It Runs in the Family (5 page)

Naomi Mayer also figures in my mother-in-law Joanne’s story. She and Rick knew Naomi as the “peace movement midwife.” Their friends who worked with her had positive home birth experiences, but Rick and Joanne lived too far away for Naomi to be their midwife.

For Joanne, the fact that the women in her community were giving birth at home was an inspiration and a motivation. Her decision to give birth at home was informed by feminism, centuries of women’s wisdom with respect to health and wellness, and a search for empowerment within the process of complete surrender to the birth process.

“Choice is so important,” she told me, “especially at a time of vulnerability. Building knowledge and retaining control makes for empowerment. Women have been giving birth for thousands of years without intervention. And then birth becomes about men and hospitals and money. I didn’t trust any of that. I wanted to be outside of all of that.”

Patrick’s older sister Annie was born while the family lived at the Community for Nonviolent Action in Voluntown, Connecticut. Helen Swallow, a nurse-midwife trained at Yale University, shepherded them through the process. There were many little things that Helen did that Joanne loved and that made her feel comfortable. For instance, Helen warmed the stethoscope before putting it on Joanne’s stomach. “A male doctor would never think of something like that,” she exclaimed. When Joanne’s limbs swelled up with edema (water retention) in the sixth and seventh month, she researched herbal remedies and found that rosehip tea would work just as well as any pharmaceutical diuretic.

By the time Joanne was pregnant with Patrick, Helen Swallow was not doing many home births, so she referred Joanne to a lay midwife who had decades of hands-on experience but no formal or medical training. Joanne didn’t see a doctor that time around, but because her first experience was so positive, she was comfortable dealing only with this lay midwife. “So many of my friends were having home births with lay midwives that I didn’t feel like I was swimming upstream anymore. I found a lot of comfort and reinforcement in that.

“On a Friday, I began to feel a lot of cramping. But then on Saturday it went away, probably because Rick stepped wrong on his foot going down the stairs and ended up in the hospital with a broken foot. He was in and out in less than an hour—because he told them he was supposed to be on hand for my labor at home—but it was hard for me to stay focused on the labor process when I had to attend to him. By evening time, the labor was getting serious. I found myself focusing on all my friends gathered at the Pentagon for the second Women’s Pentagon Action, where they wove the doors of the Department of Defense shut with yarn and string and ribbon. Their statement, drafted by celebrated author Grace Paley, read in part: ‘We understand that all is connected. The Earth nourishes us as we with our bodies will eventually feed it. Through us, our mothers connected the human past to the human future.’ I tried to tap into that energy of resistance and creativity. I thought: this hurts, this is labor, but I can do this. Thinking of all my friends at the Pentagon, surrounded by friends at home, on my hands and knees, Patrick came into the world. He looked like Yoda when he was born, a funny little head and very large ears. We opened a bottle of champagne and then everyone went to bed.” I love these two birth stories. There are such lovely overlaps and similarities: the fact that my and Patrick’s mothers both sought out the advice and inspiration of Naomi Mayer, that both rejected the sterility of Western medicine, that they both found guides and supports, wisdom and grounding in the experiences of other women. There were differences, of course: I was a first birth, quiet, intimate, at a little distance from community, whereas Patrick was a second birth, busy and in the midst of family, community, friends, and with broken bones to boot. But both births were acts of resistance, creativity, and empowerment. That is how Patrick and I came into the world and that is how we chose to birth our own children.

As I thought about labor and birth, I also thought a lot about nonviolence—about how nonviolence demands that we are responsible and educated, and apply our beliefs to daily activity. Nonviolence at a demonstration can look really different from nonviolence in our personal relationships or even in how we treat ourselves, but it is all part of the same package. Patrick and I envisioned a nonviolent birth experience, similar to our parents: a home birth that would be empowering, on our own terms, natural, and cheap!

