Tuesday, June 28, 2016

Hospital, Birth Center or Home Birth Part III

I went full circle, exploring alternatives to a hospital birth and in the end deciding to return to a hospital birth for a number of reasons. After some research and interviews of midwives, I decided that if anything were to go wrong - which in my case blessedly is a very low risk - the best place to be is in the hospital. While the risk is low of anything going wrong, the consequence of that risk is a huge risk that I am not willing to take. If something were to go wrong, I would never forgive myself that I did not go to a hospital. I say this knowing people that have delivered quite well in birth centres. Interestingly, one midwife, who not only had a wonderful energy, but seemed to very much know what she was doing (after all she has been delivering babies for 35 years), told me there was no positive in going to a birth center. If you want to be comfortable and around bacteria that are part of your normal environment the home is best, she argued. Otherwise, go to hospital. I wondered whether part of her reasoning, whether subconscious or not, was due to the fact that she performed births at home and supported births at hospital but did not have a birth center service to offer.

I met one midwife who has written texts on midwifery and trains midwives (but unfortunately does not perform this service any more) and she knew exactly where how my son was positioned from touch alone. The ultrasound a week later proved that she was spot on. My OB, whom I adore, could not do this. Albeit I believe that OBs generally don't do something that a machine can do for liability reasons. Midwives are just like any profession - some people are fantastic, some are mediocre and some are so inadequate and will probably end up being sued.

I was also pleasantly surprised to hear from midwives that my hospital was truly a very hands-off hospital that supported women having the most natural childbirth possible. Hearing this from my OB was one thing, but hearing it from midwives, whom have directly worked with the hospital, was much more reassuring.

In the end, I decided the best of both worlds was to labour with a midwife at home and have the midwife come to the hospital with me. She would not be able to deliver, but I would have the benefit of her expertise throughout. Unfortunately, this turned out to be the most expensive option and I declined to pursue this option as it would cost more than double I would pay by simply going to the hospital.

I was in fact mostly surprised at how much midwifery services cost. Giving birth at home or at a birth center was decidedly more expensive than simply delivering at my hospital (about $5000 extra). It could be that we just have fantastic insurance or that midwives, just like anything else in the Bay Area are just much more expensive as the market will handle the extra cost. They must also have high insurance premiums.

So it's back to me, hubby, baby, a birthing ball and a Hypno-Birth tape (more on that later) in the hospital room (and hopefully this time no Cervidil!).

Tuesday, June 21, 2016

Belly Madness!

Only a month to go! Pregnancy 2 is in the home stretch. The pelvic pressure is increasing. I was assessed by midwives the other day and they felt my son's positioning, noting indubitably that the scene of my distress was where my little one's head was. He is apparently in a great position for labour. That's great news, but he needs to simmer for a little while longer. In the meantime, aside from the tired feet, constant peeing and my son's propensity to forcefully kick and punch me as he tries to get into a more comfortable position as his previously capacious home becomes increasingly smaller (or in real estate parlance "cosy"), I'm also enjoying connecting with him.

I am constantly being asked by strangers when my due date was and other comments about my belly's increasing conquest of its surrounding space, attendant with what they must perceive as gesticulations sympatico, with their arms protruding out into a makeshift belly. While I just smile politely and go about my business, I am wondering when my emaciated smile in response to ceaseless comments regarding me being "about to pop" will contort into a grimace as I reveal my displeasure with some acerbic reply.

Admittedly, my belly, both the first time and this time, protrudes more than most. This isn't really a surprise. I am only 5' 2'' ( OK a little less, I'm 157.5 cm - and that half centimetre is all leg...). On top of that have a short torso for my body, so there's nowhere else for the baby to go but out. You may have noticed that the taller the woman, the less belly protrusion. I'm not sure why fundal height is recorded, but both OBs and midwives measure fundal height (the height from the pelvic bone to the top of the uterus) as a measure of gestational growth. You should measure in centrimetres according to your week of pregnancy so that by week 40 (if you get there), you would measure 40 cms. So for us short girls, we get the short end of the stick - to measure 40 cm, our belly has nowhere to go but out. I wonder whether that leads us to have more back pain etc but in the end I guess it doesn't matter - it is what it is.

