Born at home

Three more pushes and he’ll be out,” I told my midwife, Ellie. She had been monitoring my labor for about six hours.

“OK!” Ellie smiled. “When the baby is born, lean back into Tim’s arms, and I’ll bring him to your chest.”

I could feel the baby’s thick head of hair floating in the water of the birthing tub. That first physical contact with him made the birth real to me and gave me the inspiration I was seeking to bring him into the world.

Earlier, as my body approached that short period of time when my contractions were most intense and my body was running on autopilot, I admitted to Ellie that I was afraid. I doubted I could deliver the baby. She reassured me. “You’re doing a great job. When it’s time to push him out, you’ll find the strength to do it. I promise.”

It wasn’t so much her words that convinced me, but the look of confidence and comfort I saw in her eyes. Throughout the night, Ellie’s eyes centered me, again and again, making me feel safe as I groaned, moaned and howled.

In exactly three more pushes—those unbelievably powerful, involuntary sensations only a mother can know—my son was born at dawn.

Somewhere in the tub was a baby who had yet to take his first breath, but for a moment I was completely unaware that I had given birth to him. He was born like a cork off a champagne bottle, in one tremendous explosion, head and body all at once. The miraculous culmination of a year’s preparation and anticipation had arrived, and all I could think of was how grateful I was that I didn’t have to push anymore. I was exhausted.

Ellie’s sober voice brought me out of my trance. “The cord is wrapped around his neck. Twice!” Nothing to worry about, she assured us, the umbilicus was long and loose. Baby was fine.

She brought this bright pink, blue and butter-colored body to me. When I looked into my newborn son’s wide-open eyes for the first time, I knew I was witnessing a living miracle. The baby cried a few shocked sobs, then gurgled doe-eyed at his new, much larger and brighter surroundings. At his mother and father.

I kissed his delicate face and whispered a greeting to this little being. “Welcome to the world, sweet baboo!”

My baby was born in a tub of water, without medication, at home. My husband Tim, a midwife and a friend acting as labor support were the only people present.

At my childbirth classes, other expectant mothers thought I was crazy when they learned of our family’s birth plan. Even when the childbirth educator said yes, the drugs you receive during labor do affect the baby, many of the women still bragged that there was no question in their minds—they wanted their pain relief.

But I wanted my son’s entry into the world to be a pure first impression wholly his own, unclouded by the influence of drugs. So the thought of delivering my son in a hospital never seemed like an option—if I knew pharmaceutical relief was readily available, I might request it. I didn’t want to be tempted. I wanted to exude courage, tranquility, awareness and love by giving birth as my body intended. For my son’s sake. I wanted to experience one of life’s most wonderful events in the place I felt the safest—at home.

In my mind, hospitals are places where people go when they are sick and need medical attention. I didn’t view pregnancy as an illness, but as a condition of heightened healthiness. Why would I need the hospital to do something that has been done, except for the last 75 years or so, at home? I was healthy, or, to use the jargon of medical professionals, “low risk.” My family birth history was one of uneventful, vaginal deliveries; and I was willing to take responsibility for all the preparation involved in having a baby naturally. Home birth seemed the logical choice.

Of course I am grateful that I live in a country where there is easy access to hospitals and where medical professionals are trained to save lives in emergency situations. And I wasn’t dumb enough to ignore the potential risks of labor and delivery at home. I met with an open-minded obstetrician who agreed to handle the birth of my child should plans go awry. Understanding that I had done my research, this doctor respected my decision for a home birth and was willing to act as backup. She didn’t lecture me about how I might be endangering the health of my unborn child.

When a woman decides to have her child at home, she reclaims responsibility for her own prenatal care and preparation that women abdicated to physicians and hospitals in the 20th century. Before the advent of hospital births, experienced mothers helped women deliver their babies at home.

The midwifery profession began with this informal passing of knowledge about childbirth. In most countries outside of the United States, midwives are still the main provider of prenatal and labor and delivery care; obstetricians treat the complications of abnormal pregnancies, rather than participate in the care of routine, “normal” births.

From all the pregnancy texts I devoured while battling morning sickness, I knew that labor and delivery were not something to take lightly. Yet one particular book, Ina Mae Gaskin’s Spiritual Midwifery, bolstered my confidence in the body’s natural ability to give birth without medication.

Gaskin is a midwife who learned her craft on a commune she helped found in the 1970s in rural Tennessee. Commune members ran a health clinic at “The Farm.” With the oversight of a local physician, the Farm women provided prenatal care and delivered the commune’s babies and, in doing so, created a nationally recognized standard of care for women seeking “natural,” unmedicated birth experiences.

