Sunday, September 30, 2012

Maternity Reverence Off The Grid

Four times in my life I’ve been pretty damn pregnant.  Counting right now.  Right now, I’m pretty damn pregnant, so I know what is coming next.  Pretty soon, I will be quite pregnant, then incredibly pregnant, followed by so pregnant you can’t believe I’m still walking upright.  But walk upright I will, and work too, until my water breaks.  Then I’ll take a week or so off before I tie an apron back around my freshly sagging belly and I’ll return to work without the comfort of the baby safely nesting inside of it (and without the aesthetic good fortune of the baby filling it out).  

Motherhood is a long, slow process of letting go, one that begins immediately after birth.  

The days and years following a baby’s birth are devoted to fostering that kid’s independence and ability to care for himself.  If you do it right, some day your kid will look you square in the eye while you earnestly dole out some unsolicited gem of wisdom, and he will say Thanks for all the nurturing and guidance.  Thanks for the hot meals and the cookies.  Thanks for the late nights cleaning up my vomit.  But fuck you, I’ve got this.  A friend was telling me last week how happy he feels when his kid needs money.  At least there’s that.  

Varicose veins and sciatica aside, there are some real perks to being pretty damn pregnant.  The first of these is that you get to take your kid everywhere.  It will be several months before I have to leave the baby home with his father while I go to work, and several years before I have to drop him off in front of a large building and walk back home alone, praying the whole way that the people there are kind to him.  

Another benefit to being pretty damn pregnant is that everyone around you - your closest friends and total strangers alike - goes out of their way to transmit a little energy to the forming person in your belly.  Cooks at work make you toast to feed the baby.  Strangers hold doors while you walk through.  There are constant offers to lift, to carry, to ease the burden.  People reach out and touch your stomach, feeling...not you...but the baby inside, lightly pressing their hands against the firm bulge of life protruding there.  And there are the smiles.  Smiles and smiles and smiles.  Because even the most jaded and cynical bastard knows the secret there... that with every life, there is hope.  There is not a culture on the planet earth that does not revere a pregnant mother and newborn children.

Capitalism being what it is, Americans have turned our reverence of newborns into a nearly 7 billion dollar a year industry.  By the time your first baby is born, you will likely have a house full of swings, harnesses, carriers, Boppys, Bumbos, Binkies, Blankies... you’ll look around and wonder to yourself how the fuck we ever made it out of caves if this is what is required for a person’s first year of life.  Don’t worry, by the time you have your fourth baby, you will refuse all offers for a shower, having learned that the only real necessities are a stash of onesies and a way to wash them.

Here’s another area we top the charts in dollars spent on babies: maternity care.  Here, friends, is the height of irony.  Americans spend over $100 billion on maternity care (hospital and provider fees) each year.  That’s much higher than any other developed country in the world.  And you’re probably thinking, well, the US has a far superior medical system in place than most of those countries, right?  So we’re probably getting a hell of a bang for our buck, right?  Surely that money is the measure of an advanced system of care for the mothers and infants we so revere... right?

Let’s check in with the World Health Organization for affirmation.  Currently, the US ranks at the top of mother and infant death in developed countries.  33 countries reported a lower incidence of maternal death last year, and 37 reported a lower incidence of infant mortality.  65 countries reported a lower incidence of low birthweight babies.  That puts us below some countries that don’t even count as “first world.”

From Amnesty.org:

Obstacles to care are widespread, even though the USA  spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion (*that doesn’t count your doctor’s fee! -meg) than any other type of hospital care.
Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. Minorities account for just under one-third of all women in the USA  (32 percent) but over half (51 percent) of uninsured women.
One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women.
Burdensome bureaucratic procedures in Medicaid enrollment substantially delay access to vital prenatal care for pregnant women seeking government-funded care.  
A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in "shortage areas" for primary care (which includes maternal care).
Many women are not given a say in decisions about their care and the risks of interventions such as inducing labor or cesarean sections. Cesarean sections make up nearly one-third of all deliveries in the USA  – twice as high as recommended by the World Health Organization.
The number of maternal deaths is significantly understated because of a lack of effective data collection in the US A .

***Look at bullet four, where they mention that bureaucratic bullshit hoop jumping to get prenatal care if you’re uninsured.  When I learned I was pregnant in May, I immediately applied for coverage through Medicaid, just in case there’s an emergency and we end up in a hospital.  In September, my application process was complete and I was approved.  That’s five months.  Five fucking months that I might have gone without care if I was younger and poorer and didn’t know how to find care from a midwife.  I have no intention of using those state benefits, but for many women, there is no other option.

Irony.  The US spends more dollars per capita on both medical care and plastic crap to help welcome new life.  Yet each year we are losing an alarming number of mothers and babies to a failing system of care.  Each year women and their babies go months without help that would eradicate most of the health problems associated with inadequate maternity care.  Many of those health issues create a lifetime of repercussions for the child, if he survives the birth.  And we’re not talking about it.

Even on the grid, even for those of us with insurance, what we as mothers have come to consider a normal birth plan often involves scheduled cesarean sections and chemical labor inductions to conform to the churn and burn mentality of our insurance carriers and providers.  Get em in, scoop em out, change those sheets.  Sometimes this is for the health and benefit of the mothers and babies, but more often it is for the convenience of corporations and even doctors.