As my belly conquers surrounding space, it's also conquering my brain power - when off work, it shuts off so much that I believe it's basking under the sun with a marg in hand somewhere in the Seychelles. Lucky bastard. Meanwhile, in its absence, I am left with buying milk and then leaving it in the bag for the entire night and wasting it and leaving my keys continually in the front door to aid any stranger that may want to enter. This weekend, at my godson's second birthday, I made a mistake par exemplum of my current circumstance. I was perplexed, considering his name starts with L and his surname with C, why his birthday balloon was an "S" - after a while, I voiced my confusion to stunned silence and a reply that it was a "2". Yes, a balloon designating the number of years being celebrated makes much more sense that even a balloon of the first letter of his name (and I realized also, my cheeks blushing incarnadine in increasing shame that "S" could also stand for "second")....at least it provided some entertainment for everyone else present...

Saturday, June 18, 2016

Toddler Talk Through Linguistic Labryniths

I couldn't wait until I heard my son say "mama" for the first time. Once he did, everything was "mama" and he would babble it for no reason at all. At 19 months, my son is still a babbler. He loves to make sounds and repeat words he has learnt in apparently no order. As he is playing, we hear him say to himself "mama, daddy, deda, baba, bobo, vjon, apple, nana, car" etc until he has run through his vocabulary.

I find fascinating his grasping and utilisation of the different languages around him. My son has never been monolingual - from the beginning I spoke Serbian, my native tongue, to him and my husband spoke English with a mix of Greek. For a few months, we had a Spanish speaking nanny. While he had a Spanish nanny, he was able to communicate with the Spanish nanny in Spanish. This was before he could speak, so he would merely process what she was telling him and respond in a non-verbal manner, usually by a flurry of gesticulation. As he started to speak, at a time when I spent the majority of time with him, his first words were all in Serbian. However, as we started a nanny share with an English speaking nanny and his friend - who was English speaking also, he soon realized that the dominant language was English and switched his words to the dominant tongue. "Ne" became "no", for instance and has stayed that way except for the Tantrums Terrible when he reverts back, in his primal anghst, to his first tongue.

English is also his native tongue. From the time he was born (and before) English has resounded around him. We live in an English speaking country, his father speaks predominantly English to him as does everyone else save for me and my parents. It is natural that he would realize that Serbian gets him nowhere in communicating outside a very small group of people. There are however words that he still uses Serbian for when speaking with everyone, albeit I believe it is only a matter of time until he learns the English words, for instance for "eggs" and will switch to the dominant and more effective mode of communication. After all, what is language for but to communicate with each other? If he perceives the word he is using is not being effectively communicated, but another is, the switch, from a purely utilitarian sense, makes perfect sense.

I am fascinated to watch my son negotiate the various languages around him. He understands that "jaja" is "eggs" in Greek but addresses his paternal grandmother, who is Greek, as "yiayia", not being flummoxed by the use of the same word for two completely different things (albeit in Greek the word has a different pronunciation, which he is yet to command).

I have read that native polyglots, such as him, have different brain patterns than monologuists and process language - including the learning of later languages - differently. Further, native monologuists who later learnt new tongues, even as children, will process the new tongues in a different manner than native speakers even if they can no longer speak their maternal tongue. I am squarely in this category. I was monolingual at birth, speaking only Serbian. Then I learnt French and at 7, English. While I have the greatest aptitude and versatility in English - after all I have only ever been formally educated in an English setting and have lived in English speaking countries for most of my life -I will always process English differently from a native speaker. When I am extremely fatigued, I make Serbian mistakes in my English - for instance, I skip articles (which in a 7 case language, do not exists in Serbian). When I learn new languages, my mistakes and my accent are distinctly of Serbian origin. So much so that when I am speaking Italian to Italians, they can tell I am not a native Italian speaker, but rather perceive that I am a native Slavic speaker from the mistakes I make and from my accent and are incredulous that I can speak English, let alone speak it flawlessly. My son on the other hand, has always been at least bilingual, if not trilingual (since he was exposed to Greek, albeit in small bursts, from his birth). The way he grasps and negotiates the various languages around him is inherently different from the way I and other native monolingual speakers do. Whether he continues to be a polyglot or not (and I avidly hope it is the former), we have permanently changed his understanding and processing of language and hopefully, for the better.