Gaskin wrote Spiritual Midwifery to document the commune’s childbirth program. The first half of the book is a collection of birth stories authored by the Farm’s mothers and fathers. It’s filled with pictures of 1970s hippie families, labor and delivery shots of moaning, grunting mothers and the Farm midwives attending births. The second half of the book is a primer of prenatal, birth and post-natal care for midwives—the “nuts and bolts” of how to deliver a baby.

I loved this book and took its advice seriously: To ensure optimal positioning of the baby (and therefore avoid painful back labor), stay active and don’t spend much time sitting around in a comfy chair; breathe with the mouth wide open during labor (because when your mouth is open your birth canal opens quicker); think of contractions not as painful, but as “interesting sensations worthy of [my] full attention.”

In preparation for the big event, I hiked and practiced yoga every day. I visualized, over and over, how I thought my birth experience would unfold. I worked on my husband, showering him with articles, videotapes and plans about his role as father. I found an Internet pen pal who shared a common due date, with whom I could share the anticipation of imminent motherhood. I felt more healthy pregnant than I have ever felt in my life.

But in the far corners of my mind, I wondered if I truly could handle a natural delivery at home. To calm my fears, I reasoned that if childbirth were really, really so terrible, then the human race would have died out long before the year 2001. Would I be brave enough to follow through with my plans?

One tactical error in all my planning was that I never envisioned how my labor would begin. As my due date drew closer, I sensed that the baby would come early. “You wish!” people sympathized. “That’s what you think. But first babies are usually overdue, not early!”

My intuition was correct. Three weeks before my due date, Tim, our dogs and I took an early evening walk. “I think we’re ready for the baby,” I told him. “Really?” he asked. I ticked off a list of completed preparations. After pondering a minute or so, he agreed. “Yeah, I think we are ready.”

The baby must have been listening. That night my water broke, and the contractions were immediately two to three minutes apart. My total labor was eight hours. If the baby had come just two days earlier, my midwife would have made me deliver in the hospital. A premature labor was one of the “contraindications for home birth,” she explained when she agreed to supervise my pregnancy. Babies are considered premature until week 37 of a 40-week pregnancy. My baby waited to arrive until he was full term plus one day.

The hard work and diligent preparation—the exercise, the visualizations, the breathing—paid off. I delivered a healthy and staggeringly alert seven-pound boy by the light of dawn, in exactly the way I had envisioned it, naturally and unmedicated, in the care of a woman whose life’s work is bringing babies peacefully into the world.

Reno midwife Diane Schaub began her career in 1981. She explains her calling with an uncommon confidence and self-assuredness. “I was chosen. I was fascinated with pregnant women when I was a teen. I thought I would become a childbirth educator. Then I read Immaculate Deception by Suzanne Arms, saw the word midwife for the first time and thought, ‘That’s what I am going to be!’ I didn’t even know what that would involve when I decided that.”

Schaub studied midwifery at the Maternity Center in El Paso, Texas. After a one year of training, she returned to Reno as a direct-entry midwife and began working in a practice with two other women. When both stopped practicing, she remained as the only Reno-based midwife attending home births in Washoe County.

She has delivered 730 babies at last count, including breeches and twins, a number that’s always increasing. Her clientele is varied: “From heavy-duty born-again fundamentalist Christians to the hippiest folks you can imagine.” She has delivered babies while the mother was sitting on the toilet ("Oh, how I hate those!” she quips) and even at Sierra Hot Springs. Fluent in Spanish, she has many Hispanic immigrant clients who seek out her services because of the strong midwifery tradition in their home countries.

On average, she delivers about one baby per week, but her job begins well before labor starts. She conducts about 10 prenatal visits with each client before the birth. Usually these visits last for an hour, giving mother and midwife ample opportunity to discuss logistics and apprehensions and also develop a solid relationship before the home birth.

Schaub, a mother of three, planned a home birth for her first child but ended up in a hospital needing an emergency Caesarean section. That humbling personal experience has helped her relate to the concerns her clients have about home birth.

“There is so much fear surrounding childbirth,” Schaub explains. “That’s the enemy. And God’s gift to me is that I have no fear about the birth process. Normal is the miracle. Ninety-five percent of births are normal. But the medical establishment treats everyone like they have a problem. I expect normal until I’m proven wrong.”

Schaub has a 5 to 10 percent hospital transfer rate, a rate mirroring the percentage of normal childbirths versus complicated childbirths.

“And 10 percent would be a bad year,” she emphasizes. The mothers in her care must follow her orders. “I dictate when we go to the hospital. If I say ‘We have to go now,’ then we go.” Schaub says most often women transfer to the hospital for “lack of progress in labor. They’re just tired out and need some relief from all the hard work.”