In fact, it is hard to figure out the cost of the average birth in the United States. There are so many variables—type of insurance, what kind of deductible, caesarean or vaginal birth, length of labor, complications, medications, and recovery time.

With all the unknowns, I did know one thing: we would pay $650 to have our baby. That is a lot of money in our one-income household, but there are many women who don’t even get a shot of Pitocin—which induces labor—for that much. Fortunately, I have state health insurance, and our midwives (hallelujah) accepted it.

In 2009, the
Wall Street Journal’s
Healthy Consumer columnist gave “uncomplicated, traditional” birth at a Los Angeles hospital and was shocked to discover that the total costs were upwards of $36,000. Even with all our hospital intervention and high-tech medical equipment, CNN reported that in 2007 the U.S. ranked behind the majority of other developed countries in infant mortality, with a rate of almost seven deaths per one thousand live births. According to the Organization for Economic Cooperation and Development, this is the case even though all of these countries spend much less than we do on health care.

Poverty in the United States, and economic disparities, accounts for much of our infant mortality crisis. These disparities determine the degree to which women receive prenatal care and their ability to maintain a healthy diet and lifestyle throughout pregnancy and after the birth of a child. It is worth noting that at a time when the political discourse in the United States is once again fixated on abortion and the attendant rhetoric about the sanctity of life, we hear very little about women’s access to affordable health care, consistent prenatal care, and safe, appropriate, and dignified birth options.

Speaking of which, the World Health Organization says that a national caesarean rate of 5 to 10 percent provides the best outcomes for women and babies. In 2007, 32 percent of women in the United States had a caesarean, according to the Centers for Disease Control.

While it is easy to put the blame on women for being “too posh to push,” a women and children’s health organization called Childbirth Connection correctly puts the onus on the medical industry. In a concise and compelling essay, they offer several reasons for why the medical industry pushes caesareans on women, including:

•   A refusal to offer the informed choice of vaginal birth

•   Casual attitudes about surgery and caesarean sections, in particular

•   Limited awareness of harms that are more likely with C-sections

•   Providers’ fears of malpractice claims and lawsuits

•   Incentives to practice in a manner that is efficient for providers

One thing that the essay does not mention is the cost of this often unnecessary medical procedure. The average caesarean costs nearly twice what a vaginal birth does—$24,700 compared to $14,500. A California Maternal Quality Care Collaborative white paper asserts that while in some cases, like breech birth, caesareans are clinically necessary, in many cases they have “greater risks and complications than vaginal birth.” The report, published in December 2011, notes that:

Higher caesarean delivery rates have brought higher economic costs and greater health complications for mother and baby, with little demonstrable benefit for the large majority of cases. With the marked decline in vaginal births after caesarean, caesarean deliveries have become self-perpetuating; and every subsequent caesarean brings even higher risks
.

The costs are significant. The white paper’s coauthor, the Pacific Business Group on Health, estimates that additional caesareans cost public and private payers in California at least $240 million in 2011 alone. An effort to reduce caesareans could save California between $80 million and $441.5 million a year, depending on the number of caesareans prevented. And that is just one state.

Time is money. Hospitals want women to give birth and get out. So lengthy labor, with all the breathing, walking, moaning, snacking, and napping, is not allowed. After a few hours the pressure for Pitocin begins, but the drug makes the contractions much harder, longer, and more painful, and women are not prepared for the pain. An epidural or local anesthetic may arrest the pain, but it also slows the labor, which often leads to more Pitocin and another epidural. And now the baby is being squeezed and pushed by the harder contractions and is having a harder time in the birth canal. The baby goes into distress, and then a caesarean is necessary. Self-fulfilling prophecy.

To be honest, I never really thought all that much about health care before I was pregnant. We didn’t have any while we were growing up. Our parents and our community depended on doctor friends for care and prescriptions. Lee Randoll was an old-school doctor who made house calls, prescribed aspirin for most ailments, and convinced our parents not to get our tonsils taken out. He was tall and lean and carried an old-fashioned doctor bag. When Lee retired and then later died, we went to the poor people’s clinic a few miles away. I remember being shocked when the doctor asked me if I was sexually active. I was only eleven or twelve years old at the time.