Before I had my son, I read that children could grasp as many languages as provided to them - they were the sponge soaked in "universal grammar" that could acquire any and all tongues. I was warned however that one person should always speak one language to the child and not mix different tongues as that would confuse the child in negotiating the various rules of grammar for different languages. For instance, in English, you would want your child to say "sheeps", which shows they understand the difference between the singular and plural and the common rule for defining plurality and then explain the irregular rules. Unfortunately, we have not been as strict as we should have. I only have a limited number of Serbian books, for instance, so I mostly read English books to my son in Serbian (partly worrying whether this would aid his confusion and impede his reading ability, albeit I hope that at 19 months it is still too early for that problem to ripen). However, when an English book has a rhythmic pace, which my son, as most kids adores, I switch to English to get the full benefit of the book. One of my son's favourite books, read to him in English, is "Sheep in a Jeep" which begins with "beep, beep" - when he wants me to read him this book he points to it and says "beep, beep" - and I readily oblige. Apart from reading to him in English at times, I also speak to him in English whenever I am addressing him and other English speaking kids. Sometimes I say everything in English and then repeat the same thing in Serbian, but as I have to communicate to the non-Serbian speaking children, I must use English. Further, if I were to speak to my son alone and then everyone else, I worry I would give the wrong impression, for my intention is to speak to everyone in the group and have him understand that he is a part of the group I am addressing.

I worry that my laxness in this regard, for whatever reasons I can conjure to show I am not at fault and it is environmental circumstances that impel me to make exceptions, is retarding my son's lingual development. I have previously read that bilingual children and polyglots have a slower initial development with language as they process the various languages around them (for instance in achieving word groupings and sentence structure) but that they are later more formidable in their aptitude and utilisation of language than their monolingual counterparts. When I look at my son's development at 19 months - who is evidently a very verbal personality - he seems to be pretty on track even if he were monolingual. It is true he only joins words together that include an instruction or command, for instance, "mama, no", "mama, da (yes)", "mama, apple" etc but he seems to understand pretty much all we say (which might say too much about the level of our household discussions if not his increasing aptitude) and his vocabulary is increasing exponentially. However, there are words that my son says in his own toddlerlike manner, that we can't grasp the origination of. We know "vjon" is his attempt to say "avion" which is Serbian for plane. "Tch tch" is his word for helicopter, the word "helicopter" being the same in English and Serbian (although much more staccato in the latter)  and both too difficult for our son's tongue to grasp. "Tch tch" is the noise we make as we gesticulate the propeller movements for the helicopter as we say "choo choo" for the train. However, my son says "bobo" for boat and we are not certain whether it is from "brod" or "boat" or when he says "bus" whether he is saying the English word or truncating "autobus" from the Serbian. I suppose we will only know when he acquires the ability to speak the actual word.

A newfound worry of mine is that my son has lost two words that were predominant in his vocabulary for months. My son loves his duckies at bath-time and adores doggies. For months we would go out and he would run and point to any dog and say "doggy". In the past couple of weeks, he stopped using both words and I'm terrified it is a step back and due to my maligned mélange of instruction. For every time my son said "ducky" I would reply that it was the name in English but not in Serbian and use the Serbian name. I would likewise reply the same for "doggy". Further, we have been learning animal sounds for a while and this seems to have only aided his confusion. Ducks always go "quack", cows always go "moo" and dogs always go "woof" - the latter being my son's new word for dog. He has now decided that the animal sounds, which reign over both languages are the dominant designation for each animal and for cow he says "moo" rather than using the Serbian or the English word. While I could understand his processing in this circumstance, it nevertheless worries me that instead of adding words to his vocabulary his most recent progression has been the deletion of two, which I cannot see but a regression and one that must fall on my shoulders.

Unfortunately, I am not quite sure of the solution. The one thing I am resolute in, is to continue to speak Serbian to him. This is not only for heritage purposes and ability to converse with his relatives, but predominantly because the gift of one language is always pregnant with the gift of more. Serbian, a particularly difficult beast to tame, where nouns change 7 times depending on their use, riven with irregularities, will hopefully provide him with a formidable foundation to build other languages upon.

And so our linguistic acrobatic adventures continue...

