Women's Bodies, Women's Wisdom (107 page)

The pain of labor was far greater than I thought it would be. (It’s always worse after the membranes are ruptured, a point that doesn’t seem to stop some obstetricians from doing it prematurely even when there’s no need to.) I had seen hundreds of women in labor after five years of OB training. I had always focused on the women who didn’t appear to have any discomfort, and I was so sure I would be one of them. But here I was, stuck. I felt as though I were in a box and there was no way out except through. My intellect could not get me out of this—and I was determined to go through the process naturally. I already trusted the natural world more than the artificial man-made one. What I didn’t appreciate then was the depth of my own programming into and cooperation with that same man-made world.

We called my obstetrician, a sensitive man with whom I had worked in the hospital for several years. He suggested that my husband and I go into the hospital. The only problem was that all I wanted to do was stay on the floor on my hands and knees. Moving
anywhere
seemed to me the most unnatural thing I could think of. It went against every instinct in my body.

I didn’t have a bag packed for the hospital, so my husband ran around and put some underwear, a nightgown, and a toothbrush in a bag. Then he tried to get me dressed, out the door, and into the car. He nearly had to carry me. Left to my own instincts, I would never have left my position on my hands and knees on the floor.

When we got to the hospital, a place where I had worked for half a decade, I had to go through the admitting office as a patient. Admissions had lost the correct papers and would not let me go upstairs to the labor and delivery floor, where my nurse friends and my doctor were waiting. This was my introduction to the bureaucracy of hospitals, something I’d been shielded from for years. (Laboring in a hospital hallway alone is inhumane, but for thousands of women, it is their experience.) I simply walked out of the room, went to the back hall elevator, got in, and went up to labor and delivery by myself.

When my doctor examined me, I was four centimeters dilated. (You have to get to ten to be ready to push.) For the next three hours my contractions came frequently. But I failed to dilate beyond six centimeters, where I remained “stuck” for those three hours. The contraction pattern on the monitor was “dysfunctional.” Though the contractions hurt a lot and I never got much of a break between them, they simply were not getting the job done. I had what is known as hypertonic uterine inertia, which means that the contractions, though present, are not efficient—they are erratic, originating all over the uterus at the same time, like the heart when it goes into atrial fibrillation. (Sometimes the “low heart,” the uterus in the pelvis, does the same thing as the “high heart,” in the chest.) Instead of beginning at the top and moving in a wave to the bottom of the uterus, the contractions origi nated in many places at the same time. Labor didn’t progress well. It was like trying to get toothpaste out of a tube by squeezing it in fifteen places at the same time with a little bit of pressure, instead of squeezing firmly only at the back end of the tube so that the paste comes out uniformly.

When my doctor told me that I had made no progress in three hours, I knew what was next. (Remember, my intellect thought it was in control of my labor.) “Okay,” I said, “start the IV, plug in the fetal electrode, and hang the Pit.” Pitocin (oxytocin) is a drug that artificially contracts the uterus. After the Pitocin was started, the contractions became almost unbearable, going to full intensity almost as soon as they began.

No amount of Lamaze breathing distracted me from the intensity of the feeling that the lower part of my body was in the grip of a vise.
⁸⁷
At one point, I looked at the clock and saw that it was 11:15 a.m. What I recall thinking was, “If this goes on for another fifteen minutes, I’m going to need an epidural anesthetic.” I didn’t know that I was in transition—the part of labor that is most intense, just before the cervix becomes fully dilated. Within the next twelve minutes I suddenly felt the urge to push. It was the most powerful bodily sensation I’ve ever felt, and I was powerless to resist it. The thought flashed through my mind, “If I ever tell another woman not to push when every fiber in her body tells her to push, may God strike me with lightning!”

In two pushes, Ann almost flew out of my body. My obstetrician quite literally caught her. Though I was laboring in the “birthing room,” I wasn’t laboring in the “correct” delivery bed, and I barely made it to the delivery bed in time. (Birthing rooms now are equipped with beds that adjust for delivery of the baby, so that moving from one bed to another isn’t necessary.)