We got our teeth cleaned at a community dental clinic and the dentist supported our family’s peace work enough to set me and my sister up with braces at a drastically reduced rate. It’s kind of funny that we got middle-class teeth because our parents were poor revolutionaries.

As kids, we ended up in the emergency room with broken bones or bad hives more than once. My brother lost the tip of his finger when it got slammed in a door during a fight, and my mom carried the little nub of flesh with her to the hospital. When the bills came due, I think our folks just wrote a letter explaining their circumstances and then paid what they could.

In college, I used the school health services—mostly for reoccurring strep throat. Then I moved home and relied again on family friends. After peeing in the woods following an Indigo Girls concert, I got poison ivy so bad that my eyes swelled shut and blisters formed inside my nose. A doctor friend hooked me up with a prescription for steroids, and the itching and oozing cleared up like magic.

Later, when I moved to New York City and got my first real job, having health care seemed like a symbol of adulthood. However, it was also a major pain. I spent hours trying to figure out which doctors took my insurance, whether they were accepting new patients, and if they were located anywhere near my home or office. I ended up going to a community health center right near my office that took my insurance. I mostly saw interns and nurses instead of doctors, which was fine with me. It reminded me of the clinic we went to when I was growing up, except I had more than $100 taken out of every paycheck for the privilege. But I was only going for annual checkups and the occasional antibiotic. I never needed surgery or a specialist or anything exotic.

When I later quit my job to live a life of almost monastic service and squalor at the
Catholic Worker
, it was not hard to walk away from health care. I was healthy and I resented the amount of money I had paid into the system for years. I figured if I needed anything health related, I could turn to friends of the
Catholic Worker
. I got sick only once—fever, fainting, cold sweats, vomiting. It was no fun. It was hot in my little third floor room, so friends got me down to the ground floor and into a wheelchair. They pushed me three or four blocks to another friend’s apartment, where I slept for two days in air-conditioned splendor and drank tons of Gatorade. No doctors were needed.

When I moved to Connecticut to live with Patrick, he looked into adding me to his health care plan at work, but it would have cost more than 20 percent of his annual income, so we decided I would walk the tightrope without a net. I did just fine. No emergencies until the day I found myself testing positive for pregnancy at Planned Parenthood in New London.

Now what? They told me that Connecticut provides health care for low-income pregnant women and babies. It is called HUSKY Health, like the UConn sports teams. I was in luck. The local hospital even had a staff person who helped women navigate the labyrinth of paperwork and bureaucracy to ensure that everyone who qualified for the program could access it. And it was not just for pregnancy-related care—I was ten weeks pregnant when I got my teeth cleaned for the first time in three years.

The midwives we wanted to help deliver our baby accepted HUSKY insurance. And not only were we covered; we also got to make real choices about what kind of medical care was right for us. It was incredible; it was as if we lived in France. I was really relieved to be working with midwives, especially being pregnant at 38. At any hospital, I would have been seen as high-risk and pressured into lots of extra tests and stress. In contrast, the midwives explained all the tests I could take, why people take them, and then let Patrick and I make our own decisions about what made sense for us. We did a couple of ultrasounds and made sure I wasn’t anemic and that was pretty much it. I was healthy and strong and the baby was growing just fine.

Then the big day came. My water broke, my contractions started, our family and midwives were called, and time passed. The better part of three days came and went and we labored—me and Patrick, the baby, the midwives, my mom, and my family. Finally, the midwives said, “The baby is posterior. The baby is stuck. We need to go to the hospital.”

The local hospital told us that I would go straight into surgery and have a C-section immediately. So we tried calling a hospital further away. There, the doctor said, “Bring her in. You can stay with her. We’ll see what we can do to give her a natural childbirth.”