But a midwife has a toolbox of natural methods she exhausts before transferring her client to a hospital. Often a midwife can coax along a slow labor by changing the mother’s position, doing massage or by using herbs known to stimulate uterine contractions.

Schaub says most of her home birth clients are “first-timers who don’t want to have anything to do with a hospital” or “women who have had babies in the hospital and feel like they got screwed by the system.”

Carol du Plessis of Sparks is one of those mothers who felt screwed by the system. Her first son, Soren, was born in a hospital. Prior to her labor, du Plessis had prepared a birth plan—special instructions a mother prepares for the staff to be followed during labor and after a baby is born.

In du Plessis’ birth plan, she requested that the doctor refrain from giving her an episiotomy, an incision into the tissue between a woman’s vagina and anus to facilitate delivery of a baby’s head.

“But the doctor had the scissors, ready to cut,” du Plessis says. “She was sitting there with the scissors in her hand! Luckily Soren was born before she had a chance to do it. I always tell him that he saved me.”

That’s not all that went wrong.

“I asked them not to wash him off. But the nurses took him away immediately, and what did they do? Washed him off. They were all holding him, the doctor was holding him, everyone was holding him before me. Finally I said, ‘Hey, can I please hold my baby?’ “ du Plessis’s husband told her, “You can have all the instructions in the world written down, but once you are in their hands, they are in control.”

du Plessis’s second baby, a 9-pound, 14-ounce boy named Phillip, was born at home with Schaub’s assistance.

“My husband said, ‘If we want a safe birth, we’d better do it at home.’ “ She labored for nine hours, finding her second birth experience totally different from her first in the hospital. “It was a lot better, obviously. I ate a lot, joked and laughed between contractions. Believe it or not, it was actually fun.”

du Plessis’s son Soren was able to see his baby brother still attached to his mother’s umbilical cord. “He was born at home!” the 5-year-old exclaims.

In addition to home birth, Schaub provides a unique service to pregnant women—she delivers breech babies vaginally. Today obstetricians almost always deliver breech babies via Caesarean section.

Sherry Asp never dreamed she’d have a breech baby, but 36 weeks into her pregnancy her baby turned. She initially sought out Schaub’s services because of her fear of needles. A midwife, she thought, would be less likely to use any medical intervention involving needles, scissors or scalpels.

“I didn’t even pay attention to Diane when she said that she delivered breech babies,” Asp explains. “I never thought that would happen to me.

“But it was OK. No matter what, I felt confident that my body wouldn’t produce something that it couldn’t handle.” Her son William was born feet first in 11 hours. The proud mama cheerfully shares photos of his birth, including an incredible shot of the baby’s bluish toes peeking out of her birth canal.

Scientists calculate childbirth success rates by examining infant mortality per 1,000 births. Since the 1970s, the United States has had approximately 10 infant deaths per 1,000 hospital births. The mortality rate for planned and supervised homebirth is approximately 5 per 1,000 births. There is no conclusive evidence that hospital births are safer for either the mother or the newborn, and many insurance companies cover a percentage of midwifery service charges.

Emergency situations can and do arise in home births, just as they do in hospital settings. Sonograms and blood tests can diagnose potential problems in the mother or the unborn child that might require hospitalization or the intervention of a knowledgeable physician.

However, if a woman delivers her baby in a U.S. hospital, she has a one-in-four chance of receiving a Caesarean section. This statistic has prompted the World Health Organization to advocate that the United States return to a midwifery-based system of prenatal care, labor and delivery. If 95 percent of births are normal, then why do 25 percent result in surgery?

The climate in this country among physicians and midwives is often one of mutual antagonism rather than mutual support. In one of the hundreds of home birth articles I have read in the past year, a mother of eight wrote this: “[T]he greatest problem in discussing this subject is the tendency to polarize toward absolute belief in one place or the other. The fact is, neither place can be made so safe as to guarantee every woman a healthy baby every time.”

At the darkest hour of my labor, when I thought I just might have to throw in the towel and beg for some relief, I focused on an image emblazoned on my midwife’s T-shirt, of all things. It was a circle, a mandala of women and children holding hands.

That image helped me to focus my thoughts when the birth energy was so powerful that I was losing my resolve to endure. That image reminded me of all the mothers before me who had experienced the intensity of childbirth, as I was experiencing it at that very moment. Sensing their collective strength, I suddenly knew that everything was going to be OK, and that soon I would have a babe in my arms.

“Labor’s a bitch!” Schaub says. “But where is our belief that women can do this? I see it every day. One of the best parts of this job is seeing women seeing themselves as capable and strong. Our bodies already know how to do this.”

Crystal Mustric, 30, is an artist and freelance writer who lives in Janesville, Calif., with her husband, Tim, and their son, Miles, who is six months old.