Outside the Hospital: Local women discover natural birth

Written by LAWRENCE COSENTINO
Wednesday, 20 February 2008

When Haslett physician Cindy Meteyer studied medicine at Michigan State University in 1997, she observed several births at a Lansing hospital. What she saw was the norm for the overwhelming majority of American women who give birth. The norm did not strike her as normal, though.

Meteyer did not name the hospital, because she still works in the medical field.

Each mother she saw was given an epidural, a local anesthesia dripped through a catheter into the spine. None of them were able to move around to find a more comfortable position. Some ended up with cesarean sections; others had vacuum or forceps deliveries, and most got Pitocin, a commonplace drug used to intensify or speed up labor.

“All the births were high intervention,” she recalled.

It wasn’t just the drugs and surgery that disturbed her.

“These women were flat on their backs, legs in stirrups, everybody in sterile gowns and masks, even for a vaginal delivery,” Meteyer said. “I remember thinking, ‘This isn’t the way it’s supposed to be.’”

Meteyer resolved to stay out of the hospital when she gave birth, but it wasn’t easy. When her son, Ambrose, was born three years ago at the Greenhouse Birth Center in Okemos, Meteyer toughed out an epic 48-hour labor without drugs. She said it was worth it to avoid a hospital-managed birth, which she thinks would have involved a “failure to progress” diagnosis, Pitocin and a possible cesarean section.

The tradeoff: pain, pain and more pain. “I won’t lie. Natural childbirth is not for sissies,” she said.

All the same, she remembered the birth as “a magical experience.”

“It’s so powerful when you just let labor happen. It was like a dream come true when he came out.”

A daughter, Ainsley, was born to Meteyer (after considerably less labor) in January 2007, again at Greenhouse.

At home, or in the home-like setting of a birthing center, a small minority of women have chosen to play out life’s most visceral drama on their own terms, with only a midwife and a circle of friends and family around them. The science behind their choice is hotly debated, but the joy they exude from opting out of the hospital system blows your hair back.

‘He came out on his own’
In the Monty Python film “The Meaning of Life,” a wide-eyed mother is torpedoed through a series of bright corridors to surgery where she is hemmed in by rows of apparatuses and self-important doctors. “Have you got the machine that goes PING?” demands the head surgeon, played by John Cleese.

“What do I do?” asks the mother-to-be.

“Nothing, dear. You’re not qualified!”

Author Jennifer Block spent months interviewing mothers, health care workers and researchers while writing her 2007 book on modern maternity and childbirth care, “Pushed.”

The decision to have a natural birth often begins from a gut feeling, only to be confirmed later by sober research, Block says.

“Many women have been through a hospital birth that was terrible or not satisfying,” she said in a phone interview. “They didn’t like not being able to move around, not being able to eat or drink. There are fluorescent lights, it’s loud, there are residents coming in and out wanting to do vaginal exams, and all these unpleasant things that seem to work against labor on an instinctual level.”

Snippets from the Python skit pepper talk-show queen Ricki Lake’s intimate 2007 documentary, “The Business of Being Born,” which will screen twice this weekend at MSU. The film follows a handful of women, Lake included, as they plan and carry out natural births. The Tribeca Film Festival billed it as “the ‘Inconvenient Truth’ of childbirth.” A panel discussion with a variety of health care players and observers, including Block, will follow each screening. [See box.]

There are plenty of local counterparts to the women in Lake’s film and Block’s book.

Alisa Schlacht, an osteopathic physician living in Livingston County, had a birth plan for her first child. She drew up the plan during birthing classes at the hospital, which she declined to name because she, too, is still working in the health care field.

She wanted no anesthetics or labor-inducing drugs to enter her child’s bloodstream. She wanted maximum control of her physical position, minimal interference with timing of labor and surgical intervention only as a last resort.

Schlacht’s pre-natal visits, alternating among half a dozen practitioners, did not bode well. After waiting 45 minutes in a drafty gown, she was told by one obstetrician, “You know what we call patients with birth plans, do you? C-section patients.”

Jaime Williams, of Lansing, had a birth plan too. She brought it with her to Ingham Regional Medical Center in May 2002.

“One of the first things on my birth plan, which my doctor had looked at, was that I didn’t want my water broken,” Williams said. “The first thing the nurse said is that it really didn’t matter, and things spiraled away from my plan from there.”

When Williams dilated to the fullest, the doctor told her a cesarean section was necessary. She recalled the doctor telling her she was too tired to manage without it.