Monday, June 6, 2016

Hospital, Birth Center or Home Birth? Part II

I am a bit wary of indulging in proffering my opinion in this virulent and vitriolic debate, considering that a) I do not have any medical background and b) my research on this subject has been tepid at best - I don’t have years to spend on a proper assessment. On  the other hand, this is an opinion I need to make for my own upcoming delivery. Every woman should be entitled to a freedom of choice as to where and how she will deliver her baby. The issue is that most countries in the world do not provide the right infrastructure for a woman to effectively make her decision. The country may be too poor or too paternalistic - in one country, a woman is denied proper hospital care, and in the other, she is pushed into hospital with not much choice for midwifery care, whether through laws that make such care illegal or effectively difficult to obtain (for instance by not covering such care). It’s also pretty blatant that the pro-hospital/medical argument has a very paternalistic view and deems women’s choice to give birth at home or at a birth center stemming from the woman’s naïveté, or wish to be involved in the latest fashion (with home and birth center births increasing in the US) or from weighing their experiencing over risks. The women that want to give birth at home or at a birth center are thus fashioned in their paternalistic argument into children that need to be disciplined and brought into line - misogyny still at work. It is not considered that women that choose to give birth at home or at a birth center do not do so for vapid causes of fashion but because they believe that it would be a safer experience both for themselves and their baby. In fact, there are many good reasons for not going to a hospital, apart from the aim of having an “orgasmic” birth or a more pleasant experience. Hospitals are not run on the Hippocratic oath as much as on malpractice insurance. This is why your obstetrician may tell you that not one drop of alcohol is safe, for if they were to tell you a little is fine at times, or even more specifically that a glass of wine with dinner does not harm your baby - they may be responsible if you, now assured, do not quite understand what a “little” is or cannot measure your intake (which  again views women as children that cannot control themselves and must be disciplined). Of course, not all obstetricians pander to this line. My OB late in my previous pregnancy when my blood pressure was rising, told me to work less, relax and have a glass of wine. We can go further and blame malpractice insurance on a defunct tort system and go even further and blame the existence of such a system on the lack of proper public healthcare and social net in the US (with patients forced to sue to recover their medical costs and economic losses), but that’s for another topic.  

If we look at the fear of malpractice as the crux of hospital care, increased intervention - which is the main argument against hospital births- makes sense. Women will sue for injury to themselves and their child, but likely not for enduring a gruesome experience. After all, most women do not look forward to labour. If I could have my husband deliver - a fair swap considering I’ve had to carry the baby - I would. There is much literature exposing this view as stemming from the hospital experience which overcomplicates labor and turns it into a sterile, stressful and painful procedure rather than the miracle of birth. Some hospitals have a cut out time in which they induce women after natural labour is not progressing sufficiently or turn to caesarians (the etymology stemming from the fact that it was a law of the Roman Empire and therefore Caesar’s law, that no caesarean - known to cause maternal death - was to occur before the tenth month of pregnancy and only to save the baby when the mother’s life could not be saved). Much has been written on the “cascade” of intervention. For instance, induction causes much more painful labour, leading to likely requests for epidurals, which may necessitate more induction and a recursive pattern that may end up in a caesarian. The constant monitoring of women and their babies may be an obstruction as may be the cold unwelcome environment, from our natural mammalian instinct kicking in as well as obstructing movement, necessary to further labour. Women may want to squat or be on all fours to deliver and use gravity as an aid, but it is easier for obstetricians if women were sitting or laying down.  All these interventions may lead to more tears and the environment of a hospital, albeit sterile, exposes women to an infection risk. There are other arguments too - labour is an intense physical exercise but in the hospital, women are only allowed ice chips and glucose in their IV lest they require general anesthetic. If a healthy woman with a normal pregnancy were to give birth and be able to do so in an uncomplicated way, the hospital may not be the right choice for her. The issue is that pregnancy and labour are akin to Russian roulette - it is hard to discern - particularly without ultrasounds and other exams that midwifery does not encourage - whether a woman and her baby are ready for a natural, uncomplicated pregnancy. 