Ann cried and cried, and though I put her to my breast almost immediately, it still took quite a while to calm her down. I believe this was because the Pitocin made for a far too rapid second stage of labor. It was too intense both for Ann and for me. Neither she nor I had much chance to recover between contractions.

A primiparous patient—one having her first baby—usually takes an hour or more to push the baby out. From the time the cervix is fully dilated to delivery— the second stage of labor—I went from six centimeters to delivery in less than one hour; my uterus was being pushed by a powerful drug, a very intense and distinctly unnatural experience.

During her childhood, my daughter was not particularly “at home” in her body and was afraid to take physical risks, for instance in skiing or hiking. Though there are various reasons for this, I know deep within me that being propelled into the world with so little time to accommodate herself to the process of labor was a terrifying experience for her. She had difficulty nursing, and she was never a good sleeper. Part of the reason is that she was small (5 pounds, 8 ounces) and early (38.5 weeks), and part is her personality—but another part is how she was born. I didn’t know then what I know now, and I don’t for one minute blame myself about how she was born. I allowed myself to feel sadness about the experience, which would be considered a completely normal labor and delivery by most everyone.

After Ann’s birth, the cord got pulled off the placenta, so my placenta had to be manually removed by my doctor. The explosive uncontrolled delivery had left me with some vaginal tears, so removing the placenta was somewhat uncomfortable. But nothing could equal the discomfort of those Pitocin-induced contractions! I was euphoric to have the whole thing over with. I had had a “normal vaginal delivery” and felt lucky to have avoided a cesarean. Most women obstetricians end up being treated like candidates for high-risk pregnancies and deliveries, because women doctors (like other women who have been highly trained out of their instinctual feminine knowing) often split their intellects from their bodies, mistrust their bodies, and unconsciously set themselves up for the possibility of labor problems. We as a group are also at risk for working too many hours during pregnancy to “prove” that we can “handle it” and compete with the men.

When I look back now, I realize that my being stuck at six centimeters was a perfect metaphor for how I felt during my labor and for my ambivalence about having a baby. I had felt “stuck” and trapped by the pain of labor—something my intellect had not prepared me for. My intellect, you recall, thought I was doing an experiment with my uterus. And I wasn’t very invested in actually having a
baby
. I had made no room in my life for one. I had spent the previous decade proving to myself and to the world that I was as good as any man—and men don’t do babies.

Another factor in creating my dysfunctional labor was the process of moving off my hands and knees in my house, getting to the hospi tal, going through admitting, and then answering insurance and med ical questions for forms that I had already filled out several times. All those things are interruptions of the inner focus required for normal labor. I didn’t really know that at the time, though I’d seen countless women come to the hospital in active labor, only to have the process become slowed down or dysfunctional when they were “processed by the system.”

Now it was me having a baby—something that I was determined would not change my life. I realized later that what I needed when I got stuck was a midwife or a doctor with good midwifery skills, preferably some wise woman (or wise man—male midwives and male obstetricians with the souls of midwives do exist) who was a parent and who trusted the process of labor and the messages my body was sending. I needed someone who would have said to me, “Go inside and talk to your baby. Let the baby know that it’s okay to come out, that she will be fine.” Then the midwife would have taken me for a walk in the hall—a very effective way of getting contractions back on track. She might even have helped me work through my ambivalence about having a baby.

With my second labor, I did go to a midwife. I began labor at home and spent some time in the bathtub. (Studies done in Sweden have shown that women who labor in warm water dilate much faster.) I didn’t want to go to the hospital until I had to. My husband was asleep, and I didn’t wake him until I knew that the labor was moving right along, several hours later. When he examined me, I was already seven centimeters dilated. We called the midwife and then went to the hospital, where my colleague Mary Ellen Fenn, M.D., met me at the front door and parked my car, a gesture of support that I will always treasure.