“I pushed for 40 minutes and he came out on his own,” Williams said.

Schlacht’s pre-natal misgivings were fully realized at the hospital.

“I brought my birth plan and I remember them taking it patronizingly — ‘OK, that’s nice’ — and sticking it to a wall and nobody ever looked at it again,” she said.

Hospital staff told her ultrasound tests from two weeks before revealed a big baby. She was given two drugs to speed up labor and hooked to continuous fetal monitoring, which made more labor induction necessary.

“You have to be in bed and lying on your back [to be monitored], and being in that position slows labor,” Schlacht said.

The doctor performed an episiotomy, cutting her vagina wider to deliver the baby. “I had only been pushing for 10 or 15 minutes, and there was no medical reason for doing it, and I said I didn’t want one,” she said. “It was painful for months.”

Schlacht was shocked to learn that her daughter weighed only 5 pounds, 12 ounces at birth. “I hadn’t gone into labor because she wasn’t ready,” she said.

After this “frightening and frustrating” experience, Schlacht had her next child at the Greenhouse Birth Center.

Flowery, fluffy furniture, hugs of greeting in the parking lot, hour-long pre-natal visits over hot tea, handy kitchen facilities and a soothing hot tub are some of the amenities that make the center, opened in 2003, more hospitable than hospital. The rubber gloves and delivery instruments sit in a cake pan in the closet.

Women give birth in any position, any room, that suits them. Most give birth in a Jacuzzi-like tub, where water relieves pressure and soothes labor pains.

Sometimes the personalized service gets almost too personal. Upon request, Greenhouse midwife and director Clarice Winkler once sautéed a mother’s fresh placenta in olive oil for her to eat.

“Think about it, animals eat the placenta,” Winkler said at a birthing class last week, to the mixed amusement and nausea of three expecting couples. If maternal organ meat isn’t your dish, the center offers to press the placenta in ink, where the trunk and branches of veins make a print called the “tree of life.”

After her own hospital experience, Williams had another son, Kennedy, and a daughter, Emerson, at Greenhouse.

“When I went into labor with Kennedy, I felt I was going home,” Williams said. “There were candles lit around the tub, and I could hear the water filling.”

The intense glow of the average Greenhouse convert could light up a whole wing of the Mayo Clinic. “It wasn’t easy, it was painful, but it was by far the most empowering experience in my life,” Schlacht said.

Katie McTiernan of Lansing has had three home births.

“I’ve never had the hospital experience, and I sometimes feel mine is normal,” she said. “When I visit friends in the hospital, nurses and things are coming in constantly to check on them, and I’m relaxed in my own house.”

The crunchy doctor
Despite her conversion to natural birth, Williams said she has since learned that hospital birth experiences are not always discouraging.

“Natural birth does not have to take place outside the hospital,” Williams said. “There are many OB’s who are willing to work with you to get the birth you want, not the birth they think you should have.”

Nancy Herta, assistant director of the obstetrics and gynecology residency at Sparrow and a practitioner at Mid-Michigan Physicians, figures she has delivered about 2,000 babies. She agreed with Williams that the choice of doctor is crucial.

“Some physicians are very paternalistic, some are very patient-driven,” she said.

Sparrow spokesman John Lux said about 4,000 babies are born each year, or about a dozen a day, at Sparrow — “two out of every three children born in the region.”

(By comparison, about 80 are born each year at Greenhouse.)

Lux’s immediate response at the mention of natural birth was a tad flip.

“Or like the Indians used to do, just go out and lean against a tree?” he asked.

The hospital staff — or Herta, at least — didn’t seem to share the joke.

“Natural birth means different things to different people,” Herta said. “To me, it’s the sensation of delivering your child and participating in the delivery to some degree.”

Herta said she encourages mothers to lay out their philosophy in a birth plan.

“We’ve had some really beautiful births here,” she said. “I’m open to squatting bars and birthing balls and birthing plans, no anesthesia, and all of that. People can walk around in the halls in labor.”

She said Sparrow discontinued birthing in tubs only because of bacterial count. “It’s a hospital, and they’re just psycho about that,” she said.

Herta said it’s unfair to view all hospital interventions as doctor-imposed. Epidurals, for example, have spiked to over 80 percent of births in a “consumer-driven” surge.

“It’s not something I’m telling them to do,” she said. “It’s become the norm, like a stage of labor.” She said that episiotomies, among the most dreaded interventions, are “way down.”

