Feeling Like an Unnatural Woman

About 10 hours into labor I burst into tears. Not because of pain, or fear, or the absolute conviction that this baby was never ever going to come and I would spend the rest of my life a freak among womankind, although I certainly felt all those things. No, my tears were a result of the realization that instead of being the countdown-breathing, drug-refusing natural laborer that I had longed to be, I was instead a large, ungainly, practically naked science project.

Two weeks overdue, with decreasing amniotic fluid, I had been induced, so there was an IV. Induced labor is impossible to endure without drugs so there was an epidural. The pitocin was making the baby’s heartbeat do odd things now and again, so there was a fetal monitor attached to the baby’s scalp.

So there I lay, tubes fore and aft, having been dilated to 9 1/2 centimeters for five hours. Then six. The doctor came in, was utterly reassuring, said be patient. Seven hours, eight. He came in again, sat with us for another hour. Again the baby’s heart rate began dipping and finally my doctor said, “Well, I don’t think we should wait for the baby to go into distress. Let’s do a caesarean.”

I knew he was right, but I burst into tears again anyway. I felt that somehow I had failed, that I had let vast numbers of people down. My friends, my family, the Boston Women’s Health Collective. I even apologized to my husband, who quite properly pretended I was simply delirious. Things brightened up considerably when the morphine took effect, and then the skies sundered, the angels danced and God smiled upon the world when Danny Mac, healthy and hearty, was born half an hour later.

But even in the first excruciating joy of motherhood, there was a shadow. I found myself explaining the C-section in apologetic, defensive terms. And in the subsequent weeks, I caught myself obsessing about what I had done wrong--should I have refused to be induced? Gone without the epidural a little longer? Made him wait another hour or more?

See, nowhere in my birth plan did it say, “Have the most unnatural birth you can imagine.” And I did have a birth plan. OK, more like an outline. But I had done the whole Lamaze thing, had memorized “What to Expect When You’re Expecting” well into the postpartum section. I brushed aside advice to “just get the epidural.” I had the backpack full of tennis balls and paper bags and lollipops. I had aromatherapeutic mist, for God’s sake.

I was, in other words, a good little crusader.

And it is a crusade.

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A crusade that began in earnest during the consciousness-raising 1970s to give women informed control of their own pregnancy and childbirth. Lately, however, it seems more comfortable offering dictums than options.

Indeed, it has become a societal expectation that the expectant first-time mother will attend Lamaze-type classes and make every effort to forgo the use of drugs. Blithely say, “No, I intend to be medicated,” and people stare as if they had caught you mainlining heroin.

“You can always tell the ones who have the epidurals,” said my Lamaze coach disdainfully during a slide show as an image of a laboring woman smiling at her husband appeared on the screen. Quickly she flipped to another woman in full-frontal contraction rictus. “Now she’s doing it naturally.”

Epidurals, the argument goes, at best remove the woman from the reality of the miracle she is about to experience, and at worst, slow down the birthing process, leading to an increased number of caesarean sections. In fact, according to the American Society of Anesthesiologists, epidural use in recent years has increased from 25% to 60%, while the C-section rate has dipped a bit from 25% to 20%, according to the American College of Obstetricians and Gynecologists.

But the C-section is the bete noir of the natural childbirth community. Books have been written, organizations formed, Web sites posted, all dedicated to the avoidance and eradication of the “unnecessary caesarean.”

“Don’t let them give you a C-section,” a friend of mine was told by her Lamaze coach. In recent years, a loose confederation of doctors, midwives, hospitals and insurance companies have fought to lower the C-section rate to 15%--the certainty that many C-sections are unnecessary having stemmed from the increase of the procedure from 3% to an all-time high of 25% during the last 25 years. Blame for the increase falls on many factors: older mothers, improper use of fetal monitors, and most often, fear of litigation.

Of course, if you stop to think about it, most people don’t sue unless something goes wrong.

Which L.A. County learned the hard way in recent years when $24 million went out in settlements to families whose wives, mothers and newborns died or suffered irreversible damage because of a doctor’s reluctance to perform a C-section. A “necessary caesarean” means it is performed only when the alternative is clearly death to either baby or mother.

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By this definition, mine was an unnecessary caesarean, and that is fine by me. Maybe if I had insisted we wait a few more hours, everything would have worked itself out. Or maybe the baby would have gone into serious distress. I went with my doctor’s decision because I trust my doctor.

And that is the real issue of the natural childbirth movement--an underlying distrust of doctors, nurses and the medical establishment in general. As a feminist, I understand the historical underpinnings of the women’s health movement. Certainly there was a time when most doctors were men, most births done under heavy sedation, and C-sections and inductions often scheduled as a convenience for the ob/gyn. My mother remembers a certain doctor from her childhood who only did births on Wednesdays. Even as recently as 20 years ago, women were often made to feel superfluous to the birth process, problems to be managed, their requests for certain practices or positions, even their desire to breast-feed opposed or ignored.

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The women’s health movement led to a wide variety of important changes, especially in the areas of childbirth. Midwives, doulas, birthing rooms, birthing pools, lactation consultants and natural childbirth of every configuration are now standard options in most major hospitals. And whether through enlightenment or sheer necessity, most doctors are less rigid, more apt to let the parents-to-be make the major decisions. Which is not to say that all doctors are noble, wise and cooperative. But if you suspect that your doctor is not all of these things, get a new doctor.

Proponents of natural childbirth insist that it is the ultimate act of empowerment. But empowerment has always been based on choice. The availability of choices, and the ability to choose. And when it comes right down to it, the point of childbirth is not about making women feel strong or successful, it’s about producing a living, healthy child. If you get a little empowerment along the way, fabulous. But this is the first hard lesson of parenthood: It’s not really about the parents at all.

So now I am carrying another emerging miracle, and everyone asks: Will you try to do it naturally this time? Sure, I’d like to try. But you know what? It really doesn’t seem all that important. I ask my doctor what he thinks, and he says let’s see what happens.

Which seems to me the perfect birth plan.

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Mary McNamara can be reached by e-mail at mary.mcnamara@latimes.com.