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Of Mice and Men

June 26, 2011

Of Mice and Men

Genny White

Marsden Wagner compares medical professionals’ fear and avoidance of homebirth to that of a group of geographers trying to describe a country that they have never been to because they are to afraid of going there.  Some years ago I had an experience that illustrates Wagner’s point splendidly.

At the birth center I was interning at we had a client that I will call Anna.  Anna came in with her employer — Anna was a housekeeper.  Anna had become pregnant and wanted to have midwifery care for her pregnancy and birth.  Anna was a bright young woman excited about being pregnant and delivering at home.  She glowed as she spoke about the kind of birth that she wanted for her child and her brown eyes sparkled as she shared how careful she was with her food choices.  Her friend and employer looked on shaking her head in agreement that in deed Anna was nourishing herself with a diet rich in protein and nutrients.

On one occasion at one of Anna’s prenatals did not only her employer come to the birth center but also the homeowner’s husband the man of the house, who also happened to be a perinatologist.  Dr. X was charming and pleasant, making it easy to discuss matters with him.  He spoke openly and candidly to the midwife and me.  He shared that this is what his housekeeper wanted as did his wife and that he was happy to accommodate their wishes; however, it was difficult for him to legitimize home birth with his position and all.   He shared that his vision of birth had perhaps been jaded by all the negative exposure he had with caring for babies of mothers who were drug addicts and all the worst case scenarios he had come across over the years.  He continued to share how rare it was for him to encounter an uncomplicated birth.  Dr. X was gracious and offered the midwife his assistance in care if things did not go well at the birth of his housekeeper.  I recognized Dr. X at once.  A year earlier one of the midwive’s clients that I was caring for experienced a premature rupture of membranes (PROM) and on set of premature labor.  I accompanied the couple to the hospital for their transfer of care.

After examinations of the mother by the staff and the intern, Dr. X. the perinatologist was brought in.  He came in, wearing his starched white coat, and, with his voice as big as his body, pronounced the diagnosis of preterm labor and its subsequent care.  He ratted off the course of treatment and just what would be done for these parents and a room full of peers to hear (to myself it seemed like overkill).

The hospital staff wanted to make sure that these home birthing gurus were made to understand the predicament that they found themselves in.  As Dr. X finished his announcement with associative data and stats about fetal lung capacity, bedrest and all his remaining remarks, he left to a chorus of “Yes Doctor.”, “yes, Doctor,” and “yes Doctor X.”  Clearly, the man was well respected.  He was larger than life, and there he stood appointed in his own Cathedral of Medical Light.  Yes, now this Dr. X sat contently with his wife on the sofa of this natural birth center.

Anna wanted a home birth in the home of the perinatolgist and his wife her employer.  She did not care for a birth at the birth center so months went by and the pregnancy progressed un remarkably.  I received the call early one July morning with the sun just starting to rise,  The midwife and I traveled there to together to one of the gold coasts most expensive plots of real estate.  Anna resided in one of the sea coasts bleached white ocean front monuments.  Upon getting out of the car, I gazed at the mountain of steps that were before me as I carried the O2 tanks up the steps.  The midwife and I entered this mammoth house, floored with all natural hardwoods; cathedral ceilings crown molding and every exquisite touch.  We were greeted by the wife who escorted us back to a corner bedroom.  Once we entered it we saw that it’s décor was in sharp contrast to the rest of the house, for  this one room was decorated with the most humble and bare of furnishings.

There we found Anna in bed already riding through strong contractions.  She was in an advance state of labor.  But she was exhausted and dehydrated.  As Anna weakly reported she had started having contractions in the middle of the night, but did not want to disturb anybody in the house until morning. So there she stayed in her room contracting the whole night through until day break when the lady of the house arose.  Then she let her employer know that she was in labor.  The midwife and I rehydrated her and got her a something to eat.  Soon her strength returned and we got her up on her feet. We led her out of her small room, and she labored moving about in the living room.  She moved, she swayed her hips, and she moaned in and out of contractions.

As this housekeeper labored through contractions, this woman nurtured her maidservant with devoted care.  The homeowner nurtured, held and cradled her handmaiden through each contraction.  The two danced through the labor.  One would be hard pressed to find a laboring couple as caring as this homeowner and her housekeeper.  The love and concern of this relationship was something to be noted.  At one point in Anna’s labor, she squatted down to move through a contraction and out of the corner of my eye I could see Dr. X.  He was dressed in a white robe and some bed room slippers.  He darted across the hall and slid into the kitchen.  Quickly he went.  Anna had another contraction and down with her we all went; she breathed through the contraction and the wife did hold Anna and fan her to keep her cool until the contraction was over.  As I arose to see Dr. X dash across the hall caring a tray with a banana, a piece of toast and a cup of coffee. Dash he did right back into the master bedroom where he did hole up until the course of the labor and birth were through!

This great man was now a mouse in his own house. At one time I do recall that the land line phone rang and rang.  The caller gave up as no one answered, only to retry the call once more.  The phone rang a second time and rang and rang without Dr. X. opening the door and answering the call.  Finally the wife who was dutifully caring for her housekeeper in exasperation left her charge to answer the phone and carry it to her husband who did not dare leave the bed room.  She returned shortly and soon thereafter Anna gave birth to a beautiful and healthy baby boy, though Dr. X was never to be seen again.

I saw Anna and her employer once more when they came into the birth center for their two-week postpartum appointment.  The midwife reviewed with them how to pick up the baby’s birth certificate as  the father of the baby lived in Mexico and Anna did not want to return there.  They were exploring ways of reuniting with the father of the baby in the USA.

I have often thought of Doctor X, one of the most prestigious and renowned perinatologist in all ofSouthern CA.  How many births had he attended waiting at the end of the bedside for the baby to be delivered, waiting to make his assessments and to initiate his much needed care to the freshly delivered neo-nate?  How many births did he see to rise to such prominence; how many years of medicalized births had he observed; and, when there was one normal natural birth occurring under his own roof, where his interventions were not needed, why was he too petrified to leave his bedroom?

Hundreds dare I say thousands of births over the years he had observed but this one un-complicated without interventions prescribed births he could not bear witness too, all because of a hysteria, a miss giving of fear. Strange!

We live in a society where medical doctors act as advisers to health insurance companies regarding the safety and outcomes of birth.  The industry looks to the physician to establish policy.  But they are looking in the wrong place.  The medical establishment is not the place to look to for advice and standards of care for normal birth.  The midwifery community and governments that have successful outcome statistics in maternal infant mortality and morbidity are more reliable places for the insurance carriers to look for wisdom about maternity coverage.  Dr. X fully illustrates that most members of the medical establishment have an unnatural, unfitting fear about something they know nothing about: Home Birth. Quite frankly it does not pay for them to find out about the safety and satisfaction of the care in homebirth.  Dr. X is the MAN you want to be there in a complicated birth.  He has the presence and demeanor of a Lion in the Hospital, but when confronted with a normal birth at home, he is a mere mouse, shaking in his hole.

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