Here, I’ll show you:

Looking back on my own birth history, I see a pattern of unnecessary and invasive intervention in the hospital, which compromised both my and my childrens’ best interests.  In three births, I have not had one that was allowed to progress naturally.  Failure to progress, they called it in 2000, when I labored gently for two days with my first child without much pain or dilation.  Then came the intervention: I was confined to a bed and dosed with pitocin which produced seismic contractions against a rock hard cervix that was not ready to dilate.  They told me it was best for the baby.  That’s how they get you.  They present an intervention as sort of your choice, but not really a choice at all if you’re a good mother.  If you’re a good mother, you’ll do as we suggest.  I assume this was not pleasant for the baby, either, as he was forced down a birth canal with no exit strategy, a bit like being compressed against a steel wall by a relentless piston, I imagine.  Within a couple hours he was in distress and my ex-husband and I listened to the sound of his heart on the monitor as it slowed, slowed, slowed... then stopped.  Emergency c-section.

With my second baby I found a doctor who would allow me to attempt a vaginal birth despite my cesarean history.  Awesome!  I thought.  A week before my due date, that doc sent me to the hospital for a cervical softening, but again I found myself on the pitocin drip.  This isn’t what I’m here for.  The nurse informed me that pitocin was the order on the chart.  I was duped!  I’m not even technically due yet.  But if it’s what’s best for the baby.  The doctor, after all, is the authority in this situation.  What the hell do I know?  I’m just the mother.  That’s the other way they get you.  By convincing you that you are ignorant in matters of birth and the complexities of the process.  I labored in the bed, once again grounded by an iv and a fetal monitor, while the seismic chemical contractions rocked me for nine hours.  I refused the epidural not once, but three times... they really want you to take that thing.  It’s like being behind the gym of the junior high all over again ...come on, mama... seductive temptation from the nurses... it’ll make you feel good.  All the pain will go away.  The third offer was from the anesthesiologist, who just happened to be next door, and thought he’d pop in to make sure I didn’t want some relief.  But we were close, I could feel it, and I wanted to stay with the baby.  I wanted to feel every move she made, I didn’t want to abandon her with numbness.  I wanted us to do it together.  We did.

My third birth was another intervention - fetal heart monitoring alert at a routine appointment, best for the baby - with some rather suspicious motive on the part of my soon to be vacationing doctor, who had already scheduled an induction that I was seriously considering playing hookie from.  I was something like three weeks prior to due with that emergency cesarean section.  Last year, we finished paying off the nearly $10,000 that my 80/20 insurance plan didn’t cover.  

My birth history, and the expenses associated with it, is echoed in the experiences of women across the country, to the tune of $100 billion a year, and not always with the happy results I’ve had.  

Now, at 38, I’m a little wiser to the game, and living off the grid without health insurance.  When I learned I was pregnant I shopped a bit for a doctor and hospital who would allow me and my baby a natural birth (as is recommended by the American College of Obstetrics and Gynocology for mothers who’ve had one or two c-sections).  That doctor does not exist in this town, nor does a hospital or birth facility who would allow a provider to attend that birth even if he or she was willing.  I’m sure they have their reasons.  Reasons I know nothing about, being just a mother and all.

Instead, I found a midwife who is providing us with wonderful care, and who believes strongly in my body’s ability to grow and deliver this baby at home.  Her reverence for mother and child is absolute.  My trust in her is absolute.  
   
For the nine months of my pregnancy and for however many hours it takes me to bring this child forward, my connection to him is absolute.  We’ll share a body for a bit, then share a birth.  I’ve found a care provider who won’t ask me to relegate even an ounce of my power, who won’t question my instincts, who won’t rush us.  She’s ready to assist, trained to intervene if necessary.

I don’t have the big-picture answer, nor a plan for massive reform of maternity care in the US.  I only know how to manage my own reform, to avoid the pitfalls and traps that my naivete has snagged myself and my children in before, and to try to create a conversation wherein people address the larger issue: that we are allowing corporate policy and insurance companies to harm mothers and babies, and we are paying them billions of dollars a year to do it.  Billions of dollars that we would probably rather spend on Bumbos and Binkies and Boppys.  Or, shit, a college fund?

I’m pretty damn pregnant.  I am the beneficiary of your reverence.  Okay, no one has carved a statue of Oolitic Limestone in my likeness, but you make me toast. You smile. You touch my belly. You offer to lift, to carry, to ease my burden. So I know you want health for all mothers, for all babies. You get it.  I know you do. For nine months a mother is entitled to adequate care and choices by hospitals and practitioners who keep health at the forefront of the conversation, so that she can deliver a healthy baby and begin the long, slow process of letting him go.

3 comments:

  1. I haven't done it the other way, but I loved our midwife. Loved, loved, loved. Only regret is that I didn't have more help for a few days right after, but that is a first-time mama mistake that's easily fixable next time. (And I'm a bit of a wuss when I feel poorly--sounds like you're a rockstar, so perhaps that's not even a worry.) Best of thoughts to you and the growing little guy!

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  2. Love your writing. Thank you for all these big and little, personal and universal observations. I envy you the joys of pregnancy and sympathize with the physical, emotional, financial, and philosophical challenges that come along with it. Thanks for your blog.

    (Another Meg)

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  3. Hell yes, Meg. Reclaim your power! I'm so proud to be your friend and read about your birth stories. I love you, girl and little baby!

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