Home and birth center births are also not without complications and studies have shown that perinatal deaths are nearly double that of hospital births (for instance, in a recent study by the University of Oregon, albeit as one may expect, the midwifery camp disputes the findings). The one undisputed fact that both camps agree on is that if things go wrong at home or at a birth center, you must be transferred to hospital to save yourself and your baby. This begs the question of how quickly the midwifes would make this decision and how quickly you will be transferred to hospital care as well as how quickly they would assess you in hospital before they decide on a course of action. The midwifery camp discounts the importance of this fact by statistics - most pregnancies are fine and there is a low risk that something could go wrong. The stats of what happens when something goes wrong however are not so paraded. 

Maybe understanding world statistics would aid us a little. According to the WHO, 813 women died every day in 2015 from pregnancy and labour related complications. Most of these deaths occurred in very low-resource countries (sub-Saharan Africa and South Asia) so we can safely assume that the “cascade of intervention” was not the cause of these maternal deaths. The WHO further states that a woman is 33 times more likely to die from pregnancy and labour complications in developing countries rather than developed countries. We should not be too quick to immediately assume that the main reasons for death, however, is lack of proper hospital/medical care. I would have liked to see the breakdown of these statistics to account for the health of women before pregnancy, for in the poorest countries in the world, general health is worse - and health before pregnancy is a determinative factor of how complicated the pregnancy and labour would be. Further, some of the countries with the highest maternal death rates are also countries in which children are giving birth, when their bodies are not yet developed enough to handle pregnancy and labour effectively. 

So what about Europe and the United States? I’ve heard it touted that Europeans tend to give birth at home. This is patently incorrect according to facts from the European Parliament. Even the Dutch, which encourage home births, have only about a 1/3 of their births at home. Further, the Dutch have the highest - almost double - perinatal deaths in Europe. Most countries discourage home births (including France, Sweden and Germany) and some countries are neutral (Italy). Only Holland (and decreasingly so) and recently, Britain encourage home and birth center births. I am not sure where the myth of “French women give birth at home” came form (possibly because the French understand that cheese and wine are not going to kill you and your baby in pregnancy and may be quite good for you and your baby), but it’s not true. The United States has a pretty embarrassing record respecting maternal and infant mortality. Since 99.5% of births occur in the hospital, one might be quick to assume that this is the result of the “cascade of intervention” - if not for the fact that the United States has an embarrassing record of general healthcare. Women in the United States are generally more unhealthy when they become pregnant, which increases their complications during pregnancy and labour. Women are also older, increasing the risk of complications, but considering they are about the same average age as women in Europe, I would wager it’s pre-pregnancy health that may set the United State apart. If the United States had a good public healthcare system, this may not occur, but again, this is for another topic. Additionally, much has been written on the increase in maternal death rates in the United States over the past twelve or so years, but this is largely due to better information gathering due to changes in death certificates that require information as to whether the woman’s death occurred within 42 days or a year after childbirth. One thing I wonder regarding the maternal death rate statistics is whether a woman being transferred from a home or birth center birth going awry who dies in hospital is counted as a hospital death, being the place where she expired, or a home birth death? Showing that a woman was transferred would provide better statistics and reveal how well transferral in the event anything were to go wrong really is, for as both camps agree, if anything were to go wrong, transferral is the only option.

One thing to also consider is that midwifery may have knowledge and tricks that obstetricians lack and vice versa. So is the best best of both possible worlds to have a midwife with you in the hospital? This prevents any transferral problems in the case of an emergency. This does not however discount the fact that a birth center or your home may be more comfortable (and more familiar in the case of your home) than a hospital room. This also does not allow for the midwife to be in full control (particularly if she is not connected to the hospital). One thing we tend to forget in this argument is that as patients we have full rights to refuse treatment and prevent the “cascade of intervention”, so if the “cascade of intervention” were the cause of most hospital injury, it may make sense to simply refuse such intervention. Unfortunately, this is easier said than done - you are not your most cognisant self when enduring labour and while you may think your partner will stand up for you, your partner - whether they be a man or woman (albeit men I would wager would be more afraid) - seeing you in such distress, will most likely be more frightened than you and accept medical intervention. 

Nevertheless, some hospitals are much more encouraging of a more “hands off” approach. My obstetrician has assured me that Kaiser in SF will allow me to not be immediately put on an IV, refuse constant monitoring, have me walk around and use my birth ball, get in the shower and tub etc At my incredulous raised eyebrow, she retorted “the west coast is much different from the east coast, you will see.” I was also told however that the person delivering my baby would most likely be a stranger as 40 OBs were on the roll. With my previous labour, I knew that it would be one of four OBs, and I had met all of them. This was an unwelcome new element, pushing me more to midwifery.