When I arrived in the birthing room, I was nine centimeters dilated. I spent the rest of the labor rocking from one foot to the other while standing up. This second baby was a lot bigger than the first—8 pounds, 9 ounces. Her head was what is called posterior (she was face up in my body). I never felt the urge to push, but I pushed her out anyway with a great deal of effort. Even after I was fully dilated, the contractions felt the same as they had at nine centimeters. I didn’t have any episiotomy—and I didn’t tear. My baby, Kate, and I left the hospi tal an hour after she was born. Kate was calm and collected, and she has been that way ever since. Her personality and body type are entirely different from her sister’s. Part of the reason is that I was a different person during my pregnancy with Kate than with Ann.

Having my midwife in the room with me was heaven. I felt so supported. I had much more trust in myself this time—and I had all the baby things ready. I remember thinking during this second labor that every woman deserved this same amount of support.
Every
woman should be able to labor in whatever position her body wants to take. She should be surrounded by beloved friends of her choice. (Not spectators, but supporters—there’s a big difference!) Every woman should be massaged and cared for and cherished during her labor.

In this labor I had pain, to be sure, but I went deep down inside myself with it. In my first labor, I had fought the pain and reached out to my husband in desperation—I wouldn’t even let him go to the bathroom. But this second labor felt as though it was between me and my baby. I had plenty of time to rest between contractions and to chat with my midwife, husband, and obstetrics nurse. They gave me backrubs that felt fantastic. No drugs interfered with the labor. I learned to trust my body in a letting-go process that feels like a kind of surrendering to a process that
is
you but that is also
greater
than you. I didn’t learn any of this stuff in my residency training—I didn’t even learn it from watching women in labor, though I believe that it can be learned that way and that I eventually would have. What you have to do is trust nature, expect the best, and get your intellect’s death grip off your flesh.

I now wish I had groaned loudly and let my groans help me expel the baby. But I was far too “professional” (read: out of touch) to do that. I am deeply saddened by all the unnecessarily medicalized births that occur because women in labor don’t trust themselves and aren’t surrounded by those who could assist them in this process.

TURNING LABOR INTO PERSONAL POWER

Trusting the birth process and knowing how to tune in to the baby are abilities that enhance labor and make it an experience that offers us the opportunity to empower ourselves. Instead of running from these lessons, women could learn a great deal if we were willing to embrace them.

Bethany Hays, M.D., mentioned earlier, is the mother of three sons. She once wrote me the following reflections on the pain of labor and how we can work
with
it: “I used to think that labor was just a matter of dealing with pain and the fear of pain. I knew that with labor the pain was qualitatively different from any other pain experienced in our bodies. I never sub scribed to the punishment theory of labor pain. I was looking for a natural and reasonable explanation. I did not believe labor pain was a whim of Mother Nature any more than it was a punishment from God.

“With all other forms of pain, the pain is there to tell us that something is wrong. ‘Stop walking on your foot, there’s a piece of glass in it.’ ‘Don’t eat any more chili, it’s giving you heartburn.’ With labor, I knew that the reason for the pain, at least in most cases, is not related to anything being wrong. The physical process of birth is completely normal and exquisitely planned by nature to ensure the safe delivery of an infant with minimal trauma to the mother. Pain was a part of that plan, and I had but to view it in that context to understand its purpose.

“As I observed women through their pregnancies, I began to under stand that nature would have to have a signal to get women to stop what they were doing, to find a safe place to give birth, and to gather people around them to help. For some, nothing short of a sledgehammer would do. It needed to be a signal that no one could ignore but that left the mother able to participate in the birth if there were circum stances requiring her to do so.”

Certainly, the pain of labor is a strong signal that says, “Stop what you’re doing and pay attention.” Instead of the “no pain, no gain” cultural mentality that often leads to self-abuse, gaining from the pain of labor is an entirely different way of being with pain. Once a woman has stopped, gathered support people around her, and gotten herself to a safe place to birth, she has reached the point when she must use the pain for something else. Dr. Hays suggests that at this point the pain is something to allow, and she points out that one of the meanings of
to suffer
is “to allow,” as when Christ said, “Suffer the little children to come unto me.”