Childbirth - Where's my Dr. Huxtable?

Like so many other parenting choices, discussions about childbirth can be divisive. Natural childbirth vs. childbirth assisted by pain medication, hospital birth vs. home birth, obstetrician vs. midwife, when and whether to induce, and when to perform a c-section. In the case of childbirth, I believe it's definitely a "mommy" issue; the mother carrying the baby feels more ownership over birth choices than her partner, since she is birthing the baby. Adding to the sensitivity of the conversation, childbirth often doesn't go how parents would like - as with so many things in life, many factors in labor are beyond our control.

Steering clear of the divisive issues above (I'll leave those issues to documentaries like "The Business of Being Born" and "Pregnant in America"), what struck me when I was preparing for childbirth was how difficult it is to not have an anonymous birth experience where you can really only count on your partner to be there. I had dreams of having a warm relationship with my midwife through the pregnancy, which would lay the foundation for good communication and a positive experience when labor took place. We'd be that inexperienced couple, like so many of Dr. Huxtable's patients, who would be guided and cared for from pregnancy to baby's first breath. But I quickly discovered that there would be no Dr. Huxtable. That model of caring for mothers appears to be on the way out in the US healthcare system.

I am blessed to have health insurance - our family's coverage is through an HMO. When I was shopping around for a midwife, I discovered that I couldn't find a single sole practitioner midwife or obstetrician covered by our insurance. The only way we could have guaranteed to have a sole provider was to seek out a solo practicing midwife not covered by our insurance and do a home birth. While some might have the financial resources and the desire for that, we did not.

Childbirth wasn't always so amommymous in the United States. The data on obstetrician practice reveals solo practice is increasingly rare. According to research by the American Congress of Obstetricians and Gynecologists (ACOG), obstetricians are increasingly practicing in groups: the percentage of obstetricians practicing solo has decreased from 33% in 1991, to 23% in 2003, to only 19% in 2012. The causes are complex, including (though I am sure not limited to) decreasing affordability and availability of liability insurance, health care reform, higher salaries in hospital jobs, health insurance companies looking to cut costs, and the difficult lifestyle for solo practitioners who are on call 24-7. While I could not find similar data on midwife practice trends in the US, in her amazing memoir - "Baby Catcher: Chronicles of a Modern Midwife" - Peggy Vincent shares her life story as an American midwife, including dozens of memorable birth stories. Part of her tale includes the details of how her decades-long career as a solo practicing midwife came to an end when she got caught up in litigation over a woman's childbirth who was not even her client. In her view, sole practice midwifery was nearly impossible at the end of her career in the 1990s due to the lack of availability of liability insurance.

In my case, my health insurance only covered obstetricians and midwives in group practices. I selected the smallest practice I could find - it had two obstetricians and two midwives - and selected one of the midwives as my primary caregiver for my first pregnancy. She is amazing, and I felt very secure in her care. However, I did not develop the same good patient-doctor relationship with everyone in the practice, and as Lydia's due date approached, I felt nervous wondering who would attend our birth and whether she would be able to support me.

In the context of these systemic challenges facing women who are seeking a consistent caregiver during both pregnancy and birth, I have my individual issues. I'm not a person who welcomes new experiences without trepidation. I had never experienced childbirth before, and I didn't know what it was going to be like or how I was going to successfully navigate it, which made me crazy. The images in the media are ridiculous (though often hilarious) - the woman always turns into a raving lunatic. I read several books on childbirth, and we took a birthing class. However, I felt like no matter how many books Jeff and I read on the subject, we remained clueless about what labor was actually like. In fact, the more information I got from books and our class, the more nervous I felt.

As with so many life experiences, knowing about something is not the same as knowing something. Having taken French since sixth grade, I knew quite a bit about La Tour Eiffel. I had seen many pictures and read dozens of textbook descriptions, so I anticipated I wasn't going to be very impressed by her. But I still remember the feeling of having my breath taken away when I first saw her in person - what a beautiful man-made wonder. Childbirth is like that - knowing about it is quite different from experiencing it.

After leaving one of our childbirth classes in which they showed footage of women in labor, about a month and a half before Lydia was due, I told Jeff I thought we should consider hiring a doula. I had never heard of a doula before I was pregnant with Lydia. We did not have any friends or family who had hired one. I believe I first heard the term "doula" in my prenatal yoga class, which included a sharing time before the workout began. Several women mentioned their relationships with their doulas, and I was intrigued. DONA International gives a good definition: "The word 'doula' comes from the ancient Greek meaning 'a woman who serves' and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period." (For those interested, the "More Business of Being Born" documentary series has an informative episode devoted to the subject of doulas.) The idea of having a relationship with someone during our pregnancy who would attend our birth to support us sounded like the best solution for making birth less "amommymous."

Our doula, Cara, talking me through a contraction.

Based on the recommendation of a friend in my prenatal yoga class who had already given birth with a doula, we hired our first doula in my seventh month of pregnancy with Lydia. We met with her several times before the birth to go over our wishes and anxieties, and we felt more secure knowing she would be there when labor began. Ironically enough, our doula got ill when we went in to labor, and a back-up doula who we had not met before attended Lydia's birth. She was outstanding, and it was neat to have two doulas visit and care for us postpartum. Our experience having a doula during Lydia's birth was so wonderful that we wanted to have our first doula at Anna's birth, as well, but she had just made a career change. She shared a recommendation, and we hired an equally amazing doula (Cara Genesio) to attend our second birth. Jeff and I both felt that support of our doulas helped us immensely. They provided information, alleviated our worries about birth, massaged me during labor, relieved Jeff physically when he was tired, held my hand, provided encouragement, made sure I was hydrating, and intervened at key moments to advocate for us.

One really wonderful thing about the doula profession (in our local area at least) is that many doulas offer their services on a sliding scale and/or for free for families that qualify based on income. I know I worried about affordability when I was still a graduate student as we were planning for Lydia's birth, so I was amazed at how many doulas strive to support mothers of all socioeconomic levels.

While I never did find a Dr. Huxtable for our girls' births, I am grateful for doulas, who I believe have filled a real void in modern American childbirth culture. They are making lots of mothers like me feel that their birth experiences are anything but amommymous.