It seems the most neutral research would be on what the major causes of maternal and perinatal deaths are, how they occur and how they are assessed to be able to fully weigh in the risks of each option. The major causes of maternal death during childbirth are hemorrhage, hypertension and infection and the major causes of perinatal deaths appear to be trauma during childbirth (including the mother's hypertension, hemorrhage etc) and preterm labour. Which profession and location would be best equipped to prevent, assess these situations and handle them? Take hemorrhage for instance. This can be caused by uterine atony (ie exhaustion from a long labour) or rushed delivery of the placenta. Would you have a longer labour outside of hospital leading to uterine atony leading to hemorrhage and/or would obstetricians rush the placenta whereas midwives would take a more natural, slow approach? I'm not sure I'm even equipped to assess these highly medical evaluations. However, this would be the key to my opinion and I would need to do further research.

Another thing to consider is the price tag and location. For some fortunate women, this is not a concern, but for me, the dollar weighs in. I've heard that midwifery care is the least inexpensive option but for my circumstance in SF, it is the most expensive option. Knowing that second pregnancies may go much faster, I do not want to travel far to give birth to avoid having to give birth in a car or some other infection prone environment with no proper medical assistance. Home birth ticks the box here as does my hospital which is a mere 7 minutes walk away (albeit during labour and even my current third trimester waddle it may take a bit longer). I was elated to find out that SF - which surprisingly lacked a birth center- had one grand opening earlier in the year 10 mins walk from my house. It ticked the box of both being near my home and near my hospital. I was not expecting the $8k price tag however (with a hospital birth being $3200 out of pocket). I was also not too happy about the early discharge - within four hours of delivery - which in my case, meant four flights of stairs. I do like the ambience, the attentive approach - with natural pain management and help with positions, the flexibility and the post-natal care (up to three visits in the first week postpartum). 

I'm still wary of the home birth option (I am risk averse and for the me the seriousness of the risk and not its risk factor weighed in to tip the scales) but having a midwife come to the hospital or going to the birth center seem very appealling. Unfortunately, before I could make my decision as to which option I would prefer, weighing in all factors, the universe seems to have made the decision for me. My due date comes at the worst possible time for the birth center and a midwife that came strongly recommended and does both home and hospital births. The former was full, in part because one midwife's wedding is on my due date and one other is going to her wedding, leaving only one midwife and two assistants in charge. After swallowing this refusal, I was yet refused by the midwife, who is away in July. I can continue to search for midwifes, albeit most midwifes will not provide care in hospitals.... there's no reason to give up yet, but not being sure of whether I really do want to deliver away from a hospital and the universe's nudges in this direction, it may well be where I end up. Albeit this time, I will be armed with more authority and more determination for a hands off approach.

Wednesday, June 1, 2016

Hospital, Birth Center or Home Birth? Part I

In my first pregnancy, there was no question I was going to a hospital to deliver. I knew that the number one cause of death for women historically was childbirth and that infant mortality rates were much higher historically and that was the end of the story, albeit I tepidly dabbled into natural (i.e. non-hospital) births. My main aim was to try to have as much of a natural birth in a hospital as possible (my preferred option was to got to the one hospital in NYC that had a birth center, because I was assured that if anything were to go wrong, the doctors and the equipment were right there - but I was told they didn't take first time mothers). I dragged my husband to yoga partner training and religiously did all the squats and other exercises that my yoga teacher recommend for birth. While my friend gave me a book on doulas and hypno-birth, I didn't favour having a doula because I believed the experience was too private to involve a stranger (albeit ironically the hospital environment guarantees that you will be surrounded by strangers) and I feared that if hypno-birth really worked, I would go into early labour listening to the tape, so I had it in store only for the birth itself. My friends were enamoured by the Bradley Method, but after reading merely a number of pages, I found his tone extremely patronising, misogynist and outright nauseous. I believe I reached the final point when he was comparing women's struggle in labour to the ease of farm animals - not only did I not favour being compared to a ewe, but considering their physiognomy and biology are quite different to ours I didn't see the utility in his comparison. I suppose that there may be something to the fact that other animals labour easier, but other babies are also way more adept than humans. It takes a fowl about 30 mins to stand and it's walking around the same time it starts to nurse, whereas human babies are far more retarded in the pace of their development compared to most animals and can't even sit up until about five months. What other animals do just doesn't seem like the right path to investigate in finding out what is right for our species.