“I don’t know of anyone who does them routinely, and I only do one a year,” she said.

However, Herta said the cesarean section rate at Sparrow is “something horrendous, almost 30 percent” — about the same as the American norm.

“We do have very medicalized birth,” she said. “But it’s not out of a desire for control or something like that.”

Herta said fear of malpractice is the driving force.

“You just start intervening and covering and documenting. When we sit and talk about cases, there’s always that component of, ‘well, somebody looking back could sue you for this.’”

Herta herself has had seven children and described all the births as “pretty crunchy.”

“I had one at home in the bathroom and all kinds of stuff,” she said. “I always left the hospital right after I delivered.”

Herta seemed to enjoy casually dropping the bombshell that she gave birth to one of her children at Greenhouse.

“Everyone here hates me for that,” she said. “As a physician, I’m not sure I would recommend it for your first delivery, because you have no idea what it’s going to be like. But I lived five minutes from there, I had a real fast labor, knew my history, and it was the kind of experience I wanted.”

“But I have to say up front, I’m not a good example of your generic Sparrow OBGYN,” Herta said. “Nobody here would do that but me.”

Birth by numbers
Nothing gets Jennifer Block more incensed than the notion that women who choose natural childbirth are pursuing an “experience” at the expense of their own health, or worse, the health of their baby.

That’s the charge leveled by the American Council of Obstetricians and Gynecologists, or ACOG, in a Feb. 7 statement opposing home birth.

“Childbirth decisions should not be dictated by what’s fashionable, trendy of the latest cause celebre,” the statement read.

“That statement is so rich,” Block said. “They don’t acknowledge the documented benefits of giving birth outside the hospital.”

The ACOG statement went on to push the hot button that brings most women to the hospital despite all the appeal of natural birth: “a seemingly normal labor and delivery can quickly become life-threatening for both the mother and the baby.”

An obstetrician interviewed on camera in “The Business of Being Born” puts it more starkly. “In a post-partum hemorrhage, you can lose your whole blood supply in five minutes,” he warns.

Block said home birth and hospitals can work hand in hand.

“That’s how it works in England,” she said. Recently, Block visited an American friend planning a home birth there.

“We ended up transferring for pain relief,” Block said. “She had a real hard labor, and after 35 hours she needed help. It was no big deal. We walked right into the maternity ward, no questions.”

Kate Madigan started out with a normal birth at Greenhouse in 2006, but her baby had unexpectedly turned breech, meaning it wasn’t coming out headfirst. Within seven minutes, she said, she was at Sparrow, where doctors performed a C-section and delivered her son, Emerson.

“The doctors were really good and I recovered very well,” she said.

Block said despite ACOG’s warnings, the numbers show that out-of-hospital birth is no more dangerous than hospital births.

Block cited a 2005 observational study of 5,000 midwife-attended, out-of-hospital births in the United States and Canada, published in the British Medical Journal. Infant mortality was 1.7 per 1,000, about the same as that of hospital births. However, fewer than 4 percent underwent cesarean sections, compared to 30 percent in the general population. The rates of other interventions were proportionately lower as well.

The ACOG statement dismissed this study and others like it as insufficiently scientific.

Block said the only way to do get better data is to do randomized controlled trials on human beings — i.e., direct so many mothers to have cesareans, an equal amount to have vaginal births, so many to go with or without anesthetic, and so on.

“It’s not ethically possible,” Block said. “You can’t tell a woman, ‘You’re giving birth at home.’ We have to go to the next best level of evidence, and that’s what we have. That study, and others before it, have all shown that babies do just as well and mothers do much better, because they come out with less trauma to their bodies, fewer cesareans and a better experience.”

The data satisfied Adam Candeub, a professor of law at MSU. He and his wife, Julie Taiber, have had three out-of-hospital births, one in Washington and two at Greenhouse.

“People have this image of everything being crunchy granola,” Cadeub said. “That was not our approach at all. I look at facts. We wanted to minimize invasive procedures and have a healthy baby.”

The flap over statistics doesn’t give Candeub much pause. “This is epidemiology, so you’ll always get people arguing ‘Was this variable treated similarly, blah blah blah,’ but without doubt you decrease your likelihood of cesarean,” he said.

At any rate, Candeub’s enthusiasm for natural birth didn’t seem to be distorted by sentiment. “Some guys think it’s the greatest thing since sliced bread,” he said. “I hated it. A man never feels the complete uselessness of his sex until he accompanies his wife in childbirth.”

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