I was 37 years old as a first-time mother, and I might as well have been holding a sign to my forehead that flashed “cesarean section” in big, neon letters.
I knew that if I was going to give birth at a hospital, the doctors most likely would hook me up to a heartbeat monitor and limit my movement, and if I didn’t progress, I would be wheeled into the operating room before I could even say the words “birth plan.”
Although I was healthy, with absolutely no preexisting conditions, I was deemed “high-risk” and I was placed in the “advanced maternal age” category simply because I was over 35.
While the rate of successful pregnancies for women over age 35 has been growing, women in my age group have a disproportionate number of C-sections. In 2017, for example, the overall rate of cesareans (both planned and emergency) was 27 percent, but for women ages 35 to 39, it was 41 percent.
Although I was healthy, with absolutely no preexisting conditions, I was deemed “high-risk” and I was placed in the “advanced maternal age” category simply because I was over 35. My own family-practice doctor repeated this to me at my first prenatal visit like a mantra, and though I trusted her to treat my sinus infections without any qualms, I ruled her out as my birth attendant.
I didn’t want a cesarean section—unless it was absolutely, positively, medically necessary. I desired vaginal labor, without drugs or inducement, and early on, I decided I would do everything in my power to make this happen. But the more I researched hospitals and obstetricians, the less confident I felt that my birth plan would be followed.
I tried a different path, then, and interviewed a midwife, Deb, who explained that midwives look at birth differently. “Doctors treat births as a medical condition,” Deb said. “Midwives treat births as a part of life. We know what healthy birth looks like, and we know when medical intervention is needed.” Deb also pointed out that if I needed medical intervention, she would know, and she would make sure I got to a hospital if I needed to be there.
Statistics also backed her up: A study of low-risk pregnant women who gave birth in a hospital under a midwife’s care experienced fewer interventions and experienced a C-section rate that was 30 percent lower among first-time moms than those who were under the care of an OB-GYN.
In thinking about my preferred birth environment, I also considered my family history. I was born at a big, teaching hospital outside of Chicago. My mom told me that by the time we went home, my newborn feet had been pricked so many times with needles that it looked like I had run across barbed wire. A younger, first-time mother, she had been given a pain block—even though she was already past the transition phase of labor and arguably didn’t need it at that point—which prevented her from pushing when she needed to, and got an episiotomy. I was pulled out with forceps.
Every time I thought about giving birth in a hospital—even with a nurse midwife—I inwardly cringed and envisioned that neon sign on my forehead.
Both my mom’s experience and my research nudged me toward choosing a midwife over an obstetrician or a family practice doc. But the next step was deciding between a certified nurse midwife (CNM) and a certified professional midwife (CPM), and as I learned more, it became clear that the nurse midwives in my area only attended hospital births. Every time I thought about giving birth in a hospital—even with a nurse midwife—I inwardly cringed and envisioned that neon sign on my forehead.
At this point, then, I was leaning toward a home birth, but my husband had his doubts, especially when Deb presented us with a shopping list and rental places to get the things we needed—like a birthing pool. The list reminded both of us that birth itself is not a “neat” experience, and my husband was concerned that we wouldn’t be able to find everything or that we might forget something essential. The logistics of a home birth seemed overwhelming.
That led us to consider a third option: a freestanding birth center.
The only one in our area was 45 minutes away, tucked away behind a maternity shop. We learned that the store—and its classes—would close during a live birth. The room was appointed like a hotel suite, but outfitted with things like birthing chairs and pools instead of minibars and flat-screens. Though located on a busy street, it boasted a quiet, peaceful vibe, and the only people who would be there during my son’s birth would be Deb, her assistant midwife, my husband, and my mom. Choosing the birth center just felt right, and when I thought of giving birth here, I felt relaxed and confident. (An added bonus was that even though we had to pay for the birth center and midwife out of pocket, it would end up costing less than a hospital birth, even with insurance!)
The first week of March, my 39th week of pregnancy, brought cool temperatures hovering around the mid-40s with a smattering of sunshine—and some Braxton-Hicks contractions. Two nights later, real contractions started. Our neighbors picked up our dog, and we headed to the birth center. Deb met us there, and she checked my vitals. Labor had begun. I really couldn’t sleep, and the next day, Deb had me walking, sitting, and moving to get things going.
She also made sure I ate—though I hadn’t had much of an appetite—and she kept me hydrated with water fortified with herbs. That day blurred into a second night, and while there were no signs of fetal distress, my cervix remained stubbornly dilated to only three centimeters. I don’t remember sleeping that night, but I remember forcefully urging (OK, yelling at) my husband to keep his fingers on my back because every time he removed them, the pain grew intense.
My mom tells me that I catnapped between contractions, which stayed steady at seven minutes apart. Around midnight, Deb had to leave to deliver another baby. When she returned, she told me that I was dilated to nine centimeters. “We’re going to have a baby today,” she announced.
Choosing the birth center just felt right, and when I thought of giving birth here, I felt relaxed and confident.
She was right. That afternoon, some 42 hours after my labor began, our son popped out—on his predicted birth date (which several people told me never happens). And he did pop out—like a cork from a champagne bottle. I remember asking Deb, “Is his head out yet?” She answered, “Nope. Here’s your baby,” as she wiped him off with a towel and placed him on my chest. Apparently, he had been kicking at the same time I was pushing, and he came out completely, instead of the usual head-shoulders-body progression.
We stayed in the hospital for one more night, entranced by our new love. The next day, we went home, and I learned that my husband’s family, some of whom had worked at hospitals, had been badgering him to convince me to opt for a hospital birth and that they had stepped up their campaign during my last week of pregnancy. “I’m really glad we didn’t go to the hospital,” my husband later told them. “The midwives were so professional, and the birth center was like a bed-and-breakfast.”
And that’s exactly how I’d describe a birth center. It’s like having a home birth in someone else’s home, and you don’t have to make the bed or empty the birthing pool. And nobody will tell you that you’re too old to have a safe, natural labor.
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