But back to my wonderful first hospital labour. Armed with yoga positions, a list of mantras to listen to and repeat (with the main mantra, which I still favour in bringing me ease and strength is om gum ganapatayei namaha - simply put, to call on Ganesha to remove obstacles in your path - not specific to maternity nor childbirth but very revitalizing), and my trusty hypno-tape, I was pretty confident that my birth would go well and if it didn't, I knew I would be in a place that would keep me and my baby safe (as much as that were possible). Apart from the fact that my son was delivered healthy through vaginal delivery, nothing about my experience was expected or to be desired. First, I was induced and induced by Cervadil which to my doctors' surprise, gave rise to eruptions of contractions without a break leading to their apology and subsequent removal of Cervadil from my system. I was told labour would build up and that you rested during contractions, but I was instead tossed about by a recursive onslaught of thumping tsunamis with intense pain in my back for nine hours. There was no break. My whole body was shaking and bleeding so much that I couldn't do any of the squats, nor did I want to listen to anything I had brought. All I wanted was darkness and silence (albeit my screams and groans regularly pierced this). When my husband decided to use the massage and pressure point techniques he had learnt in our yoga partner class, I backed away - the last thing I wanted was to be touched (except that I was gripping his hand until he gently pointed out that I was about to dislocate his thumb). During this debacle, my IV fell out, but I didn't notice. My husband, growing pale, called for the nurse to come as he saw blood all over the bed. By the end of nine hours, I knew I had no energy to push and caved in and get on an epidural. This allowed my body to stop shaking for two hours so that I could push my son out during a 40 minute stint so he was born at 11:11 am on Hindu New Year's Day. Thank God for the drugs. If it weren't for the epidural, I would indubitably have ended up under the knife. I was also grateful for my OB, who performed an expert maneuvre to get my son's broad shoulders out, which my pushes alone were not progressing. The pain of labour was so excruciating and so unexpected and followed by my three months of nursing in which everything that could go wrong did (but blessedly it was easy street after that) leading to more pain, that I felt invaded and tortured.

This time around, thinking over everything that went wrong - should I have been induced at 39 weeks 2 days when my amniotic fluid had dropped to 4 and my mucus plug had already dropped? Should I have been induced by Cervidil? Should I have been given an IV right away and not been allowed to eat anything but ice chips? Should I have been connected to a machine the whole time when my baby and I were doing fine after hours of monitoring? I started to wonder whether there wasn't more to the argument that the hospital may not be the safest place to birth. I had previously thought that while the experience of having your child at home or in a center was probably much better than at a hospital (provided nothing went wrong), it was not safer and assumed that women that decided to give birth at home or at a birth center did so because they wanted more control over their own birth and that coveted beautiful experience, considering this more important than the risks of themselves and their babies. This pregnancy, I started to wonder whether mothers who gave birth at home or in birth centers were rather of the belief that it were safer. Possibly I had such a horrible labour in hospital in order for the universe to expose my previously held naive judgement (which, as I've experienced in my life time and again, the universe is wont to do).

As always, we start with research and review. The only problem is that it is very difficult to find a non-biased and non-prejudiced analysis as everyone who writes about this issue is writing on this issue because they are proffering a certain view in an extremely polarized debate. If you read what doctors say, you will end up with an analysis that favours medical care and hospitals. If you read what midwifes say, you will conversely end up with the benefits of home births and/or birth centers and the risks of hospital births.  This is of course fairly common throughout all topics, but considering the topic is medical care, it makes it more difficult to comprehend without medical knowledge and experience (which I lack).One must be diligent in sifting through each author's rolling punches of persuasion and carefully arranged facts in the midst of panglossian prose as to their profession invariably followed by terrorising tirades against the other side. The battle between midwifery, which has historically - and still appears to be - female and the medical profession, which has historically been male, is rife and as virulent and explosive as if the Girondists and Jacobins were facing each other on the other side of the aisle.