a veritable epidemic in Africa of teenage girls who get fistulas during labor. Their bodies literally rip open with holes. Afterward they suffer from constant incontinence and are then shunned by their husbands and communities.

The operation to fix a fistula costs about $450, by the way. You can donate here.

Fistulas used to be common enough in developed countries even in the 19th century, and it was doubtless common across the world for millennia. And that’s one of the better examples of what can go wrong in childbirth, because at least both mother and child live. You want a macho pregnancy? Try undergoing a cesarian birth without anaesthesia, which also has happened throughout history. (Though the story that Julius Caesar himself was delivered by this method is surely apocryphal.)

The idea that if those evil men hadn’t gotten involved in pregnancy (beyond conception), then every birth would be a profound, if difficult, experience bathed in a golden glow of Natural, is doubtful.

And keep in mind that in Judeo-Christian cultures, the idea that women are being continually punished for Eve’s transgression in the Garden of Eden is a durable thread that persists to this day. If you’re all down with natural womanhood and against the patriarchy, make sure you’re not falling into the trap of thinking that fate of woman is to suffer, and that in fact you must suffer if you’re going to be a good mother—labor being your first test.

My goal has been to find some sort of middle ground between the two extremes—the pregnancy-as-disease mindset, and the strangely macho Mother Earth birth.

I had to make some kind of decision while I was still in the single-digit weeks of pregnancy, when the idea of this person growing inside me, let alone the idea of giving birth to said person, was still utterly surreal. I had no idea how I might feel about labor come the Big Day, but I knew I wanted to leave my options open.

For that reason, I chose an obstetrician who has midwives on staff, and a hospital that has both a natural birthing center and a standard hospital LDR ward. (Incidentally, and hilariously, in the pamphlets Roosevelt Hospital hands out to expectant parents, giving birth in the LDR ward is called having “the traditional birth experience.” So I’ll be squatting in a mud hut while the nurse hooks me up to a fetal monitor, right?)

I knew a few things. First of all, I wanted to give birth in a way that made sense. A strange criterion, maybe, but there it is. No help from gravity and pushing against nothing make no sense. An inability to switch labor positions makes no sense. Neither does it make sense to needlessly suffer from pain just to prove I’m a hard ass. (I know I’m a hard ass. C’mere so I can punch you!)

Secondly, I knew that I like drugs. Drugs are my friend! I’m not a crazy pill popper—I rarely take even cold medicine or Tylenol—but the drugs that I’ve come to know and love I, well, know and love. Give me a Xanax on an intercontinental flight. Let me pop an Ambien when insomnia has me near insane with unsatisfied exhaustion.

Lastly, I wanted to participate in the birth, neither so doped up I can’t feel anything nor so frantic with pain that I’d plead with someone to knock me out with a hammer just to put me out of my misery.

Is there a way to have pain relief and yet some mobility? Is there a way to have an experience couched by a) the safety and security of a modern medical facility and b) patience and assurance from someone who knows that, despite the rocky record, this is indeed a process for which my body is not particularly well designed (thanks, no-master-plan evolution!) but that it mostly can handle?

There may be. Roosevelt gives something called a “walking epidural,” which is essentially a lower dose of anaesthesia; it will provide pain relief but may—the midwife was a bit doubtful—allow me to switch positions in bed; I plan to do my squatting above the floor of the mud hut, thanks. Right now the plan is to deliver in the LDR area, attended by the midwife I’ve been seeing for months (I’ve only seen the obstetrician once). I may enter the ward hollering for drugs, or I may not. Who knows. I do know, though, that I’m going to do whatever feels right at the time.

On April 23, Dr. Awesome and I begin a five-week childbirth education class. Think cring-inducing birth films and breathing techniques. The class I chose offers pain-coping methods, some of which are already going to be familiar to me from yoga and meditation, but it also fully covers pain-relief options, i.e. drugs.

Whatever happens, I’m sure that the experience will turn out to be much as Dr. Awesome predicted after we wrapped up the maternity-ward tour. As we walked back to Columbus Circle to catch the A train, he dragged on his cigarette and said, “Everytime we went into a new room I thought, ‘Is this where I’m going to get my mind fucking blown? Or is this? Or is this?‘”